PURPOSE: This systematic review and meta-analysis study evaluated the effects of Pilates on pain and disability in patients with chronic low back pain.
METHODS: Six electronic databases were searched between January 2012 and December 2022. From these databases, only randomized controlled trials were selected. The criteria for assessing methodological quality using the PEDro scale were selected. The risk of bias was assessed using the Cochrane Risk of Bias Tool RoB 2.0. Additionally, the primary outcomes were pain and disability in this analysis.
RESULTS: The corresponding results confirmed that Pilates training led to a significant improvement in pain (Visual Analog Scale: weighted mean difference = -29.38, 95% confidence interval, -33.24 to -25.52, I² value = 56.70%; Pain Numerical Rating Scale: weighted mean difference = -2.12, 95% confidence interval, -2.54 to -1.69, I² value = 0.00%) and disability (Roland- Morris Disability Index: weighted mean difference = -4.73, 95% confidence interval, -5.45 to -4.01, I² value = 41.79%). Six months after completion of Pilates training, the improvement in pain (Pain Numerical Rating Scale: weighted mean difference = -1.67, 95% confidence interval, -2.03 to -1.32, I² value = 0.00%) and disability (Roland-Morris Disability Index: weighted mean difference = -4.24, 95% confidence interval, -5.39 to -3.09, I² value = 52.79%) was maintained.
CONCLUSION: Pilates training may be an effective strategy to improve pain and disability in patients with chronic low back pain.
AIMS: To describe and synthesize diverse empirical evidence regarding physical activity (PA) in the context of advanced breast cancer (ABC). DESIGN: Integrative review guided by the work of Whittemore and Knafl (2005). Data sources: Six electronic databases were systematically searched to identify relevant literature published between January 2007–June 2019. Review methods: Abstracts of papers that met the inclusion criteria were reviewed by two researchers and full texts of eligible papers were assessed. Data were extracted by two independent researchers and inter-rater reliability of data extraction established. Quality of papers was evaluated using the Mixed Methods Appraisal Tool. Data were organized according to comprehensive thematic analysis and the biobehavioural model for the study of exercise interventions. RESULTS: Of the 532 abstracts, 18 studies met the inclusion criteria which included six randomized controlled trials, one quantitative non-randomized study, seven quantitative descriptive studies, three mixed method studies and one qualitative study. Results from studies enrolled fell into four domains: PA performance and its influence on survival; barriers and preferences for PA; interventions to enhance PA; perceived benefits of PA from qualitative feedback. CONCLUSION: Evidence suggests that ABC patients are physically inactive. Main barriers of PA are less aerobic fitness and heavy symptom burden. Simple, tailored and specialist-supervised PA is preferred by ABC patients. Form of joint self-instructed and group accompanying is advocated as well. PA intervention programmes identified in this review vary on type, intensity, duration and frequency, while generally, are found to be feasible, safe and beneficial to patients’ physical and psychosocial well-being. Impact: The results propose tailored, supervised, group-based PA programmes are in urgent need for ABC patients. Clinical professionals should manage more feasible and safer PA interventions to help improve patients’ overall health. More research with rigorous methodology design is warranted to explore PA’s effect on long-term health outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Objective: To systematically review and quantitatively synthesize gait and balance impairments in breast cancer survivors compared with age-matched controls or normative values for adults who never had breast cancer. Data Sources: PubMed, Cumulative Index of Nursing and Allied Health, and Web of Science was searched using terms associated with breast cancer, mobility, and adult until November 2018. Study Selection: Studies were included if they were randomized control trials, cross-sectional, prospective, pre-post, or case-control by design, included adult breast cancer survivors, reported gait and/or balance metrics as primary or secondary outcomes, were peer-reviewed publications, and were written in English. The search yielded 2117 results with 29 studies meeting the inclusion criteria. Data Extraction: Two reviewers assessed study quality by the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies to determine the strength of evidence for each study that met the inclusion criteria. Basic descriptors of each study, study protocol, and balance and gait measures were extracted. Meta-analysis was performed for the single leg stance, functional reach, center of pressure velocity, gait speed, and timed up and go. Data Synthesis: For quality assessment, 3 studies were rated good, 16 fair, and 10 poor. The meta-analysis indicated that there were no significant differences in single leg stance between breast cancer survivors and those who never had breast cancer (P=.33). Pooled values of the functional reach task (22.16cm; 95% CI, 8.98-35.33) and center of pressure velocity (1.2cm/s; 95% CI, 0.87-1.55) suggest balance impairment in breast cancer survivors when compared with normative values. Breast cancer survivors also performed worse than those who never had breast cancer in challenging balance conditions that reduced sensory information or altered base of support. Pooled gait speed at a usual speed (0.91m/s; 95% CI, 0.2-1.6), fast speed across a short distance (1.2m/s; 95% CI, 0.31-2.1), and fast gait speed across a long distance (1.65m/s; 95% CI, 1.64-1.66) suggest gait impairments when compared with normative values. Conclusions: Breast cancer survivors may demonstrate gait and balance impairments compared with normative values. Clinicians should consider assessing changes in balance and gait in breast cancer survivors to improve functional independence and prevent fall-related injuries.
OBJECTIVES: Many interventions are available to manage chronic pain; understanding the durability of treatment effects may assist with treatment selection. We sought to assess which noninvasive nonpharmacological treatments for selected chronic pain conditions are associated with persistent improvement in function and pain outcomes at least 1 month after the completion of treatment.
DATA SOURCES: Electronic databases (Ovid MEDLINE®, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews) through November 2017, reference lists, and ClinicalTrials.gov.
REVIEW METHODS: Using predefined criteria, we selected randomized controlled trials of noninvasive nonpharmacological treatments for five common chronic pain conditions (chronic low back pain; chronic neck pain; osteoarthritis of the knee, hip, or hand; fibromyalgia; and tension headache) that addressed efficacy or harms compared with usual care, no treatment, waitlist, placebo, or sham intervention; compared with pharmacological therapy; or compared with exercise. Study quality was assessed, data extracted, and results summarized for function and pain. Only trials reporting results for at least 1 month post-intervention were included. We focused on the persistence of effects at short term (1 to <6 months following treatment completion), intermediate term (≥6 to <12 months), and long term (≥12 months).
RESULTS: Two hundred eighteen publications (202 trials) were included. Many included trials were small. Evidence on outcomes beyond 1 year after treatment completion was sparse. Most trials enrolled patients with moderate baseline pain intensity (e.g., >5 on a 0 to 10 point numeric rating scale) and duration of symptoms ranging from 3 months to >15 years. The most common comparison was against usual care. Chronic low back pain: At short term, massage, yoga, and psychological therapies (primarily CBT) (strength of evidence [SOE]: moderate) and exercise, acupuncture, spinal manipulation, and multidisciplinary rehabilitation (SOE: low) were associated with slight improvements in function compared with usual care or inactive controls. Except for spinal manipulation, these interventions also improved pain. Effects on intermediate-term function were sustained for yoga, spinal manipulation, multidisciplinary rehabilitation (SOE: low), and psychological therapies (SOE: moderate). Improvements in pain continued into intermediate term for exercise, massage, and yoga (moderate effect, SOE: low); mindfulness-based stress reduction (small effect, SOE: low); spinal manipulation, psychological therapies, and multidisciplinary rehabilitation (small effects, SOE: moderate). For acupuncture, there was no difference in pain at intermediate term, but a slight improvement at long term (SOE: low). Psychological therapies were associated with slightly greater improvement than usual care or an attention control on both function and pain at short-term, intermediate-term, and long-term followup (SOE: moderate). At short and intermediate term, multidisciplinary rehabilitation slightly improved pain compared with exercise (SOE: moderate). High-intensity multidisciplinary rehabilitation (≥20 hours/week or >80 hours total) was not clearly better than non–high-intensity programs. Chronic neck pain: At short and intermediate terms, acupuncture and Alexander Technique were associated with slightly improved function compared with usual care (both interventions), sham acupuncture, or sham laser (SOE: low), but no improvement in pain was seen at any time (SOE: llow). Short-term low-level laser therapy was associated with moderate improvement in function and pain (SOE: moderate). Combination exercise (any 3 of the following: muscle performance, mobility, muscle re-education, aerobic) demonstrated a slight improvement in pain and function short and long term (SOE: low). Osteoarthritis: For knee osteoarthritis, exercise and ultrasound demonstrated small short-term improvements in function compared with usual care, an attention control, or sham procedure (SOE: moderate for exercise, low for ultrasound), which persisted into the intermediate term only for exercise (SOE: low). Exercise was also associated with moderate improvement in pain (SOE: low). Long term, the small improvement in function seen with exercise persisted, but there was no clear effect on pain (SOE: low). Evidence was sparse on interventions for hip and hand osteoarthritis . Exercise for hip osteoarthritis was associated with slightly greater function and pain improvement than usual care short term (SOE: low). The effect on function was sustained intermediate term (SOE: low). Fibromyalgia: In the short term, acupuncture (SOE: moderate), CBT, tai chi, qigong, and exercise (SOE: low) were associated with slight improvements in function compared with an attention control, sham, no treatment, or usual care. Exercise (SOE: moderate) and CBT improved pain slightly, and tai chi and qigong (SOE: low) improved pain moderately in the short term. At intermediate term for exercise (SOE: moderate), acupuncture, and CBT (SOE: low), slight functional improvements persisted; they were also seen for myofascial release massage and multidisciplinary rehabilitation (SOE: low); pain was improved slightly with multidisciplinary rehabilitation in the intermediate term (SOE: low). In the long term, small improvements in function continued for multidisciplinary rehabilitation but not for exercise or massage (SOE: low for all); massage (SOE: low) improved long-term pain slightly, but no clear impact on pain for exercise (SOE: moderate) or multidisciplinary rehabilitation (SOE: low) was seen. Short-term CBT was associated with a slight improvement in function but not pain compared with pregabalin. Chronic tension headache: Evidence was sparse and the majority of trials were of poor quality. Spinal manipulation slightly improved function and moderately improved pain short term versus usual care, and laser acupuncture was associated with slight pain improvement short term compared with sham (SOE: low). There was no evidence suggesting increased risk for serious treatment-related harms for any of the interventions, although data on harms were limited.
CONCLUSIONS: Exercise, multidisciplinary rehabilitation, acupuncture, CBT, and mind-body practices were most consistently associated with durable slight to moderate improvements in function and pain for specific chronic pain conditions. Our findings provided some support for clinical strategies that focused on use of nonpharmacological therapies for specific chronic pain conditions. Additional comparative research on sustainability of effects beyond the immediate post-treatment period is needed, particularly for conditions other than low back pain.
OBJETIVO: Los metanálisis previos han encontrado que el ejercicio previene las caídas en las personas mayores. Este estudio tuvo como objetivo comprobar si este efecto aún está presente cuando se agregan nuevos ensayos, y se explora si las características del diseño del ensayo, la muestra o la intervención están asociados con mayores efectos de prevención de caídas. Diseño: Actualización de una revisión sistemática con metanálisis de efectos aleatorios y meta-regresión. Se realizaron búsquedas entre enero de 2010 y enero de 2016. CRITERIOS DE ELEGIBILIDAD DEL ESTUDIO: Se incluyeron ensayos controlados aleatorios que compararon las tasas de caída en personas mayores asignadas al azar para recibir ejercicio como una sola intervención Con tasas de caída en los asignados al azar a un grupo control. RESULTADOS: 99 comparaciones de 88 ensayos con 19 478 participantes estuvieron disponibles para metanálisis. En general, el ejercicio redujo la tasa de caídas en las personas mayores de la comunidad en un 21% (proporción de la tasa combinada de 0,79, IC del 95%: 0,73 a 0,85, p <0,001, I (2) 47%, 69 comparaciones) Programas que desafiaron el equilibrio e involucraron más de 3 horas / semana de ejercicio. Estas variables explicaron el 76% de la heterogeneidad entre ensayos y en combinación condujeron a una reducción del 39% en las caídas (tasa de incidencia 0,61, IC del 95%: 0,53 a 0,72, p <0,001). El ejercicio también tuvo un efecto de prevención de caídas en las personas que viven en la comunidad con enfermedad de Parkinson (proporción de la tasa combinada 0,47, IC del 95%: 0,30 a 0,73, p = 0,001, I (2) 65%, 6 comparaciones) o deterioro cognitivo , IC del 95%: 0,37 a 0,83, p = 0,004, I (2) 21%, 3 comparaciones). No hubo evidencia de un efecto de prevención de caídas del ejercicio en entornos de atención residencial, ni entre los supervivientes de un accidente cerebrovascular o personas recién egresadas del hospital. RESUMEN / CONCLUSIONES: El ejercicio como una sola intervención puede prevenir las caídas en las personas mayores que viven en la comunidad. Los programas de ejercicio que desafían el equilibrio y son de una dosis más alta tienen efectos más grandes. El impacto del ejercicio como una sola intervención en grupos clínicos y residentes de centros de cuidado de ancianos requiere investigación adicional, pero los resultados prometedores son evidentes para las personas con enfermedad de Parkinson y deterioro cognitivo.
Summary Introduction: Breast cancer is the leading type of cancer causing death in women worldwide. The incidence of the disease is expected to grow worldwide due to the aging of the population and risk factors related to lifestyle behaviors. Considering the lifestyle of women with breast cancer before or after surgery, pilates exercise may be a complementary intervention additionally to standard treatment. Objective: To analyze the efficacy of pilates compared to other exercises and to no exercise for women with breast cancer diagnosis. Method: We searched Medline via Pubmed, Embase via Ovid, Amed via EBSCO, Biosis via Ovid, Lilacs and the Cochrane Library for relevant publications until March 2017. The keywords used were pilates and "breast cancer," and only randomized controlled trials were included. Critical appraisal was done using Risk of Bias Tool and GRADE score for assessing the quality of evidence. Results: A total of five studies were included in our review. Our results demonstrate that pilates or home-based exercises are better than no exercise in each individual study. We observed significant improvements in the pilates groups compared to home-based exercises. Additionally, in the individual studies, we observed improvements in range of motion, pain and fatigue. Conclusion: The evidence shows that pilates or home-based exercise should be encouraged to women with breast cancer.
El dolor de espalda es un problema de salud importante en los países occidentales y el 60% -80% de los adultos es probable que experimenten dolor lumbar. Este artículo explora el impacto del dolor de espalda en la sociedad y el papel de la actividad física para el tratamiento del dolor de espalda no específico. Se realizó una revisión de la literatura utilizando las bases de datos SPORTDiscuss, Medline y Google Scholar. Un programa general de ejercicios que combina la fuerza muscular, la flexibilidad y la aptitud aeróbica es beneficioso para la rehabilitación del dolor lumbar crónico no específico. Aumentar la fuerza muscular del núcleo puede ayudar a apoyar la columna lumbar. Mejorar la flexibilidad del músculo-tendones y ligamentos en la espalda aumenta la amplitud de movimiento y ayuda con el movimiento funcional del paciente. El ejercicio aeróbico aumenta el flujo sanguíneo y los nutrientes a los tejidos blandos en la espalda, mejorando el proceso de curación y reduciendo la rigidez que puede resultar en dolor de espalda.
DISEÑO DEL ESTUDIO: Revisión sistemática. OBJETIVO: Determinar los efectos del método Pilates en pacientes con dolor lumbar agudo, subagudo o crónico inespecífico. RESUMEN DE DATOS ANTECEDENTES: El método Pilates es una de las formas más comunes de intervención basada en el ejercicio utilizado para tratar a pacientes con dolor lumbar. Sin embargo, su eficacia no está bien establecida. Métodos: Se realizaron búsquedas en CENTRAL, MEDLINE, EMBASE, CINAHL, PEDro y SPORTDiscus hasta marzo de 2014. Se incluyeron ensayos controlados aleatorios que examinaron la efectividad de Pilates en pacientes con dolor lumbar inespecífico, agudo, subagudo o crónico. Los resultados evaluados fueron dolor, discapacidad, función e impresión global de recuperación. Dos revisores independientes examinaron los estudios potencialmente elegibles, evaluaron el riesgo de sesgo y extrajeron los datos. Se evaluó la calidad general de la evidencia utilizando el enfoque GRADE y se describieron los tamaños del efecto del tratamiento usando diferencias de medias e intervalos de confianza del 95%. RESULTADOS: Se recuperaron 126 ensayos, de los cuales 10 fueron incluidos en la revisión (n = 510 participantes). Se consideró que siete estudios tenían bajo riesgo de sesgo, y tres se consideraron de alto riesgo de sesgo. Cuando se compara con una intervención mínima, Pilates reduce el dolor a corto y medio plazo con evidencia de baja a moderada calidad y tamaños de efecto medio. Para la discapacidad, también existe una diferencia significativa a favor de Pilates con baja a moderada calidad de pruebas y tamaño pequeño efecto de corto y mediano efecto de tamaño medio plazo en comparación con la intervención mínima. No está claro si Pilates es mejor que otros ejercicios para el dolor a corto plazo, pero hay evidencia de baja calidad que Pilates reduce el dolor en el término intermedio. Para la discapacidad, existe una evidencia de calidad moderada de que no hay diferencia significativa entre Pilates y otros ejercicios en el corto plazo o en el término intermedio. CONCLUSIÓN: Existe evidencia de baja a moderada calidad de que Pilates es más efectivo que una intervención mínima, siendo la mayoría de los tamaños del efecto considerados medios. Sin embargo, no hay pruebas concluyentes de que Pilates es superior a otras formas de ejercicios. NIVEL DE EVIDENCIA: 1.
This systematic review and meta-analysis study evaluated the effects of Pilates on pain and disability in patients with chronic low back pain.
METHODS:
Six electronic databases were searched between January 2012 and December 2022. From these databases, only randomized controlled trials were selected. The criteria for assessing methodological quality using the PEDro scale were selected. The risk of bias was assessed using the Cochrane Risk of Bias Tool RoB 2.0. Additionally, the primary outcomes were pain and disability in this analysis.
RESULTS:
The corresponding results confirmed that Pilates training led to a significant improvement in pain (Visual Analog Scale: weighted mean difference = -29.38, 95% confidence interval, -33.24 to -25.52, I² value = 56.70%; Pain Numerical Rating Scale: weighted mean difference = -2.12, 95% confidence interval, -2.54 to -1.69, I² value = 0.00%) and disability (Roland- Morris Disability Index: weighted mean difference = -4.73, 95% confidence interval, -5.45 to -4.01, I² value = 41.79%). Six months after completion of Pilates training, the improvement in pain (Pain Numerical Rating Scale: weighted mean difference = -1.67, 95% confidence interval, -2.03 to -1.32, I² value = 0.00%) and disability (Roland-Morris Disability Index: weighted mean difference = -4.24, 95% confidence interval, -5.39 to -3.09, I² value = 52.79%) was maintained.
CONCLUSION:
Pilates training may be an effective strategy to improve pain and disability in patients with chronic low back pain.
Pregunta de la revisión sistemática»Revisión sistemática de intervenciones
