PMID- 35701082
OWN - NLM
STAT- Publisher
LR  - 20240216
IS  - 1473-0480 (Electronic)
IS  - 0306-3674 (Linking)
DP  - 2022 Jun 14
TI  - Does motor control training improve pain and function in adults with symptomatic 
      lumbar disc herniation? A systematic review and meta-analysis of 861 subjects in 
      16 trials.
LID - bjsports-2021-104926 [pii]
LID - 10.1136/bjsports-2021-104926 [doi]
AB  - OBJECTIVE: To evaluate the effectiveness of motor control training (MCT) compared 
      with other physical therapist-led interventions, minimal/no intervention or 
      surgery in patients with symptomatic lumbar disc herniation (LDH). DESIGN: 
      Systematic review and meta-analysis. DATA SOURCES: Eight databases and the 
      ClinicalTrials.gov were searched from inception to April 2021. ELIGIBILITY 
      CRITERIA: We included clinical trial studies with concurrent comparison groups 
      which examined the effectiveness of MCT in patients with symptomatic LDH. Primary 
      outcomes were pain intensity and functional status which were expressed as mean 
      difference (MD) and standardised mean difference (SMD), respectively. RESULTS: We 
      screened 6695 articles, of which 16 clinical trials (861 participants) were 
      eligible. Fourteen studies were judged to have high risk of bias and two studies 
      had some risk of bias. In patients who did not undergo surgery, MCT resulted in 
      clinically meaningful pain reduction compared with other physical therapist-led 
      interventions (ie, transcutaneous electrical nerve stimulation (TENS)) at 
      short-term (MD -28.85, -40.04 to -17.66, n=69, studies=2). However, the 
      robustness of the finding was poor. For functional status, a large and 
      statistically significant treatment effect was found in favour of MCT compared 
      with traditional/classic general exercises at long-term (SMD -0.83 to -1.35 to 
      -0.31, n=63, studies=1) and other physical therapist-led interventions (ie, TENS) 
      at short-term (SMD -1.43 to -2.41 to -0.46, n=69, studies=2). No studies compared 
      MCT with surgery. In patients who had undergone surgery, large SMDs were seen. In 
      favour of MCT compared with traditional/classic general exercises (SMD -0.95 to 
      -1.32 to -0.58, n=124, studies=3), other physical therapist-led interventions 
      (ie, conventional treatments; SMD -2.30 to -2.96 to -1.64, n=60, studies=1), and 
      minimal intervention (SMD -1.34 to -1.87 to -0.81, n=68, studies=2) for 
      functional improvement at short-term. The overall certainty of evidence was very 
      low to low. CONCLUSION: At short-term, MCT improved pain and function compared 
      with TENS in patients with symptomatic LDH who did not have surgery. MCT improved 
      function compared with traditional/classic general exercises at long-term in 
      patients who had undergone surgery. However, the results should be interpreted 
      with caution because of the high risk of bias in the majority of studies. 
      PROSPERO REGISTRATION NUMBER: CRD42016038166.
CI  - (c) Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and 
      permissions. Published by BMJ.
FAU - Pourahmadi, Mohammadreza
AU  - Pourahmadi M
AUID- ORCID: 0000-0001-5202-5478
AD  - Rehabilitation Research Center, Department of Physiotherapy, School of 
      Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
FAU - Delavari, Somayeh
AU  - Delavari S
AUID- ORCID: 0000-0001-7451-3077
AD  - Center for Educational Research in Medical Sciences (CERMS), Department of 
      Medical Education, School of Medicine, Iran University of Medical Sciences, 
      Tehran, Iran.
FAU - Hayden, Jill A
AU  - Hayden JA
AUID- ORCID: 0000-0001-7026-144X
AD  - Department of Community Health & Epidemiology, Dalhousie University, Halifax, 
      Nova Scotia, Canada.
FAU - Keshtkar, Abbasali
AU  - Keshtkar A
AUID- ORCID: 0000-0002-4786-2818
AD  - Department of Health Sciences Education Development, School of Public Health, 
      Tehran University of Medical Sciences, Tehran, Iran.
FAU - Ahmadi, Maryam
AU  - Ahmadi M
AD  - Department of Physiotherapy, School of Rehabilitation Sciences, Iran University 
      of Medical Sciences, Tehran, Iran.
FAU - Aletaha, Azadeh
AU  - Aletaha A
AUID- ORCID: 0000-0002-3431-4660
AD  - Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical 
      Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
AD  - Department of Medical Library and Information Science, School of Health 
      Management and Information Sciences, Iran University of Medical Sciences, Tehran, 
      Iran.
FAU - Nazemipour, Maryam
AU  - Nazemipour M
AUID- ORCID: 0000-0002-5352-6298
AD  - Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences 
      Institute, Tehran University of Medical Sciences, Tehran, Iran.
FAU - Mansournia, Mohammad Ali
AU  - Mansournia MA
AUID- ORCID: 0000-0003-3343-2718
AD  - Department of Epidemiology and Biostatistics, School of Public Health, Tehran 
      University of Medical Sciences, Tehran, Iran mansournia_ma@yahoo.com.
FAU - Rubinstein, Sidney M
AU  - Rubinstein SM
AUID- ORCID: 0000-0002-4819-994X
AD  - Faculty of Science, Department of Health Sciences, Vrije Universiteit, Amsterdam, 
      The Netherlands.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20220614
PL  - England
TA  - Br J Sports Med
JT  - British journal of sports medicine
JID - 0432520
SB  - IM
OTO - NOTNLM
OT  - back
OT  - exercise therapy
OT  - exercise training
OT  - physical therapy specialty
OT  - rehabilitation
COIS- Competing interests: None declared.
EDAT- 2022/06/15 06:00
MHDA- 2022/06/15 06:00
CRDT- 2022/06/14 21:13
PHST- 2022/05/25 00:00 [accepted]
PHST- 2022/06/14 21:13 [entrez]
PHST- 2022/06/15 06:00 [pubmed]
PHST- 2022/06/15 06:00 [medline]
AID - bjsports-2021-104926 [pii]
AID - 10.1136/bjsports-2021-104926 [doi]
PST - aheadofprint
SO  - Br J Sports Med. 2022 Jun 14:bjsports-2021-104926. doi: 
      10.1136/bjsports-2021-104926.