Are stabilisation exercises different to other treatments offered by physiotherapists in improving physical activity or reducing disability for people with persistent low back pain? A Systematic Literature Review

Background: Stabilisation exercises (SE) are commonly prescribed for people with persistent low back pain (LBP). However, for some people, it has been hypothesised that SE could draw attention to “protecting” the core, promote hypervigilance and inhibit volitional movement. Aims: To compare the effectiveness and reported adverse events, in particular fear avoidance, of SE compared with placebo or other treatments offered by physiotherapists on the outcome of disability and activity at 12 and 24 month follow-up. Design: Systematic literature review Methods: Key databases were searched from inception to June 2019. Study selection, data extraction, and appraisal of quality criteria using PEDro, were undertaken by two independent assessors. Findings: Seven studies (n=1820) were eligible. Of six studies reporting adverse effects in the group receiving SE, four reported none, and two reported mild exacerbation of pain locally or elsewhere. Fear avoidance was not investigated in any of the studies. Three outcomes were reported, ODI (n=1), RMDQ (n=5), PSFS (n=4), only two studies including 24 in addition to 12 month follow up. SE were more effective than: manual therapy or education (ODI 15.71, 95% CI 19.3 to 10.01) at 12 but not 24 months; placebo for the PSFS (1.5, 95% CI 0.7 to 2.2) but not the RMDQ; and high load lifting (PSFS 1.8 95% CI 2.8 to 0.7) at 12 months. Four studies reported no significant difference for any comparators. Conclusion: SE are safe and effective and may be superior to other treatments for some outcomes and time points. Their association with fear avoidance is uncertain; none of the studies included this as an outcome.