The Effectiveness of Stabilization Exercises in Treating Patients with Chronic Low Back Pain: A Systematic Review
Asian Journal of Orthopaedic Research,
Page 30-46
Abstract
Background: Chronic low back pain is one of the biggest health problems around the world. It is considered as one of the main causes of disability, high medical expenses and absenteeism. Chronic low back pain can be treated indifferent ways. However, the efficacy of most of these treatments has not been studied so medical intervention for chronic low back pain varies widely. Stabilization exercise is one form of physiotherapy treatment recommended in some guidelines. However, there is an argument about the effectiveness of this intervention.
Objective: This systematic review aimed to investigate the effectiveness of stabilization exercises on patients with chronic low back pain and disability.
Study Design: Systematic Review.
Search Strategy: An online research through the electronic databases, such as Ovid, Medline, CINHAL, Google Scholar, Cochrane library, Pedro database and Pub med was conducted. Citation searches within studies, as well as online tracking of references were also conducted in this review.
Mean of Analysis: The Pedro scale was used to assess the quality of the included randomized controlled trials, where studies which scored equal to or more than 5/10 were considered as a high quality studies. In addition, a simple qualitative analysis was performed to analyze data and give accurate results.
Main Results: Twenty studies met the inclusion criteria. Seventeen studies were randomized controlled studies; one was a study case series, one a cohort study, and one a comparative study. The most outcome measures among the studies were pain (numerical pain rating scale, visual analogue scale and short-form McGill pain scale) and disability (Ronald & Morris disability questionnaire and Oswestry disability questionnaire). The results show significant changes between the studies in terms of pain and disability. However, there is moderate evidence about effectiveness of the stabilization exercises for long term sufferers (>6 months).
Conclusion: Using stabilization exercises on patients with chronic low back pain is helpful to reduce pain and disability. However, there is no preference for this intervention over other physiotherapy interventions.
Recommendation: High quality studies are needed to investigate the efficacy of this intervention for long term.
Keywords:
- Lumbar stabilization exercises
- core stability exercises
- motor control exercises
- chronic low back pain.
How to Cite
Alzubeidi, S. A., Alfawaz, A. A., Algharawi, M. Y., Alrashidi, A. S., Alamrani, M. A., & Alsayed, A. B. (2020). The Effectiveness of Stabilization Exercises in Treating Patients with Chronic Low Back Pain: A Systematic Review. Asian Journal of Orthopaedic Research, 3(2), 30-46. Retrieved from https://journalajorr.com/index.php/AJORR/article/view/30119
References
Van Tulder M, Koes B, Bouter L. A cost-of-illness study of back pain in The Netherlands. Pain. 1995;62:233–40.
Van Tudler M, Malmivaara A, Esmail R, Koes B. Exercise therapy for low back pain: A systematic review within the framework of cochrane collaboration back review group. Spine. 2000;25(21):2784-2796.
Chew-Graham C, May C. Chronic low back pain in general practice: The challenge of consultation. Family Practice. 1999;16(1):46-49.
Koes B, van Tudler M, Thomas S. Diagnosis and treatment of low back pain. British Medical Journal. 2006;232:1430-1434.
Fauci A, Braunwald E, Hauser S, Longo D, Jameson J, Loscalzo J. Harrison’s Principles of Internal Medicine. McGraw-Hill; 2008.
Liddle S, Baxter G, Gracey J. Exercise and chronic low back pain: What works? Pain. 2004;107:176-190.
Rathmell J. A 50-year-old man with chronic low back pain. Journal of American Medical Association. 2008;299(17):2066-2077.
Borenstein D. Epidemiology, etiology, diagnostic evaluation and treatment of low back pain. Current Opinion in Rheumatology. 2000;11(3):225-231.
NHS Centre for Reviews and Dissemination. Acute and chronic low back pain. Effective Health Care. 2000;6(5).
McGill S. Low back exercises: Evidence for improving exercise regimens. Physical therapy. 1998;78(7):754-765.
O‟Sullivan P. Lumbar segmental instability: Clinical presentation and specific exercise management. Manual Therapy. 2000;5(1):2-12.
Panjabi M. The stabilizing system of the spine, part 1 and part 2. Journal of Spinal Disorders. 1992;5(4):383-397.
Comerford M, Mottram S. Functional stability re-training: Principles and strategies for managing mechanical dysfunction. Manual Therapy. 2001;6(1):3-14.
Cholewicke J, McGill S. Mechanical stability of the in-vivo lumbar spine: Implications for injury and chronic low back pain. Clinical Biomechanics. 1996;11(1):1-15.
Knudsen H. Spinal segmental stabilization: Specific exercises for deep stabilizing muscles of the back and abdominal wall; 2011.
Avialable:http://www.back-exercises.com/Segmental-Stabilization.html
(Accessed: November 6, 2013)
McGill SM, Norman RW. Low back pain biomechanics in industry: The prevention of injury through safer lifting. Human Kinetics Publishers. 1993;69-120.
Hodges PW, Richardson CA. Delayed postural contraction of transversus abdominis associated with movement of lower limb in people with low back pain. Journal of Spinal Disorders. 1998;11(1):46-56.
O‟Sullivan P, Twomey L, Allison G. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine. 1997;22(24): 2959–2967.
Celestini M, Marchese A, Serenelli A, Graziani GA. Randomized controlled trial on the effects of physical exercise in patients braced for instability of the lumbar spine. Euro Medicophys. 2005;41:223–31.
Miller ER, Schenk RJ, Karnes JL, Rouselle JG. A comparison of the McKenzie approach to a specific spine stabilization program for chronic low back pain. J Man Manip Ther. 2005;13:103–12.
Bakhtiary AH, Safavi-Farokhi Z, Rezasoltani A. Lumbar stabilizing exercises improve activities of daily living in patients with lumbar disc herniation. J Back Muscul. 2005;18:55–60.
Cairns M, Foster N, Wright C. Randomized controlled trial of specific spinal stabilization exercises and conventional physiotherapy for recurrent low back pain. Spine. 2006;31(19): e670-e681.
You Y, Lee Y. The effect of core stabilization exercises using a sling on pain and muscle strength of patients with chronic low back pain. J. Phys. Ther. Sci. 2012;24:671-674.
Franca F, Burke T, Caffaro R, Ramos L, Marques A. Effect of muscular stretching and segmental stabilization on functional disability and pain in patients with chronic low back pain: A randomized controlled trial. Journal of Manipulative and Physiological Therapeutics. 2012;35(4): 279-285.
Kachanathu SJ, Zakaria AR, Sahni A, Jaiswal P. Chronic low back pain in fast bowlers a comparative study of core spinal stabilization and conventional exercises. Journal of Physical Therapy Science. 2012;24(9):821-825.
Hicks GE, Fritz JE, Delitto A, McGill SM. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehab. 2005;86:1753–62.
Richardson CA, Jull GA. Muscle control-pain control. What exercises would you prescribe? Manual Therapy. 1995;1:2-10.
Hodges PW, Moseley GL, Gabrielsson A, Gandevia SC. Experimental muscle pain changes feedforward postural responses of the trunk muscles. Experimental Brain Research. 2003;151(2):262-271.
Norris C, Matthews M. The role of an integrated back stability program in patients with chronic low back pain. Complementary Therapies in Clinical Practice. 2008;14:255-263.
Koftolis ND, Vlachopoulos SP, Kellis E. Sequentially allocatedclinical trial of rhythmic stabilization exercises and TENS in women with chronic low back pain. Clinic Rehab. 2008;22: 99-111.
Ota M, Kaneoka K, Hangai M, Koizumi K, Muramatsu T. Effectiveness of lumbar stabilization exercises for reducing chronic low back pain and improving quality-of-life. Journal of Physical Therapy Science. 2013;23(4):679-681.
Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine. 2005;30:1331–1334.
Lewis JS, Hewitt JS, Billington L, Cole S, Byng J, Karayiannis S. A randomized controlled trial comparing two physiotherapy interventions for chronic low back pain. Spine. 2005;30(7):711-721.
Shaughnessy M, Culfield B. A pilot study to investigate the effect of lumbar stabilisation exercise training on functional ability and quality of life in patients with chronic low back pain. Int J Rehab. 2004;27:297–301.
Moseley L. Combined physiotherapy and education is efficacious for chronic low back pain. Aust J Physio. 2002;48:297–302.
Van Tulder M, Furlan A, Bombardier C, Bouter L. Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine (Phila Pa 1976). 2003;28(12): 1290-1299.
DOI: 10.1097/01.brs.0000065484.95996
Goldby L. A Randomized controlled trial investigating the efficiency of musculoskeletal physiotherapy on chronic low back pain. Spine. 2006;31(10):1083-1093.
Ferreira ML, Ferreira PH, Latimer J, Herbert R, Hodges P, Jennings M, Maher C. Comparison of general exercises, motor control exercises and spinal manipulative therapy for chronic low back pain: A randomized controlled trial. Jour of Pain. 2007;131:31-37.
Razmjou H, Kramer JF, Yamada R. Intertester reliability of the McKenzie evaluation in assessing patients with mechanical lowback pain. J Orthop Sports PhysTher. 2000;30:368-369.
Macedo LG, Jane L, Maher C, Hodges P, McAuley J, Nicholas M, Stanton T. Effect of motor exercises versus graded activity in patients with chronic nonspecific low back pain: A randomized controlled trial. Physical Therapy. 2012;92(3):363-377.
Lindstrom I, Ohlund C, Eek C, et al. Theeffect of graded activity on patients with subacute low back pain: A randomized prospective clinical study with an operant condition in behavioural approach. PhysTher. 1992;72:279–293.
Koumantakis G, Watson P, Oldham J. Trunk muscle stabilization training plus general exercise versus general exercise only: Randomized controlled trial of patients with recurrent low back pain. Physical Therapy. 2005;85(3):209-225.
Hides JA, Stokes MJ, Said M, Jull GA, Cooper DH. Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacutelow back pain. Spine. 1994;16(9):165-177.
Hides JA, Jull GA, Richardson CA. Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine. 2001;26(11):e243-e248.
Monticone M, Barbarino A, Testi C, Arzano S, Moschi A, Negrini S. Symptomatic efficacy of stabilizing treatment versus laser therapy for sub-acute low back pain with positive tests for sacroiliac dysfunction: A randomised clinical controlled trial with 1 year follow-up. Europa Medicophysica. 2004;40(4):263-268.
Brennan GP, Fritz JM, Hunter SJ, Thackeray A, Delitto A, Erhard RE. Identifying subgroups of patients with acute/subacute “nonspecific” low back pain: Results of a randomized clinical trial. Spine. 2006;31(6):623-631.
Elden H, Ladfors L, Olsen MF, Ostgaard HC, Hagberg H. Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: Randomised single blind controlled trial. Bmj. 2005;330(7494):761.
Stuge B, Lærum E, Kirkesola G, Vøllestad N. The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: A randomized controlled trial. Spine. 2004a;29(4):351-359.
Stuge B, Lærum E, Kirkesola G, Vøllestad N. The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: A randomized controlled trial. Spine. 2004b;29(4):351-359.
Filiz M, Cakmak A, Ozcan E. The effectiveness of exercise programmes after lumbar disc surgery: A randomized controlled study. Clinical Rehabilitation. 2005;19(1):4-11.
Beaton DE, Boers M, Wells GA. Many faces of the minimal clinically important difference (MCID): A literature review and directions for future research. CurrOpinRheumatol. 2002;14(2): 109-114.
Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain. 2004;8(4):283-291.
DOI: 10.1016/j.ejpain.2003.09.004
Armitage P. The role of randomization in clinical trials. Stat Med. 1982;1(4):345-352.
May S, Johnson R. Stabilisation exercises for low back pain: A systematic review. Physiotherapy. 2008;94(3): 179-189.
Rackwitz B, de Bie R, Limm H, von Garnier K, Ewert T, Stucki G. Segmetal stabilizing exercises and low back pain. What is the evidence? A systematic review of randomized controlled trials. Clinical Rehabilitation. 2006;20(7):553-567.
Jadad AR, Cook DJ, Jones A, Klassen TP, Tugwell P, Moher M, Moher D. Methodology and reports of systematic reviews and meta-analyses: A comparison of cochrane reviews with articles published in paper-based journals. Jama. 1998;280(3):278-280.
Higgins JP, Green S, Collaboration C. Cochrane handbook for systematic reviews of interventions: Wiley Online Library. 2008;5.
Bhogal SK, Teasell RW, Foley NC, Speechley MR. The PEDro scale provides a more comprehensive measure of methodological quality than the Jadad Scale in stroke rehabilitation literature. Journal of Clinical Epidemiology. 2005;58(7):668-673.
DOI: 10.1016/j.jclinepi.2005.01.002
Rys P, Wladysiuk M, Skrzekowska-Baran I, Malecki MT. Review articles, systematic reviews and meta-analyses: Which can be trusted? Pol Arch Med Wewn. 2009;119(3):148-156.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. Annals of Internal Medicine. 2009;151(4):W-65-W-94.
Gartlehner G, West SL, Mansfield AJ, Poole C, Tant E, Lux LJ, Lohr KN. Clinical heterogeneity in systematic reviews and health technology assessments: synthesis of guidance documents and the literature. Int J Technol Assess Health Care. 2012;28(1):36-43.
DOI: 10.1017/s0266462311000687.
Cohn LD, Becker BJ. How meta-analysis increases statistical power. Psychol Methods. 2003;8(3):243-253.
DOI: 10.1037/1082-989x.8.3.243
Van Tudler M, Malmivaara A, Esmail R, Koes B. Exercise therapy for low back pain: A systematic review within the framework of cochrane collaboration back review group. Spine. 2000;25(21):2784-2796.
Chew-Graham C, May C. Chronic low back pain in general practice: The challenge of consultation. Family Practice. 1999;16(1):46-49.
Koes B, van Tudler M, Thomas S. Diagnosis and treatment of low back pain. British Medical Journal. 2006;232:1430-1434.
Fauci A, Braunwald E, Hauser S, Longo D, Jameson J, Loscalzo J. Harrison’s Principles of Internal Medicine. McGraw-Hill; 2008.
Liddle S, Baxter G, Gracey J. Exercise and chronic low back pain: What works? Pain. 2004;107:176-190.
Rathmell J. A 50-year-old man with chronic low back pain. Journal of American Medical Association. 2008;299(17):2066-2077.
Borenstein D. Epidemiology, etiology, diagnostic evaluation and treatment of low back pain. Current Opinion in Rheumatology. 2000;11(3):225-231.
NHS Centre for Reviews and Dissemination. Acute and chronic low back pain. Effective Health Care. 2000;6(5).
McGill S. Low back exercises: Evidence for improving exercise regimens. Physical therapy. 1998;78(7):754-765.
O‟Sullivan P. Lumbar segmental instability: Clinical presentation and specific exercise management. Manual Therapy. 2000;5(1):2-12.
Panjabi M. The stabilizing system of the spine, part 1 and part 2. Journal of Spinal Disorders. 1992;5(4):383-397.
Comerford M, Mottram S. Functional stability re-training: Principles and strategies for managing mechanical dysfunction. Manual Therapy. 2001;6(1):3-14.
Cholewicke J, McGill S. Mechanical stability of the in-vivo lumbar spine: Implications for injury and chronic low back pain. Clinical Biomechanics. 1996;11(1):1-15.
Knudsen H. Spinal segmental stabilization: Specific exercises for deep stabilizing muscles of the back and abdominal wall; 2011.
Avialable:http://www.back-exercises.com/Segmental-Stabilization.html
(Accessed: November 6, 2013)
McGill SM, Norman RW. Low back pain biomechanics in industry: The prevention of injury through safer lifting. Human Kinetics Publishers. 1993;69-120.
Hodges PW, Richardson CA. Delayed postural contraction of transversus abdominis associated with movement of lower limb in people with low back pain. Journal of Spinal Disorders. 1998;11(1):46-56.
O‟Sullivan P, Twomey L, Allison G. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine. 1997;22(24): 2959–2967.
Celestini M, Marchese A, Serenelli A, Graziani GA. Randomized controlled trial on the effects of physical exercise in patients braced for instability of the lumbar spine. Euro Medicophys. 2005;41:223–31.
Miller ER, Schenk RJ, Karnes JL, Rouselle JG. A comparison of the McKenzie approach to a specific spine stabilization program for chronic low back pain. J Man Manip Ther. 2005;13:103–12.
Bakhtiary AH, Safavi-Farokhi Z, Rezasoltani A. Lumbar stabilizing exercises improve activities of daily living in patients with lumbar disc herniation. J Back Muscul. 2005;18:55–60.
Cairns M, Foster N, Wright C. Randomized controlled trial of specific spinal stabilization exercises and conventional physiotherapy for recurrent low back pain. Spine. 2006;31(19): e670-e681.
You Y, Lee Y. The effect of core stabilization exercises using a sling on pain and muscle strength of patients with chronic low back pain. J. Phys. Ther. Sci. 2012;24:671-674.
Franca F, Burke T, Caffaro R, Ramos L, Marques A. Effect of muscular stretching and segmental stabilization on functional disability and pain in patients with chronic low back pain: A randomized controlled trial. Journal of Manipulative and Physiological Therapeutics. 2012;35(4): 279-285.
Kachanathu SJ, Zakaria AR, Sahni A, Jaiswal P. Chronic low back pain in fast bowlers a comparative study of core spinal stabilization and conventional exercises. Journal of Physical Therapy Science. 2012;24(9):821-825.
Hicks GE, Fritz JE, Delitto A, McGill SM. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehab. 2005;86:1753–62.
Richardson CA, Jull GA. Muscle control-pain control. What exercises would you prescribe? Manual Therapy. 1995;1:2-10.
Hodges PW, Moseley GL, Gabrielsson A, Gandevia SC. Experimental muscle pain changes feedforward postural responses of the trunk muscles. Experimental Brain Research. 2003;151(2):262-271.
Norris C, Matthews M. The role of an integrated back stability program in patients with chronic low back pain. Complementary Therapies in Clinical Practice. 2008;14:255-263.
Koftolis ND, Vlachopoulos SP, Kellis E. Sequentially allocatedclinical trial of rhythmic stabilization exercises and TENS in women with chronic low back pain. Clinic Rehab. 2008;22: 99-111.
Ota M, Kaneoka K, Hangai M, Koizumi K, Muramatsu T. Effectiveness of lumbar stabilization exercises for reducing chronic low back pain and improving quality-of-life. Journal of Physical Therapy Science. 2013;23(4):679-681.
Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine. 2005;30:1331–1334.
Lewis JS, Hewitt JS, Billington L, Cole S, Byng J, Karayiannis S. A randomized controlled trial comparing two physiotherapy interventions for chronic low back pain. Spine. 2005;30(7):711-721.
Shaughnessy M, Culfield B. A pilot study to investigate the effect of lumbar stabilisation exercise training on functional ability and quality of life in patients with chronic low back pain. Int J Rehab. 2004;27:297–301.
Moseley L. Combined physiotherapy and education is efficacious for chronic low back pain. Aust J Physio. 2002;48:297–302.
Van Tulder M, Furlan A, Bombardier C, Bouter L. Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine (Phila Pa 1976). 2003;28(12): 1290-1299.
DOI: 10.1097/01.brs.0000065484.95996
Goldby L. A Randomized controlled trial investigating the efficiency of musculoskeletal physiotherapy on chronic low back pain. Spine. 2006;31(10):1083-1093.
Ferreira ML, Ferreira PH, Latimer J, Herbert R, Hodges P, Jennings M, Maher C. Comparison of general exercises, motor control exercises and spinal manipulative therapy for chronic low back pain: A randomized controlled trial. Jour of Pain. 2007;131:31-37.
Razmjou H, Kramer JF, Yamada R. Intertester reliability of the McKenzie evaluation in assessing patients with mechanical lowback pain. J Orthop Sports PhysTher. 2000;30:368-369.
Macedo LG, Jane L, Maher C, Hodges P, McAuley J, Nicholas M, Stanton T. Effect of motor exercises versus graded activity in patients with chronic nonspecific low back pain: A randomized controlled trial. Physical Therapy. 2012;92(3):363-377.
Lindstrom I, Ohlund C, Eek C, et al. Theeffect of graded activity on patients with subacute low back pain: A randomized prospective clinical study with an operant condition in behavioural approach. PhysTher. 1992;72:279–293.
Koumantakis G, Watson P, Oldham J. Trunk muscle stabilization training plus general exercise versus general exercise only: Randomized controlled trial of patients with recurrent low back pain. Physical Therapy. 2005;85(3):209-225.
Hides JA, Stokes MJ, Said M, Jull GA, Cooper DH. Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacutelow back pain. Spine. 1994;16(9):165-177.
Hides JA, Jull GA, Richardson CA. Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine. 2001;26(11):e243-e248.
Monticone M, Barbarino A, Testi C, Arzano S, Moschi A, Negrini S. Symptomatic efficacy of stabilizing treatment versus laser therapy for sub-acute low back pain with positive tests for sacroiliac dysfunction: A randomised clinical controlled trial with 1 year follow-up. Europa Medicophysica. 2004;40(4):263-268.
Brennan GP, Fritz JM, Hunter SJ, Thackeray A, Delitto A, Erhard RE. Identifying subgroups of patients with acute/subacute “nonspecific” low back pain: Results of a randomized clinical trial. Spine. 2006;31(6):623-631.
Elden H, Ladfors L, Olsen MF, Ostgaard HC, Hagberg H. Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: Randomised single blind controlled trial. Bmj. 2005;330(7494):761.
Stuge B, Lærum E, Kirkesola G, Vøllestad N. The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: A randomized controlled trial. Spine. 2004a;29(4):351-359.
Stuge B, Lærum E, Kirkesola G, Vøllestad N. The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: A randomized controlled trial. Spine. 2004b;29(4):351-359.
Filiz M, Cakmak A, Ozcan E. The effectiveness of exercise programmes after lumbar disc surgery: A randomized controlled study. Clinical Rehabilitation. 2005;19(1):4-11.
Beaton DE, Boers M, Wells GA. Many faces of the minimal clinically important difference (MCID): A literature review and directions for future research. CurrOpinRheumatol. 2002;14(2): 109-114.
Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain. 2004;8(4):283-291.
DOI: 10.1016/j.ejpain.2003.09.004
Armitage P. The role of randomization in clinical trials. Stat Med. 1982;1(4):345-352.
May S, Johnson R. Stabilisation exercises for low back pain: A systematic review. Physiotherapy. 2008;94(3): 179-189.
Rackwitz B, de Bie R, Limm H, von Garnier K, Ewert T, Stucki G. Segmetal stabilizing exercises and low back pain. What is the evidence? A systematic review of randomized controlled trials. Clinical Rehabilitation. 2006;20(7):553-567.
Jadad AR, Cook DJ, Jones A, Klassen TP, Tugwell P, Moher M, Moher D. Methodology and reports of systematic reviews and meta-analyses: A comparison of cochrane reviews with articles published in paper-based journals. Jama. 1998;280(3):278-280.
Higgins JP, Green S, Collaboration C. Cochrane handbook for systematic reviews of interventions: Wiley Online Library. 2008;5.
Bhogal SK, Teasell RW, Foley NC, Speechley MR. The PEDro scale provides a more comprehensive measure of methodological quality than the Jadad Scale in stroke rehabilitation literature. Journal of Clinical Epidemiology. 2005;58(7):668-673.
DOI: 10.1016/j.jclinepi.2005.01.002
Rys P, Wladysiuk M, Skrzekowska-Baran I, Malecki MT. Review articles, systematic reviews and meta-analyses: Which can be trusted? Pol Arch Med Wewn. 2009;119(3):148-156.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. Annals of Internal Medicine. 2009;151(4):W-65-W-94.
Gartlehner G, West SL, Mansfield AJ, Poole C, Tant E, Lux LJ, Lohr KN. Clinical heterogeneity in systematic reviews and health technology assessments: synthesis of guidance documents and the literature. Int J Technol Assess Health Care. 2012;28(1):36-43.
DOI: 10.1017/s0266462311000687.
Cohn LD, Becker BJ. How meta-analysis increases statistical power. Psychol Methods. 2003;8(3):243-253.
DOI: 10.1037/1082-989x.8.3.243
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