Core Stability Exercise Versus General Exercise for Chronic Low Back Pain

Reference: Wang XQ, Zheng JJ, Yu ZW, et al. A metaanalysis of core stability exercise versus general exercise for chronic low back pain. PLoS One. 2012; 7(12): e52082. Clinical Questions: Is core stability exercise more effective than general exercise in the treatment of patients with nonspecific low back pain (LBP)? Data Sources: The authors searched the following data-bases: China Biological Medicine disc, Cochrane Library, Embase, and PubMed from 1970 through 2011. The key medical subject headings searched were chronic pain, exercise, LBP, lumbosacral region, and sciatica. Study Selection: Randomized controlled trials comparing core stability exercise with general exercise in the treatment of chronic LBP were investigated. Participants were male and female adults with LBP for at least 3 months that was not caused by a specific known condition. A control group receiving general exercise and an experimental group receiving core stability exercise were required for inclusion in the meta-analysis. Core stability was defined as the ability to ensure a stable neutral spine position, but the type of exercise was not specified. Outcome measures of pain intensity, back-specific functional status, quality of life, and work absenteeism were recorded at 3-, 6-, and 12-month intervals. Data Extraction: The study design, participant information, description of interventions in the control and experimental groups, outcome measures, and follow-up period were extracted. The mean difference (MD) and 95% confidence interval (CI) were calculated to evaluate statistical significance. Risk of bias was assessed using the Cochrane Collaboration Recommendations, and all articles were rated as high risk for other bias with no further explanation given. Main Results: Five studies involving 414 patients were included. Four studies assessed pain intensity using the visual analog scale or numeric rating scale. In the core stability exercise group, the reduction in pain was significant at 3 months (MD = - 1.29, 95% CI = - 2.47, - 0.11; P =.003) but not at 6 months (MD = - 0.50, 95% CI = - 1.36, 0.35; P =.26). Functional status was improved at 3 months (MD = - 7.14, 95% CI = - 11.64, - 2.65; P =.002) but not at 6 months (MD = - 0.50, 95% CI = 0.36, 0.35; P =.26) or 12 months (MD = - 0.32, 95% CI = - 0.87, 0.23; P =.25). All of the included studies assessed back-specific functional status: 4 used the Oswestry Disability Index and 1 used the Roland-Morris Disability Questionnaire. Patients in the core stability exercise groups experienced improved functional status versus the general exercise group at 3 months (MD = - 7.14, 95% CI = - 11.64, - 2.65; P -.002); no results were recorded at 6 or 12 months. Conclusions: In the short term, core stability exercise was more effective than general exercise for decreasing pain and increasing back-specific functional status in patients with LBP.