Core strengthening for chronic nonspecific low back pain: systematic review

The term of core strengthening has been used to include lumbar stabilization, motor control training, and other interventions focused on activation of the deep trunk muscles. This is systematic review and meta analysis aim to determine the efficacy, effectiveness of various core strengthening programs for adult patients with chronic nonspecific low back pain. Present study measures self-reported pain, disability, function and quality of life. We identified studies by searching multiple electronic databases from inception to June 2018 and examining reference lists. We selected randomized controlled trials comparing core strengthening exercises with sham, no treatment, other active therapies, and multimodal therapeutic approaches. We assessed risk of bias using "PEDro" scale. We pooled data using random effects meta-analysis. We assessed the overall quality of the evidence using the GRADE approach. Thirty four trials were included in the systematic review (n=2514). The majority of included studies had low risk of bias.There is low to moderate evidence suggests that there is significant effect of core strengthening exercise compared with general exercise on pain and disability at short and intermediate term follow-up. There is very low to low evidence that there is significant effect favoring core strengthening compared with multimodal physical therapy only on disability. Moderate evidence supports no significant effect of core strengthening compared with manual therapy. There is low to moderate evidence suggests that core strengthening results in reducing pain at all follow-up periods and reducing disability at short term follow-up compared with minimal intervention. There is very low evidence that there is significant effect favoring core strengthening compared with McKenzie exercises only on disability. In patients with chronic low back pain there was no clinically important difference between core strengthening and manual therapy but core strengthening exercises seem to be slightly superior to several other treatments.