Next Article in Journal
Dissolved Organic Phosphorus Removal in Secondary Effluent by Ferrate (VI): Performance and Mechanism
Next Article in Special Issue
Ultrasound Imaging and Guidance for Cervical Myofascial Pain: A Narrative Review
Previous Article in Journal
Prevalence and Factors Associated with Eating Disorders in Military First Line of Defense against COVID-19: A Cross-Sectional Study during the Second Epidemic Wave in Peru
Previous Article in Special Issue
Effects of 8-Week Electromyostimulation Training on Upper-Limb Muscle Activity and Respiratory Gas Analysis in Athletes with Disabilities
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
IJERPH
Volume 20
Issue 4
10.3390/ijerph20042850
ijerph-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Systematic Review

Efficacy of Pilates on Pain, Functional Disorders and Quality of Life in Patients with Chronic Low Back Pain: A Systematic Review and Meta-Analysis

by
Zhengze Yu
1,
Yikun Yin
1,
Jialin Wang
2,3,
Xingxing Zhang
1,
Hejia Cai
1 and
Fenglin Peng
1,*
1
College of Physical Education and Health, Guangxi Normal University, Guilin 541006, China
2
College of Physical Education and Health, Geely University of China, Chengdu 641432, China
3
Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu 610041, China
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2023, 20(4), 2850; https://doi.org/10.3390/ijerph20042850
Submission received: 14 December 2022 / Revised: 1 February 2023 / Accepted: 2 February 2023 / Published: 6 February 2023
(This article belongs to the Special Issue Musculoskeletal Injuries, Rehabilitation and Impact on Public Health)
Browse Figures
Review Reports Versions Notes

Abstract

:
Background: Chronic low back pain (CLBP) is a common health problem. Pilates is a unique exercise therapy. This meta-analysis aims to evaluate the efficacy of Pilates on pain, functional disorders, and quality of life in patients with chronic low back pain (CLBP). Methods: PubMed, Web of Science, CNKI, VIP, Wanfang Data, CBM, EBSCO, and Embase were searched. Randomized controlled trials of Pilates in the treatment of CLBP were collected based on the inclusion and exclusion criteria. The meta-analysis was performed using RevMan 5.4 and Stata 12.2. Results: 19 randomized controlled trials with a total of 1108 patients were included. Compared with the controls, the results showed the following values: Pain Scale [standard mean difference; SMD = −1.31, 95%CI (−1.80, −0.83), p < 0.00001], Oswestry Disability Index (ODI) [mean difference; MD = −4.35, 95%CI (−5.77, −2.94), p < 0.00001], Roland–Morris Disability Questionnaire (RMDQ) [MD = −2.26, 95%CI (-4.45, −0.08), p = 0.04], 36-item Short-Form (SF-36) (Physical Function (PF) [MD = 5.09, 95%CI (0.20, 9.99), p = 0.04], Role Physical (RP) [MD = 5.02, 95%CI (−1.03, 11.06), p = 0.10], Bodily Pain (BP) [MD = 8.79, 95%CI (−1.57, 19.16), p = 0.10], General Health (GH) [MD = 8.45, 95%CI (−5.61, 22.51), p = 0.24], Vitality (VT) [MD = 8.20, 95%CI(−2.30, 18.71), p = 0.13], Social Functioning (SF) [MD = −1.11, 95%CI (−7.70, 5.48), p = 0.74], Role Emotional (RE) [MD = 0.86, 95%CI (−5.53, 7.25), p = 0.79], Mental Health (MH) [MD = 11.04, 95%CI (−12.51, 34.59), p = 0.36]), Quebec Back in Disability Scale (QBPDS) [MD = −5.51, 95%CI (−23.84, 12.81), p = 0.56], and the sit-and-reach test [MD = 1.81, 95%CI (−0.25, 3.88), p = 0.09]. Conclusions: This meta-analysis reveals that Pilates may have positive efficacy for pain relief and the improvement of functional disorders in CLBP patients, but the improvement in quality of life seems to be less obvious. Registration: PROSPERO CRD42022348173.

1. Introduction

Low back pain (LBP) has been a prevalent health problem for adults. The incidence is as high as 84%. In modern society, with the accelerated pace of life and the increased pressure of work, the incidence of LBP is increasing year by year. From 2006 to 2016, the incidence of LBP increased by 18% [1]. Typically, LBP is clinically characterized by pain at the lower costal margin, lumbosacral region, and buttock region, with the potential for radiating pain to the lower extremities [2]. From 1990 to 2015, the years lived with disability caused by LBP increased by 54% [3]. The lifetime prevalence of LBP is approximately 70% to 80%. About 10% to 20% of LBP patients experienced pain lasting at least 3 months and progressed to chronic low back pain (CLBP). Clinically, CLBP is treated in a variety of ways. Major non-surgical treatment methods for CLBP include pharmacotherapy, physiotherapy, and exercise therapy [4,5]. However, pharmacotherapy may cause nausea, constipation, tiredness, and other side effects, and it is difficult for physiotherapy to relieve long-term pain [6,7,8]. In recent years, exercise therapy has been a preferred treatment method because of its characteristics of minimal harm, low cost, and ease of implementation [9].
Pilates, as an exercise therapy, is widely used in clinical rehabilitation. Pilates has been proven to have positive effects in relieving shoulder–neck discomfort and low back pain, enhancing joint mobility, improving physical balance ability, reducing the risk of falling in the elderly, and so on [10,11,12,13]. Pilates is a unique training system that was created in the early 20th century by a German named Joseph Pilates [14]. Pilates mainly trains deep core muscles, including transversus abdominis, diaphragm, abdominal oblique muscles, multifidus, and pelvic floor muscles, to enhance core muscles strength and endurance, maintain and improve somatic motor nerve control, increase spinal control, and improve somatic stability [15,16,17].
Some clinical studies have found that Pilates had positive effects on pain relief and improvement of functional disability in CLBP patients [18,19,20], while some other studies showed that it was not significantly different from routine rehabilitation training [21,22]. In addition, existing systematic reviews of RCTs have confirmed that Pilates provide better pain relief than minimal interventions in patients with chronic low back pain [23,24]. Another systematic review has confirmed that Pilates offers greater improvement in pain and functional ability compared to usual care and physical activity in the short term [25]. However, in these studies, only the minimal intervention, the usual care, and the routine physical activity were included in the integration process to the control groups of RCTs. This may have certain limitations for a complete demonstration of the benefits of Pilates in patients with chronic low back pain. Therefore, the objective of this systematic review and meta-analysis is to ascertain the efficacy of Pilates on pain, functional disorders, and quality of life in the treatment of patients with chronic low back pain. Additionally, it sought to ascertain whether Pilates can serve as a safe treatment method for patients with chronic low back pain.

2. Materials and Methods

2.1. Retrieval Strategy

This meta-analysis was planned and implemented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [26]. The protocol was registered on the international prospective register of systematic reviews (http://www.crd.york.ac.uk/PROSPERO, accessed on 1 August 2022) with the registration number CRD42022348173.
In this study, PubMed, Web of Science, CNKI, VIP, Wanfang Data, CBM, EBSCO, and Embase were searched. The search time ranged from the date of database construction to November 2022. The last retrieval date is 20 November 2022. The literature search was conducted using a combination of subject terms and free terms. The search terms included “Pilates”, “Pilates training”, “low back pain”, “back pain”, “low back ache”, “nonspecific low back pain”, “chronic nonspecific low back pain”, “chronic nonspecific lumbago”, “chronic nonspecific lower back pain”, “chronic nonspecific lumbar pain”, and “non-specific lower back pain”. In order to obtain all the randomized control trials related to Pilates intervention in the treatment of CLBP patients, we also traced the references of the retrieved literature to supplement the relevant literature. The full search strategy for each database is presented in Supplemental Table S1.

2.2. Eligibility Criteria and Outcome Indicators

The eligibility criteria were as follows:
  • Participants—CLBP patients (disease duration more than 3 months/12 weeks, aged 18–64 years), regardless of race and nationality, whose physical examination showed tenderness or pain in the lumbosacral region but no positive result in the straight leg raising test and the strengthening test, while excluding low back pain caused by other diseases, such as fracture, infection, and tumor, and ensuring no structural lesion in the lumbar spine in the imaging examination;
  • Study design—randomized controlled trials (RCTs);
  • Primary treatment methods—Pilates alone or in combination with other treatment methods;
  • Treatment methods for the controls—any other treatment methods, including routine treatment, sham treatment, and no treatment;
  • Literature data—the literature with complete data, which is able to effectively extract data and obtain original texts;
  • Languages—the literature published in English or Chinese;
  • Literature type—journal articles.
  • The primary outcome indicators were as follows:
  • Pain Scale, which was used to evaluate the pain intensity, including the Visual Analogue Scale (VAS) (ICC = 0.76–0.84) and Numerical Rating Scale (NRS) [27,28,29];
  • Oswestry Disability Index (ODI). The ODI was used to evaluate lumbar vertebra function disorders in CLBP patients, consisting of 9 questions with 6 options per question, corresponding to 0 to 5 points, thus, giving a maximum score of 50, with a final score equal to actual score/45 × 100%. The higher the final score, the more severe the lumbar vertebra dysfunction (ICC = 0.99) [30,31];
  • Roland–Morris Disability Questionnaire (RMDQ). The RMDQ was used to evaluate self-test dysfunction in CLBP patients. Scores ranged from 0 (no functional impairment) to 24 (severe functional impairment), with higher scores indicating more pronounced function disorders [32,33,34].
  • The secondary outcome indicators were as follows:
  • A 36-item Short-Form (SF-36). The SF-36 was used to evaluate the quality of life in CLBP patients, including eight dimensions of Physical Function (PF), Role Physical (RP), Bodily Pain (BP), General Health (GH), Vitality (VT), Social Functioning (SF), Role Emotion (RE), and Mental Health (MH). Scores ranged from 0 to 100, with higher scores indicating better quality of life (ICC > 0.85) [35];
  • Quebec Back in Disability Scale (QBPDS). The QBPDS was used to assess fear of reinjury following a sports injury. The scale consists of 17 items with scores ranging from 17 (no fear) to 68 (highest fear), and the scale has good reliability and validity in CLBP patients [36,37,38,39];
  • Sit-and-reach test. The test was used to evaluate hamstring tendon flexibility as well as lower back flexibility and lumbar extension (ICC = 0.94) [40,41].

2.3. Literature Screening and Data Extraction

Step 1—import the retrieved literature to the literature management software Endnotex9 (www.endnote.com). Step 2—exclude duplicate materials. Step 3—perform the first round of screening by reading titles and abstracts. Step 4—after downloading full texts, conduct the second round of screening to determine if the inclusion criteria were met.
Two independent reviewers, ZY and YY, conducted the literature screening and data extraction. Then, cross-checking was performed. When a possible disagreement occurred, we solved it through discussion or negotiation with a third independent reviewer, XZ. In the literature screening, we first read the title to exclude the irrelevant literature. Then, we further read the abstract and the full text to determine whether to include it. If necessary, we would contact the author of the original research by email or telephone to obtain the unconfirmed information.
The extracted data were as follows:
  • General information of the included literature, namely the title, the first author, and the year of publication;
  • General characteristics of the patients, namely the number of cases in each group, the age, and the duration of the disease;
  • Treatment specifics and the follow-up time;
  • Key elements of bias risk assessment;
  • Focused outcome indicators.

2.4. Quality Assessment

Two independent reviewers used the Cochrane Collaboration tool to examine the risk of bias for the included studies [42,43], and cross-checking was conducted. A grading of the literature quality was performed according to the Jadad scale. A score of 1 to 3 was considered low quality, and a score of 4 to 7 was considered high quality. The grading was also conducted by two independent reviewers, with the opinions of a third independent reviewer being consulted in the event of any disagreement.

2.5. Statistical Analysis

The statistical analysis was based on RevMan5.4 (the Review Manager software 5.4, The Nordic Cochrane Center, The Cochrane Collaboration). If the results included in the literature were continuous variables and from the same assessment method, we used the mean difference (MD) and 95% confidence interval (CI) for statistics. If the results were not from the same assessment method, the standard mean difference (SMD) and 95% confidence interval (CI) were conducted. The p-value and the I2 index were used as indicators to assess the heterogeneity among studies. There was no heterogeneity between studies when p ≥ 0.10, while p < 0.10 indicates that there was heterogeneity between studies. The I2 index represented the degree of heterogeneity between studies. If I2 < 50%, it indicated that there was slight heterogeneity between the studies, and the fixed effect model was used for analysis. If I2 ≥ 50%, there was heterogeneity in the study, and the random effect model was used for analysis [44]. The α value was set at 0.05. Stata 12.0 software was used to conduct the publication bias analysis and sensitivity analysis of Begg’s test for the studies with more than five included outcome indicators. The threshold for statistical significance was set at p < 0.05. The safety analysis was conducted to confirm the safety of Pilates.

3. Results

The initial search resulted in a total of 537 studies, and 6 studies were selected in other ways. EndNote X9 was used to remove duplicate documents, and there were 416 studies left. After reading the titles and abstracts, 41 studies were selected. Then, after reading the full texts, 22 studies were discarded because they did not meet the inclusion and exclusion criteria, and 19 studies were finally included [12,18,19,20,21,22,23,36,45,46,47,48,49,50,51,52,53,54,55]. The process is shown in Figure 1.

3.1. Study Characteristics

A total of 1108 patients were included in the 19 RCTs. The average disease duration ranged from 86 days to 11.6 years. The sample size of each study ranged from 17 to 101 patients. The average intervention cycle is 6.8 weeks (ranging from 4 to 13 weeks), with training 3.1 times a week on average (ranging from 1 to 6 times per week). A total of 16 articles were published in the past 10 years (2013 to 2022), accounting for 84%. In 12 RCTs, the treatment method in trial groups was Pilates alone. In the remaining 7 RCTs, the treatment methods in trial groups were Pilates respectively combined with usual care, home exercise, physical therapy treatment, a standardized education program, infra-red radiation and back care, tendon puncture, the suspension training method, and non-steroidal anti-inflammatory drugs. For the controls, the treatment methods were conducted after the removal of Pilates in seven included RCTs, and there were six RCTs using the method of no treatment. Furthermore, usual care, home exercise, physical therapy treatment, as well as infra-red radiation and back care were, respectively, conducted in one, three, one, and one of the included RCTs. The details of the research characteristics are shown in Table 1 and Table 2.
Of the included 19 RCTs, 17 RCTs [12,18,19,20,21,22,23,36,45,48,49,50,51,52,53,54,55] conducted Pain Scale. Furthermore, ODI and RMDQ were used in nine [12,19,20,21,46,50,52,53,55] and eight [20,23,36,46,48,49,51,54] RCTs, respectively. In addition, SF-36, the sit-and-reach test, and QBPDS were separately performed in four [45,46,48,53], 3 [21,48,53] and two [47,53] RCTs.
The risk of bias assessment was performed using RevMan5.4 software, according to the Cochrane Handbook for Systematic Reviews. The results are shown in Figure 2 and Figure 3. The quality of the literature was graded according to the Jadad scale, with two studies judged to be of low quality and the remaining studies considered to be of high quality. The details are presented in Supplemental Table S2.

3.2. Results of Meta-Analysis

According to the results of the heterogeneity assessment, the random effects model meta-analysis was conducted to analyze the efficacy of Pilates in the context of the Pain Scale, ODI, and RMDQ of CLBP patients. The results showed that there were statistically significant differences between trial groups and control groups, which indicated that Pilates has a positive improvement on Pain Scale [SMD = −1.31, 95%CI (−1.80, −0.83), p < 0.00001], ODI [MD = −4.35, 95%CI(−5.77,−2.94), p < 0.00001], and RMDQ [MD = −2.26, 95%CI (−4.45, −0.08), p = 0.04] in CLBP patients. The results of the meta-analysis are presented in Figure 4, Figure 5 and Figure 6.
Four of the included RCTs [45,46,48,53] reported the effect of Pilates on four dimensions of SF-36, including Physical Function (PF), Role Physical (RP), Bodily Pain (BP), and General Health (GH), in the CLBP patients. The fixed effects model and random effects model were, respectively, used in the meta-analysis. The results showed the following: PF in trial groups was significantly different from control groups [MD = 5.09, 95%CI (0.20, 9.99), p = 0.04], and there was no statistically significant difference in RP [MD = 5.02, 95%CI (−1.03, 11.06), p = 0.10], BP [MD = 8.79, 95%CI (−1.57, 19.16), p = 0.10], and GH [MD = 8.45, 95%CI (−5.61, 22.51), p = 0.24] between trial groups and the controls. These results indicated that Pilates could positively improve SF-36-PF but not RP, BP, and GH in CLBP patients. The results of the meta-analysis are presented in Figure 7A–D. Three RCTs [45,46,48] involved the dimensions of Vitality (VT), Social Functioning (SF), Role Emotion, (RE) and Mental Health (MH). The meta-analysis showed that there was no statistically significant difference in VT [MD = 8.20, 95%CI (−2.30, 18.71), p = 0.13], SF [MD = −1.11, 95%CI (−7.70, 5.48), p = 0.74], RE [MD = 0.86, 95%CI (−5.53, 7.25), p = 0.79], and MH [MD = 11.04, 95%CI (−12.51, 34.59), p = 0.36] between trial groups and control groups, which suggested that Pilates had no positive effect on SF-36-VT, SF, RE, and MH in CLBP patients. The results of the meta-analysis are presented in Figure 7E–H.
Finally, meta-analyses for the efficacy of Pilates on QBPDS [MD = −5.51, 95%CI (−23.84, 12.81), p = 0.56] and the sit-and-reach test [MD = 1.81, 95%CI (−0.25, 3.88), p = 0.09] in CLBP patients were conducted. The results showed that there was a significant difference in the sit-and-reach test, but not QBPDS, between trial groups and control groups, which indicated that Pilates had a positive effect on the sit-and-reach test but not QBPDS in CLBP patients. The results of the meta-analysis are presented in Figure 8 and Figure 9.

3.3. Follow-Ups Analysis

To determine the long-term effects of Pilates on chronic low back pain, we performed a meta-analysis for Pain Scale, ODI, RMDQ, and SF-36 in follow-ups. A total of six RCTs followed the Pain Scale [12,23,45,48,50,54]; a random effects model meta-analysis showed that Pilates was superior to the controls in long-term pain relief in CLBP patients, the difference was statistically significant [MD = −0.70, 95%CI (−1.38, −0.03), p = 0.04]. In two RCTs [12,50], the follow-ups involved ODI. A random effects model meta-analysis showed that the decrease in ODI scores was more pronounced in CLBP patients after the treatment of Pilates compared with the controls, with a statistically significant difference [MD = −6.66, 95%CI (−13.12, −0.86), p = 0.03]. Furthermore, there were three RCTs [23,48,54] which reported RMDQ in follow-ups, and a fixed effects model meta-analysis showed that Pilates had a more positive effect on the decrease in RMDQ scores in CLBP patients in the comparison with the controls, with a statistically significant difference [MD = −1.97, 95%CI (−3.53, −0.40), p = 0.01]. For RCTs with follow-ups on SF-36, we included a total of two [45,48]. A fixed effects model meta-analysis showed that there was no statistically significant difference in all dimensions of SF-36 between the trial groups and control groups. The details are presented in Supplementary Figures S1–S4.

3.4. Publication Bias and Sensitivity Analysis

Begg’s test was conducted to analyze publication bias for the outcome indicators which were involved in five or more RCTs. The results showed that there was a publication bias risk for Pain Scale (t = −2.98, p = 0.008, p < 0.05), and there was no publication bias for ODI (t = −0.89, p = 0.405, p > 0.05) and RMDQ (t = −0.42, p = 0.686, p > 0.05). The details are presented in Supplementary Figures S5–S7.
We conducted a sensitivity analysis through one-by-one elimination for Pain Scale, ODI, and RMDQ in the included RCTs. After excluding any RCTs, there was no significant change in the pooled results and the results were stable. The details are presented in Supplementary Table S3.

3.5. Safety Analysis

Only one RCT [36] reported on safety and adverse events in patients after Pilates. In this study, the patient’s symptoms in the lumbar spine showed no aggravation, but we cannot determine the safety of Pilates.

4. Discussion

In this meta-analysis, we included 19 RCTs, with 1108 CLBP patients. The results showed that Pilates had a positive effect on Pain Scale, ODI, RMDQ and the sit-and-reach test, but that it had no obvious improvement on most dimensions of SF-36 and QBPDS. This suggested a beneficial effect of Pilates on the relief of pain and improvement of functional disability in patients with chronic low back pain, with little effect on the quality of life. Furthermore, the results of the follow-up analysis revealed that the effect of relieving pain and improving functional disability was still maintained in the future period after Pilates treatment. The results on the relief of pain in CLBP patients by Pilates were approximately consistent with those of three previous systematic reviews on Pilates in the treatment of CLBP mentioned in the text. However, one of the systematic reviews summarized that Pilates is no better than other types of exercise in reducing pain in the short term [23]. This negative result, which differs from this meta-analysis, may be caused by the difference in the included studies due to the difference in the inclusion and exclusion criteria. Moreover, this past systematic review may have included a smaller number of studies.
Usually, patients with acute low back pain would experience better improvement and relief in pain as well as dysfunction within 6 weeks [56]. However, acute low back pain would develop into chronic low back pain in approximately 40% of patients, and back pain, as well as functional disability, will persist for more than 12 weeks [6,57]. Furthermore, CLBP patients usually suffered from muscle atrophy in core stable muscle groups (erector spinae, quadratus lumborum, rectus abdominis, internal and external oblique, transversus abdominis and multifidus, etc.) and decreased muscle strength and muscle endurance. Over time, muscle group coordination to maintain strength and stability was dysregulated, with spinal motor flexibility decreased and postural control dysfunction appearing. In exercise, unnecessary compensatory phenomena occurred to maintain spinal stability, and the threshold of muscle fatigue was reduced, leading to rapid fatigue [58,59]. In addition, due to the neurological control disorder of CLBP patients, the local stabilizing muscles started relatively late during the body movement, and the muscle recruitment was delayed, which leads to a further decrease in spinal stability [60]. Long-term low back pain would also lead to core reflex inhibition and nervous system control disorders, resulting in lumbar stability decline [61,62,63]. In this way, patients with chronic low back pain fell into a vicious circle of “muscle atrophy-pain-activity restriction”.
Pilates is a unique training method in that it follows six important training principles, consisting of centering (i.e., activation of core muscle groups), concentration (i.e., cognitive attention when performing exercises), control (i.e., postural control management during exercises), precision (i.e., exercises with few repetitions but precise movements, emphasizing the quality of the exercise), breathing (i.e., the coordination of movements and breathings in exercises, promoting the activation of deep trunk muscles), and flow (i.e., smoothness during exercises and flowing transition between consecutive exercises) [14,15,64]. Pilates focuses on the activation of deep core muscles, spinal stabilization exercises and body postural controls [65], which in turn enhances the muscle strength and muscle endurance of deep muscle groups, increases the interaction between them and the whole muscle, reduces joint compression and changes pelvic inclination, improves postural control, and improves the stability of the spine, so that the spine is upright and neutral in the pelvis, and decreases the perceived force of the lumbar spine on the stimuli sent by nociceptors, thereby achieving pain relief [20,55]. It may be precisely, therefore, that Pilates may relieve the pain in patients with chronic low back pain. Furthermore, Pilates emphasizes both the local stability movement of the spine and the overall movement of the body, as well as strengthening the nerve control of the core muscle group and sending out the command of voluntary movement through the vertebral bundle to control the musculoskeletal system to correct body deviation in real time to maintain stability, gradually form the correct sensorimotor ability, and improve lumbar dysfunction [62,66,67]. Probably because of these, Pilates promotes the improvement of functional disorders in patients with chronic low back pain.

5. Conclusions and Suggestions

In view of the results of this meta-analysis, Pilates seems to have positive efficacy for pain relief and the improvement of functional disorders in patients with chronic low back pain, and the effects of treatment may be maintained for a period. However, there appears to be no positive effect on quality of life in CLBP patients. Furthermore, the safety of Pilates could not be determined.
It is suggested that a more uniform and standardized study design and treatment protocol should be established in future studies, while the doses of Pilates should also be intensively studied. Furthermore, measurements of objective instruments, such as electromyography and nuclear magnetic resonance, should also be added, in order to explore changes in neuromuscular regulation and imaging, and further verify the authenticity of the efficacy.

6. Limitations

  • In this meta-analysis, the study languages of the included RCTs were only Chinese and English, and the study sample sizes were relatively small, which may have biased the results.
  • In the included RCTs, the exercise methods of Pilates were not all consistent, and the treatment methods of the controls were not all consistent.
  • There was high heterogeneity among small parts of the literature, which may have caused some influences on the reliability of the meta-analysis.
  • The bias risk in Pain Scale, according to the publication bias analysis, may be due to the difference in the pain assessment methods among studies, which may lead to an effect on the reliability of study results.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/ijerph20042850/s1, Figure S1: Meta-analysis of the effect of Pilates on Pain Scale follow-up; Figure S2: Meta-analysis of the effect of Pilates on ODI follow-up; Figure S3: Meta-analysis of the effect of Pilates on RMDQ follow-up; Figure S4: Meta-analysis of the effect of Pilates on SF-36 follow-up; Figure S5: Pain Scale publication bias graph of the included RCTs; Figure S6: ODI publication bias graph of the included RCTs; Figure S7: RMDQ publication bias graph of the included RCTs; Table S1: The pooled results of sensitivity analyses [MD (95% CI)]; Table S2: Jadad scale score of included RCTs; Table S3: Search strategy for each database.

Author Contributions

Conceptualization, Z.Y. and Y.Y.; methodology, Y.Y. and J.W.; software, Y.Y. and Z.Y.; validation, X.Z. and H.C.; formal analysis, Z.Y. and Y.Y.; investigation, Z.Y. and Y.Y.; resources, Z.Y. and J.W.; data curation, Y.Y.; writing—original draft preparation, Z.Y. and Y.Y.; writing—review and editing, Z.Y. and F.P.; supervision, F.P.; project administration, F.P. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by National Natural Science Foundation of China, grant number 31560291.

Data Availability Statement

The data are not publicly available for privacy reasons.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Disease, G.B.D.; Injury, I.; Prevalence, C. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017, 390, 1211–1259. [Google Scholar] [CrossRef]
  2. Maher, C.; Underwood, M.; Buchbinder, R. Non-specific low back pain. Lancet 2017, 389, 736–747. [Google Scholar] [CrossRef]
  3. Hartvigsen, J.; Hancock, M.J.; Kongsted, A.; Louw, Q.; Ferreira, M.L.; Genevay, S.; Hoy, D.; Karppinen, J.; Pransky, G.; Sieper, J.; et al. What low back pain is and why we need to pay attention. Lancet 2018, 391, 2356–2367. [Google Scholar] [CrossRef]
  4. Savigny, P.; Watson, P.; Underwood, M.; Guideline Development, G. Early management of persistent non-specific low back pain: Summary of NICE guidance. BMJ (Clin. Res. Ed.) 2009, 338, b1805. [Google Scholar] [CrossRef] [PubMed]
  5. Sutanto, D.; Ho, R.S.T.; Poon, E.T.C.; Yang, Y.; Wong, S.H.S. Effects of Different Trunk Training Methods for Chronic Low Back Pain: A Meta-Analysis. Int. J. Environ. Res. Public Health 2022, 19, 2863. [Google Scholar] [CrossRef]
  6. Xueqiang, W.; Peijie, C.; Wei, J.; Jiejiao, Z.; Jianhua, L.; Yuling, W.; Yi, Z.; Zhijie, Z.; Li, W.; Quansheng, M.; et al. Exercise Therapy for Back Pain: Expert Consensus. China Sport Sci. 2019, 39, 19–29. [Google Scholar] [CrossRef]
  7. French, S.D.; Cameron, M.; Walker, B.F.; Reggars, J.W.; Esterman, A.J. Superficial heat or cold for low back pain. Cochrane Database Syst. Rev. 2006, 2006, CD004750. [Google Scholar] [CrossRef]
  8. Weng, L.M.; Wang, R.; Yang, Q.H.; Chang, T.T.; Wu, C.C.; Li, W.L.; Du, S.H.; Wang, Y.C.; Wang, X.Q. Effect of exercise intervention on social distance in middle-aged and elderly patients with chronic low back pain. Front. Aging Neurosci. 2022, 14, 976164. [Google Scholar] [CrossRef]
  9. Qaseem, A.; Wilt, T.J.; McLean, R.M.; Forciea, M.A.; Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann. Intern. Med. 2017, 166, 514–530. [Google Scholar] [CrossRef]
  10. de Araujo Cazotti, L.; Jones, A.; Roger-Silva, D.; Ribeiro, L.H.C.; Natour, J. Effectiveness of the Pilates Method in the Treatment of Chronic Mechanical Neck Pain: A Randomized Controlled Trial. Arch. Phys. Med. Rehabil. 2018, 99, 1740–1746. [Google Scholar] [CrossRef]
  11. Carrasco-Poyatos, M.; Rubio-Arias, J.A.; Ballesta-Garcia, I.; Ramos-Campo, D.J. Pilates vs. muscular training in older women. Effects in functional factors and the cognitive interaction: A randomized controlled trial. Physiol. Behav. 2019, 201, 157–164. [Google Scholar] [CrossRef]
  12. Mazloum, V.; Sahebozamani, M.; Barati, A.; Nakhaee, N.; Rabiei, P. The effects of selective Pilates versus extension-based exercises on rehabilitation of low back pain. J. Bodyw. Mov. Ther. 2018, 22, 999–1003. [Google Scholar] [CrossRef]
  13. Oliveira, L.C.; Oliveira, R.G.; Pires-Oliveira, D.A. Comparison between static stretching and the Pilates method on the flexibility of older women. J. Bodyw. Mov. Ther. 2016, 20, 800–806. [Google Scholar] [CrossRef] [PubMed]
  14. Yamato, T.P.; Maher, C.G.; Saragiotto, B.T.; Hancock, M.J.; Ostelo, R.W.; Cabral, C.M.; Costa, L.C.; Costa, L.O. Pilates for low back pain. Sao Paulo Med. J. Rev. Paul. De Med. 2016, 134, 366–367. [Google Scholar] [CrossRef]
  15. Eliks, M.; Zgorzalewicz-Stachowiak, M.; Zenczak-Praga, K. Application of Pilates-based exercises in the treatment of chronic non-specific low back pain: State of the art. Postgrad. Med. J. 2019, 95, 41–45. [Google Scholar] [CrossRef]
  16. Csepregi, E.; Gyurcsik, Z.; Veres-Balajti, I.; Nagy, A.C.; Szekanecz, Z.; Szanto, S. Effects of Classical Breathing Exercises on Posture, Spinal and Chest Mobility among Female University Students Compared to Currently Popular Training Programs. Int. J. Environ. Res. Public Health 2022, 19, 3728. [Google Scholar] [CrossRef]
  17. Urits, I.; Burshtein, A.; Sharma, M.; Testa, L.; Gold, P.A.; Orhurhu, V.; Viswanath, O.; Jones, M.R.; Sidransky, M.A.; Spektor, B.; et al. Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment. Curr. Pain Headache Rep. 2019, 23, 23. [Google Scholar] [CrossRef]
  18. Rydeard, R.; Leger, A.; Smith, D. Pilates-based therapeutic exercise: Effect on subjects with nonspecific chronic low back pain and functional disability: A randomized controlled trial. J. Orthop. Sport. Phys. Ther. 2006, 36, 472–484. [Google Scholar] [CrossRef]
  19. Baskan, Ö.; Cavlak, U.; Baskan, E. Effectiveness of a clinical pilates program in women with chronic low back pain: A randomized controlled trial. Ann. Clin. Anal. Med. 2021, 12, 478–482. [Google Scholar] [CrossRef]
  20. Manman, M.; Renzhang, L. Effect of suspension training combined with Pilates exercise on core strength in patients with chronic low back pain. Chin. Manip. Rehabil. Med. 2022, 13, 18–20. [Google Scholar] [CrossRef]
  21. Gladwell, V.; Head, S.; Haggar, M.; Beneke, R. Does a Program of Pilates Improve Chronic Non-Specific Low Back Pain? J. Sport Rehabil. 2006, 15, 338–350. [Google Scholar] [CrossRef]
  22. Lopes, S.; Correia, C.; Felix, G.; Lopes, M.; Cruz, A.; Ribeiro, F. Immediate effects of Pilates based therapeutic exercise on postural control of young individuals with non-specific low back pain: A randomized controlled trial. Complement. Ther. Med. 2017, 34, 104–110. [Google Scholar] [CrossRef]
  23. Miyamoto, G.C.; Costa, L.O.; Galvanin, T.; Cabral, C.M. Efficacy of the addition of modified Pilates exercises to a minimal intervention in patients with chronic low back pain: A randomized controlled trial. Phys. Ther. 2013, 93, 310–320. [Google Scholar] [CrossRef]
  24. Lim, E.C.; Poh, R.L.; Low, A.Y.; Wong, W.P. Effects of Pilates-based exercises on pain and disability in individuals with persistent nonspecific low back pain: A systematic review with meta-analysis. J. Orthop. Sport. Phys. Ther. 2011, 41, 70–80. [Google Scholar] [CrossRef]
  25. Wells, C.; Kolt, G.S.; Marshall, P.; Hill, B.; Bialocerkowski, A. The effectiveness of Pilates exercise in people with chronic low back pain: A systematic review. PloS ONE 2014, 9, e100402. [Google Scholar] [CrossRef]
  26. Moher, D.; Shamseer, L.; Clarke, M.; Ghersi, D.; Liberati, A.; Petticrew, M.; Shekelle, P.; Stewart, L.A.; Group, P.-P. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst. Rev. 2015, 4, 1. [Google Scholar] [CrossRef]
  27. Hawker, G.A.; Mian, S.; Kendzerska, T.; French, M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res. 2011, 63, S240–S252. [Google Scholar] [CrossRef]
  28. Jensen, M.P.; Karoly, P.; Braver, S. The measurement of clinical pain intensity: A comparison of six methods. Pain 1986, 27, 117–126. [Google Scholar] [CrossRef]
  29. Chien, C.W.; Bagraith, K.S.; Khan, A.; Deen, M.; Strong, J. Comparative responsiveness of verbal and numerical rating scales to measure pain intensity in patients with chronic pain. J. Pain 2013, 14, 1653–1662. [Google Scholar] [CrossRef]
  30. Koc, M.; Bayar, B.; Bayar, K. A Comparison of Back Pain Functional Scale With Roland Morris Disability Questionnaire, Oswestry Disability Index, and Short Form 36-Health Survey. Spine 2018, 43, 877–882. [Google Scholar] [CrossRef] [PubMed]
  31. Fairbank, J.C.; Couper, J.; Davies, J.B.; O’Brien, J.P. The Oswestry low back pain disability questionnaire. Physiotherapy 1980, 66, 271–273. [Google Scholar]
  32. Garg, A.; Pathak, H.; Churyukanov, M.V.; Uppin, R.B.; Slobodin, T.M. Low back pain: Critical assessment of various scales. Eur. Spine J. 2020, 29, 503–518. [Google Scholar] [CrossRef] [PubMed]
  33. Chiarotto, A.; Maxwell, L.J.; Terwee, C.B.; Wells, G.A.; Tugwell, P.; Ostelo, R.W. Roland-Morris Disability Questionnaire and Oswestry Disability Index: Which Has Better Measurement Properties for Measuring Physical Functioning in Nonspecific Low Back Pain? Systematic Review and Meta-Analysis. Phys. Ther. 2016, 96, 1620–1637. [Google Scholar] [CrossRef]
  34. Smeets, R.; Koke, A.; Lin, C.W.; Ferreira, M.; Demoulin, C. Measures of function in low back pain/disorders: Low Back Pain Rating Scale (LBPRS), Oswestry Disability Index (ODI), Progressive Isoinertial Lifting Evaluation (PILE), Quebec Back Pain Disability Scale (QBPDS), and Roland-Morris Disability Questionnaire (RDQ). Arthritis Care Res. 2011, 63, S158–S173. [Google Scholar] [CrossRef]
  35. Brazier, J.E.; Harper, R.; Jones, N.M.; O’Cathain, A.; Thomas, K.J.; Usherwood, T.; Westlake, L. Validating the SF-36 health survey questionnaire: New outcome measure for primary care. BMJ (Clin. Res. Ed.) 1992, 305, 160–164. [Google Scholar] [CrossRef] [PubMed]
  36. Cruz-Diaz, D.; Bergamin, M.; Gobbo, S.; Martinez-Amat, A.; Hita-Contreras, F. Comparative effects of 12 weeks of equipment based and mat Pilates in patients with Chronic Low Back Pain on pain, function and transversus abdominis activation. A randomized controlled trial. Complement. Ther. Med. 2017, 33, 72–77. [Google Scholar] [CrossRef] [PubMed]
  37. Vlaeyen, J.W.; Kole-Snijders, A.M.; Rotteveel, A.M.; Ruesink, R.; Heuts, P.H. The role of fear of movement/(re)injury in pain disability. J. Occup. Rehabil. 1995, 5, 235–252. [Google Scholar] [CrossRef]
  38. Vlaeyen, J.W.S.; Kole-Snijders, A.M.J.; Boeren, R.G.B.; van Eek, H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995, 62, 363–372. [Google Scholar] [CrossRef]
  39. Swinkels-Meewisse, E.J.; Swinkels, R.A.; Verbeek, A.L.; Vlaeyen, J.W.; Oostendorp, R.A. Psychometric properties of the Tampa Scale for kinesiophobia and the fear-avoidance beliefs questionnaire in acute low back pain. Man. Ther. 2003, 8, 29–36. [Google Scholar] [CrossRef]
  40. Jackson, A.; Langford, N.J. The criterion-related validity of the sit and reach test: Replication and extension of previous findings. Res. Q. Exerc. Sport 1989, 60, 384–387. [Google Scholar] [CrossRef]
  41. Mayorga-Vega, D.; Merino-Marban, R.; Viciana, J. Criterion-Related Validity of Sit-and-Reach Tests for Estimating Hamstring and Lumbar Extensibility: A Meta-Analysis. J. Sport. Sci. Med. 2014, 13, 1–14. [Google Scholar]
  42. Higgins, J.P.; Altman, D.G.; Gotzsche, P.C.; Juni, P.; Moher, D.; Oxman, A.D.; Savovic, J.; Schulz, K.F.; Weeks, L.; Sterne, J.A.; et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ (Clin. Res. Ed.) 2011, 343, d5928. [Google Scholar] [CrossRef] [Green Version]
  43. Cumpston, M.; Li, T.; Page, M.J.; Chandler, J.; Welch, V.A.; Higgins, J.P.; Thomas, J. Updated guidance for trusted systematic reviews: A new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst. Rev. 2019, 10, ED000142. [Google Scholar] [CrossRef]
  44. Cochrane, M.; Mitchell, E.; Hollingworth, W.; Crawley, E.; Trepel, D. Cost-effectiveness of Interventions for Chronic Fatigue Syndrome or Myalgic Encephalomyelitis: A Systematic Review of Economic Evaluations. Appl. Health Econ. Health Policy 2021, 19, 473–486. [Google Scholar] [CrossRef]
  45. Wajswelner, H.; Metcalf, B.; Bennell, K. Clinical pilates versus general exercise for chronic low back pain: Randomized trial. Med. Sci. Sport. Exerc. 2012, 44, 1197–1205. [Google Scholar] [CrossRef] [PubMed]
  46. Notarnicola, A.; Fischetti, F.; Maccagnano, G.; Comes, R.; Tafuri, S.; Moretti, B. Daily pilates exercise or inactivity for patients with low back pain: A clinical prospective observational study. Eur. J. Phys. Rehabil. Med. 2014, 50, 59–66. [Google Scholar] [PubMed]
  47. Mostagi, F.Q.; Dias, J.M.; Pereira, L.M.; Obara, K.; Mazuquin, B.F.; Silva, M.F.; Silva, M.A.; de Campos, R.R.; Barreto, M.S.; Nogueira, J.F.; et al. Pilates versus general exercise effectiveness on pain and functionality in non-specific chronic low back pain subjects. J. Bodyw. Mov. Ther. 2015, 19, 636–645. [Google Scholar] [CrossRef]
  48. Natour, J.; Cazotti Lde, A.; Ribeiro, L.H.; Baptista, A.S.; Jones, A. Pilates improves pain, function and quality of life in patients with chronic low back pain: A randomized controlled trial. Clin. Rehabil. 2015, 29, 59–68. [Google Scholar] [CrossRef]
  49. Akodu, A.; Okonkwo, S.; Akinbo, S. Comparative efficacy of core stabilization exercise and pilates exercise on patients with non-specific chronic low back pain. Physiotherapy 2016, 102, e243–e244. [Google Scholar] [CrossRef]
  50. Cruz-Diaz, D.; Martinez-Amat, A.; Osuna-Perez, M.C.; De la Torre-Cruz, M.J.; Hita-Contreras, F. Short- and long-term effects of a six-week clinical Pilates program in addition to physical therapy on postmenopausal women with chronic low back pain: A randomized controlled trial. Disabil. Rehabil. 2016, 38, 1300–1308. [Google Scholar] [CrossRef]
  51. Ying, Z.; Baoqiang, D.; Xingxing, L.; Xiaoqing, Z. Tendon puncture combined with pilates training in the treatment of chronic nonspecific low back pain: A randomized controlled study. Acad. J. Shanghai Univ. Tradit. Chin. Med. 2018, 32, 50–55. [Google Scholar] [CrossRef]
  52. Minghui, L. Effects of Pilates Exercise on Pain and Lumbar Function of Patients with Chronic Low Back Pain. Genom. Appl. Biol. 2019, 38, 3263–3267. [Google Scholar] [CrossRef]
  53. Batibay, S.; Kulcu, D.G.; Kaleoglu, O.; Mesci, N. Effect of Pilates mat exercise and home exercise programs on pain, functional level, and core muscle thickness in women with chronic low back pain. J. Orthop. Sci. Off. J. Jpn. Orthop. Assoc. 2021, 26, 979–985. [Google Scholar] [CrossRef]
  54. Yang, C.Y.; Tsai, Y.A.; Wu, P.K.; Ho, S.Y.; Chou, C.Y.; Huang, S.F. Pilates-based core exercise improves health-related quality of life in people living with chronic low back pain: A pilot study. J. Bodyw. Mov. Ther. 2021, 27, 294–299. [Google Scholar] [CrossRef]
  55. Fei, W.; Jianhua, W.; Yan, S.; Qingfan, X. Therapeutic effect of Pilates exercise combined with massage on chronic non-specific lower back pain. Chin. Manip. Rehabil. Med. 2022, 13, 4–6. [Google Scholar] [CrossRef]
  56. Costa Lda, C.; Maher, C.G.; McAuley, J.H.; Hancock, M.J.; Herbert, R.D.; Refshauge, K.M.; Henschke, N. Prognosis for patients with chronic low back pain: Inception cohort study. BMJ (Clin. Res. Ed.) 2009, 339, b3829. [Google Scholar] [CrossRef]
  57. Asano, H.; Plonka, D.; Weeger, J. Effectiveness of Acupuncture for Nonspecific Chronic Low Back Pain: A Systematic Review and Meta-Analysis. Med. Acupunct. 2022, 34, 96–106. [Google Scholar] [CrossRef]
  58. Li, P.; Nie, Y.; Chen, J.; Ning, N. Application progress of surface electromyography and surface electromygraphic biofeedback in low back pain. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2017, 31, 504–507. [Google Scholar] [CrossRef]
  59. Nakamura, M.; Otani, K.; Kaneko, Y.; Sekiguchi, M.; Konno, S.I. The Relationship between Exercise-Induced Low Back Pain, the Fat Infiltration Rate of Paraspinal Muscles, and Lumbar Sagittal Balance. Spine Surg. Relat. Res. 2022, 6, 261–270. [Google Scholar] [CrossRef]
  60. Jingzhou, C.; Huijuan, W.; Zhenrun, S.; fan, J.-Z. The isokinetic mechanical characteristics and electromyogram of trunk muscles in people with chronic non-specific low back pain. Chin. J. Rehabil. Med. 2021, 36, 51–56. [Google Scholar]
  61. Zhou, X.; Kong, L.; Ren, J.; Song, P.; Wu, Z.; He, T.; Lv, Z.; Zhang, S.; Sun, W.; Zhang, J.; et al. Effect of traditional Chinese exercise combined with massage on pain and disability in patients with lumbar disc herniation: A multi-center, randomized, controlled, assessor-blinded clinical trial. Front. Neurol. 2022, 13, 952346. [Google Scholar] [CrossRef]
  62. Hayden, J.A.; Ellis, J.; Ogilvie, R.; Malmivaara, A.; van Tulder, M.W. Exercise therapy for chronic low back pain. Cochrane Database Syst. Rev. 2021, 9, CD009790. [Google Scholar] [CrossRef]
  63. Xiao-dong, S.; Hong-hai, Z.; Shun-chang, Z.; Wei-en, H.; Jing-shen, F.; Jun-ming, T. Overview of spinal integrity theory and related clinical studies. China J. Tradit. Chin. Med. Pharm. 2019, 34, 1134–1138. [Google Scholar]
  64. Latey, P. The Pilates method: History and philosophy. J. Bodyw. Mov. Ther. 2001, 5, 275–282. [Google Scholar] [CrossRef] [Green Version]
  65. Grooten, W.J.A.; Bostrom, C.; Dedering, A.; Halvorsen, M.; Kuster, R.P.; Nilsson-Wikmar, L.; Olsson, C.B.; Rovner, G.; Tseli, E.; Rasmussen-Barr, E. Summarizing the effects of different exercise types in chronic low back pain—A systematic review of systematic reviews. BMC Musculoskelet. Disord. 2022, 23, 801. [Google Scholar] [CrossRef]
  66. Cruz-Diaz, D.; Romeu, M.; Velasco-Gonzalez, C.; Martinez-Amat, A.; Hita-Contreras, F. The effectiveness of 12 weeks of Pilates intervention on disability, pain and kinesiophobia in patients with chronic low back pain: A randomized controlled trial. Clin. Rehabil. 2018, 32, 1249–1257. [Google Scholar] [CrossRef]
  67. Bhadauria, E.A.; Gurudut, P. Comparative effectiveness of lumbar stabilization, dynamic strengthening, and Pilates on chronic low back pain: Randomized clinical trial. J. Exerc. Rehabil. 2017, 13, 477–485. [Google Scholar] [CrossRef] [Green Version]
Ijerph 20 02850 g001 550
Figure 1. Study selection represented by a PRISMA flowchart.
Figure 1. Study selection represented by a PRISMA flowchart.
Ijerph 20 02850 g001
Ijerph 20 02850 g002 550
Figure 2. Résumé of results of risk of bias assessment.
Figure 2. Résumé of results of risk of bias assessment.
Ijerph 20 02850 g002
Ijerph 20 02850 g003 550
Figure 3. Punctuation of risk of bias tool [12,18,19,20,21,22,23,36,45,46,47,48,49,50,51,52,53,54,55].
Figure 3. Punctuation of risk of bias tool [12,18,19,20,21,22,23,36,45,46,47,48,49,50,51,52,53,54,55].
Ijerph 20 02850 g003
Ijerph 20 02850 g004 550
Figure 4. Meta-analysis of the effect of Pilates on Pain Scale in CLBP patients [12,18,19,20,21,22,23,36,43,45,48,49,50,51,52,54,55].
Figure 4. Meta-analysis of the effect of Pilates on Pain Scale in CLBP patients [12,18,19,20,21,22,23,36,43,45,48,49,50,51,52,54,55].
Ijerph 20 02850 g004
Ijerph 20 02850 g005 550
Figure 5. Meta-analysis of the effect of Pilates on ODI in CLBP patients [12,19,20,46,50,51,52,53,55].
Figure 5. Meta-analysis of the effect of Pilates on ODI in CLBP patients [12,19,20,46,50,51,52,53,55].
Ijerph 20 02850 g005
Ijerph 20 02850 g006 550
Figure 6. Meta-analysis of the effect of Pilates on RMDQ in CLBP patients [20,23,36,48,49,51,54].
Figure 6. Meta-analysis of the effect of Pilates on RMDQ in CLBP patients [20,23,36,48,49,51,54].
Ijerph 20 02850 g006
Ijerph 20 02850 g007 550
Figure 7. Meta-analysis of the effect of Pilates on eight dimensions of SF-36 in CLBP patients [45,46,48,53].
Figure 7. Meta-analysis of the effect of Pilates on eight dimensions of SF-36 in CLBP patients [45,46,48,53].
Ijerph 20 02850 g007
Ijerph 20 02850 g008 550
Figure 8. Meta-analysis of the effect of Pilates on QBPDS in CLBP patients [47,53].
Figure 8. Meta-analysis of the effect of Pilates on QBPDS in CLBP patients [47,53].
Ijerph 20 02850 g008
Ijerph 20 02850 g009 550
Figure 9. Meta-analysis of the effect of Pilates on the sit-and-reach test in CLBP patients [21,48,53].
Figure 9. Meta-analysis of the effect of Pilates on the sit-and-reach test in CLBP patients [21,48,53].
Ijerph 20 02850 g009
Table
Table 1. The details of the research’s general characteristics.
Table 1. The details of the research’s general characteristics.
ReferenceCountry Sample Size (T/C)Mean Age, Years (T/C)Disease Duration
Gladwell, V. 2006 [21]UK20/1436.9 ± 8.1/45.9 ± 8.09.6 ± 8.4 y/11.6 ± 12.3 y
Rydeard, R. 2006 [18]Canada18/2137 ± 9/34 ± 85.5 y/9 y
Wajswelner, H. 2012 [45]Australia44/4349.3 ± 14.1/48.9 ± 16.413.6 ± 14.2 y/14.2 ± 12.7 y
Miyamoto, G.C. 2013 [23]Brazil41/4340.7 ± 11.8/38.3 ± 11.473.3 ± 79.6 m/56.7 ± 53.5 m
Notarnicola, A. 2014 [46]Italy30/3046.9 ± 10.3/55.5 ± 7.196 ± 86.1 d/86 ± 89.6 d
Mostagi, F.Q. 2015 [47]Brazil10/736.1 ± 9/34.7 ± 8.1-
Natour, J. 2015 [48]Brazil30/3048.08 ± 12.98/47.79 ± 11.47-
Akodu, A. 2016 [49]Nigeria10/1045.30 ± 11.31/40.33 ± 14.5-
Cruz-Díaz, D. 2016 [50]Spain53/4869.57 ± 2.18/72.69 ± 3.53-
Cruz-Díaz, D. 2017 [36]SpainPMG:34; PAG:34/30PMG:36.94 ± 12.46; PAG:35.5 (11.98)/36.32 (10.67)-
Lopes, S. 2017 [22]Portugal23/2321.8 ± 3.2/22.8 ± 3.627.1 ± 16.6 m/31.0 ± 25.8 m
Mazloum, V. 2018 [12]Iran16/1637.1 ± 9.5/39.3 ± 9.832.3 ± 18.3 m/32.4 ± 16.4 m
Ying, Z. 2018 [51]Chinaa:30; b:29/29a:36.29 ± 4.61;
b:36.95 ± 4.40/36.25 ± 5.30		a:15.94 ± 5.08 m;b:14.98 ± 5.17 m/15.68 ± 5.23 m
Minghui, L. 2019 [52]China32/3243.24 ± 11.54/45.16 ± 10.3713.36 ± 3.44 m/12.12 ± 3.37 m
Baskan, Ö. 2021 [19]Turkey20/2041.55 ± 3.39/38.95 ± 3.96-
Batıbay, S. 2021 [53]Turkey28/2549.3 ± 10.4/48.4 ± 9.35.8 ± 4.1 y/6.3 ± 3.5 y
Yang, C. 2021 [54]China20/1950.5 ± 11.8/47.9 ± 15.9-
Fei, W. 2022 [55]China40/4037.4 ± 6.5/36.1 ± 7.73.4 ± 1.8 m/3.4 ± 1.8 m
Manman M.2022 [20]China34/3244.21 ± 10.97
/44.39 ± 10.03		33.24 ± 11.01 m/32.35 ± 10.42 m
Abbreviations are as follows: t = time, d = day, w = week, m = month, y = year. Here, “-” indicates not mentioned. Furthermore, T = trial group, C = control group; a, tendon puncture combined with Pilates; b, Pilates alone; PAG, Pilates with apparatus group; PMG, Pilates mat group.
Table
Table 2. The details of research intervention and outcome indicators.
Table 2. The details of research intervention and outcome indicators.
ReferenceTreatment MethodsDosageOutcomeFollow-Up
TC
Gladwell, V. 2006 [21]PilatesⅩ60 min/t, 1 t/w, 6 w①②③⑤-
Rydeard, R. 2006 [18]PilatesⅠ75 min/t, 3 t/w, 4 w①3 m, 6 m, 12 m
Wajswelner, H. 2012 [45]PilatesⅡ60 min/t, 2 t/w, 6 w①④12 w, 24 w
Miyamoto, G.C. 2013 [23]PilatesⅩ2 t/w, 6 w①③6 m
Notarnicola, A. 2014 [46]PilatesⅩ60 min/t, 5 t/w, 6 m②③④-
Mostagi, F.Q. 2015 [47]PilatesⅢ2 t/w, 8 w⑥3 m
Natour, J. 2015 [48]Pilates and ⅣⅣ50 min/t, 2 t/w, 90 d①③④⑤180 d
Akodu, A. 2016 [49]PilatesⅤ2 t/w, 4 w①③-
Cruz-Díaz, D. 2016 [50]Pilates and ⅢⅢ2 t/w, 6 w①②1 y
Cruz-Díaz, D. 2017 [36]PMG/PAGⅩ50 min/t, 2/w, 12 w①③-
Lopes, S. 2017 [22]PilatesⅩ20 min/t①-
Mazloum, V. 2018 [12]PilatesⅩ3 t/w, 6 w①②10 w
Ying, Z. 2018 [51]a:Pilates and Ⅵ
b:Pilates		Ⅵ5 t/w, 8 w①③-
Minghui, L. 2019 [52]Pilates and ⅦⅦ30 min/t, 5 t/w, 4 w①②-
Baskan, Ö. 2021 [19]PilatesⅡ45 min/t, 3 times/w, 8 w①②-
Batıbay, S. 2021 [53]PilatesⅡ60 min/t, 3 t/w, 8 w①②④⑤⑥-
Yang, C. 2021 [54]Pilates and ⅧⅧ60 min/t, 2 t/w, 8 w①③26 w
Fei, W. 2022 [55]Pilates and ⅨⅨ30 min/t, 6 t/w, 4 w①②-
Manman, M. 2022 [20]Pilates and ⅧⅧ30 min/t, 5 t/w, 4 w①②-
Abbreviations are as follows: t = time, d = day, w = week, m = month, y = year; “-” indicates not mentioned; T = trial group, C = control group; a, tendon puncture combined with Pilates; b, Pilates alone; PAG, Pilates with apparatus group; PMG, Pilates mat group;Ⅰ, usual care; Ⅱ, home exercise; Ⅲ, physical therapy treatment; Ⅳ, standardized education program; Ⅴ, infra-red radiation and back care; Ⅵ, tendon puncture; Ⅶ, suspension training method, Ⅷ: non-steroidal anti-inflammatory drug; Ⅸ, massage; Ⅹ, no treatment. ① Pain Scale (VAS/NRS); ② Oswestry disability index, ODI; ③ Roland–Morris Disability Questionnaire, RMDQ; ④ 36-item Short-Form, SF-36; ⑤ sit-and-reach test; ⑥ Quebec Back in Disability Scale, QBPDS.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Yu, Z.; Yin, Y.; Wang, J.; Zhang, X.; Cai, H.; Peng, F. Efficacy of Pilates on Pain, Functional Disorders and Quality of Life in Patients with Chronic Low Back Pain: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2023, 20, 2850. https://doi.org/10.3390/ijerph20042850

AMA Style

Yu Z, Yin Y, Wang J, Zhang X, Cai H, Peng F. Efficacy of Pilates on Pain, Functional Disorders and Quality of Life in Patients with Chronic Low Back Pain: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2023; 20(4):2850. https://doi.org/10.3390/ijerph20042850

Chicago/Turabian Style

Yu, Zhengze, Yikun Yin, Jialin Wang, Xingxing Zhang, Hejia Cai, and Fenglin Peng. 2023. "Efficacy of Pilates on Pain, Functional Disorders and Quality of Life in Patients with Chronic Low Back Pain: A Systematic Review and Meta-Analysis" International Journal of Environmental Research and Public Health 20, no. 4: 2850. https://doi.org/10.3390/ijerph20042850

APA Style

Yu, Z., Yin, Y., Wang, J., Zhang, X., Cai, H., & Peng, F. (2023). Efficacy of Pilates on Pain, Functional Disorders and Quality of Life in Patients with Chronic Low Back Pain: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 20(4), 2850. https://doi.org/10.3390/ijerph20042850

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop