Effects of exercise on balance in patients with non-specific low back pain: a systematic review and meta-analysis

Fulvio Dal Farra, Federico Arippa, Mauro Arru, Martina Cocco, Elisa Porcu, Marco Tramontano, Marco Monticone, Fulvio Dal Farra, Federico Arippa, Mauro Arru, Martina Cocco, Elisa Porcu, Marco Tramontano, Marco Monticone

Abstract

Introduction: Non-specific low back pain (NS-LBP) is one of the most common musculoskeletal conditions related to medical expenses and disability. Evidence suggests that changes in motion patterns could induce trunk instability and impaired postural control. Therefore, this systematic review investigated the effects of exercise on balance in patients with NS-LBP.

Evidence acquisition: A systematic review and meta-analysis were conducted. Findings were reported following the 2020 PRISMA statement and the main databases were searched for RCTs. Studies were independently screened through a standardized form and their internal validity assessed by using the Cochrane risk of bias (RoB) tool. Pooled effects were calculated at post-treatment and quality of evidence was assessed through the GRADE framework.

Evidence synthesis: Twelve articles were included in the review, eight in the meta-analysis. None of the studies were judged at low RoB. There is very low-quality evidence that exercise is effective in reducing Centre of Pressure (CoP) displacement (-16.99 [-27.29, -6.68]; P=0.001) and in improving single-leg stance test performance (-28.7 [-48.84, -8.67]; P=0.005) and dynamic balance (-4.74 [-8.02, -1.46]; P=0.005). Conversely, no significant results were observed in "ellipse area" and in "limits of stability" indexes. Other results were summarized in a qualitative synthesis.

Conclusions: Exercise could be effective in improving both static and dynamic balance in patients with NS-LBP over a short-term period. However, quality of evidence was estimated as very low, hence further double-blinded, high-quality RCTs are needed to address clinical practice and research.

Conflict of interest statement

Conflicts of interest.—The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Figures

Figure 1
Figure 1
—Flow diagram based on PRISMA statement.
Figure 2
Figure 2
—Risk of bias summary: review authors’ judgement about each risk of bias item for included studies.25-36
Figure 3
Figure 3
—Risk of bias assessment graph for the included studies.
Figure 4
Figure 4
—Forest plot of comparison: effect of exercise vs. control interventions for balance in NS-LBP.25, 34 Outcome: single-leg stance test. CI: Confidence interval; SD: standard deviation.
Figure 5
Figure 5
—Forest plot of comparison: effect of exercise vs. control interventions for balance in NS-LBP.29, 30 Outcome: CoP displacement. CI: Confidence interval; SD: standard deviation.
Figure 6
Figure 6
—Forest plot of comparison: effect of exercise vs. control interventions for balance in NS-LBP.29, 30, 33 Outcome: ellipse area. CI: Confidence interval; SD: standard deviation.
Figure 7
Figure 7
—Forest plot of comparison: effect of exercise vs. control interventions for balance in NS-LBP.28, 35 Outcome: Anterior-Posterior Index (limits of stability). CI: Confidence interval; SD: standard deviation.
Figure 8
Figure 8
—Forest plot of comparison: effect of exercise vs. control interventions for balance in NS-LBP.28, 35 Outcome: Medium-Lateral Index (limits of stability). CI: Confidence interval; SD: standard deviation.
Figure 9
Figure 9
—Forest plot of comparison: effect of exercise vs. control interventions for balance in NS-LBP.27, 29 Outcome: dynamic balance (SEBT). CI: Confidence interval; SD: standard deviation.

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