Pauline Anderson
January 08, 2016
Motor control exercises (MCEs) may help reduce pain and disability caused by chronic lower back pain (LBP), but so may other exercise interventions, a new literature review suggests.
“Targeting the strength and coordination of muscles that support the spine through motor control exercise offers an alternative approach to treating lower back pain,” lead author, physiotherapist Bruno T. Saragiotto, PhD student, Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, Australia, said in a press release.
The review was published online January 7 in the Cochrane Library. 
LBP is one of the most common health conditions. As well as having a substantial health impact, this type of pain represents a significant economic cost as patients experience disability and often have to take time off work.
Although exercise has been shown to be a modestly effective treatment for chronic LBP, no evidence suggests that one form of exercise is superior to another. One of the most commonly used exercise interventions is MCE.
MCE aims to improve coordination of the muscles that control and support the spine. With this intervention, patients are initially guided by a therapist to practice normal use of these muscles with simple tasks. As the patient’s skill increases, the exercises become more complex and include functional tasks.
For the analysis, researchers searched electronic databases, including CENTRAL, MEDLINE, and Embase, and two trial registers, for randomized controlled trials that examined the effectiveness of MCE in patients with chronic nonspecific LBP.
The review included data from 29 trials involving a total of 2431 men and women. Of these, 16 trials compared MCE with other types of exercises, including general or conventional exercises, stretching and/or strengthening exercises, and lumbar dynamic exercises.
Seven trials compared MCE with minimal intervention, which included a placebo physiotherapy intervention, education or advice, and no treatment. Five trials compared MCE with manual therapy, and three compared it with a combination of exercise and electrophysical agents (EPAs) that in some cases included ultrasound.
The duration of the treatment programs in the included trials ranged from 20 days to 12 weeks. The number of treatment sessions ranged from one to five per week.
Most of the study participants were middle-aged (median age, 40.9 years; range, 20.8 to 54.8 years). They were generally recruited from primary or tertiary care centers and had chronic (persisting for 12 weeks or more) LBP.
Trial Outcomes
A primary outcome was pain intensity, typically measured with a visual analogue scale or numeric rating scale. Researchers converted all pain outcomes to a 0- to 100-point scale.
Another primary outcome was disability, mostly measured by using the Oswestry Disability Index or the Roland Morris Disability Questionnaire. Researchers converted all disability outcomes to a 0- to 100- point scale.
Secondary outcomes included function, quality of life, and return to work.
The authors found that when compared with minimal intervention, there was low to moderate quality evidence that MCE is effective for improving pain at short-, intermediate-, and long-term follow-up, with medium effect sizes (long-term, mean difference, –12.97; 95% confidence interval, –18.51 to –7.42).
Evidence that MCE has a clinically important effect compared with exercise plus EPAs was very low to low quality. There was moderate- to high-quality evidence that MCE provides outcomes similar to those seen with manual therapies and low- to moderate-quality evidence that it provides similar outcomes compared with other forms of exercises.
Given the evidence that MCE is not superior to other forms of exercise, the choice of exercise for chronic LBP should probably depend on the patient’s or therapist’s preferences, therapist training, costs, and safety, said Saragiotto.
It’s unclear, he added, how motor control exercise compares with other forms of exercise in the long term. “It’s important that we see more research in this field so that patients can make more informed choices about persisting with treatment.”
Bruno Saragiotto has disclosed no relevant financial relationships.
Cochrane Library. Published online January 7, 2016. Abstract