The effectiveness of hip interventions in patients with low-back pain: A systematic review and meta-analysis

Background: Low-back pain (LBP) may be directly or indirectly related to impairments from the hip joint.Objective: To evaluate the effectiveness of hip interventions on pain and disability in patients with LBP in the short-, medium-, and long-term.Methods: PubMed, Cochrane Library, PEDro, Web of Science, and SCOPUS databases were searched in November 2022. Randomized controlled trials involving hip-targeted interventions compared to specific low back interventions in patients with LBP were selected. The outcomes were pain intensity and disability. The quality of the studies was assessed with the risk of bias tool. GRADE was used to rate the certainty of evidence. Meta-analyses were conducted using random effects models.Results: A total of 2581 studies were screened. Eight were included in the meta-analysis involv-ing 508 patients with LBP. The results provided very low certainty that both hip strengthening and hip stretching improved pain (MD =-0.66; 95% CI-0.86,-0.48; I2:0%) (MD =-0.55; 95% CI-1.02,-0.08) and disability (SMD =-0.81; 95% CI-1.53,-0.10; I2: 80%) (SMD =-1.03; 95% CI-1.82,-0.25) in the short-term, respectively. No benefits were found in the medium-or long-term. The risk of bias, heterogeneity, and imprecision of the results downgraded the level of evidence.Conclusions: Very low certainty evidence suggest a positive effect of hip strengthening in isola-tion or combined with specific low back exercise and hip stretching combined with specific low back exercise for decreasing pain intensity and disability in the short-term, in patients with LBP.Systematic review registration number: PROSPERO CRD42022303173 (c) 2023 Associacao Brasileira de Pesquisa e Pos-Graduacao em Fisioterapia. Published by Elsevier Espana, S.L.U. All rights reserved.