Table 2 Characteristics of included studies

Akbari 2008 [67]

58 patients recruited from physiotherapy clinics in Iran (mean age = 39.8/sex not defined).

Physiotherapy clinic setting.

Main outcome assessed at baseline and at 8 weeks were:

1. N = 29. Instruction of isometric abdominal drawing in manoeuvre, in 4 point kneeling, supine, sitting and standing. Progressing to 10 contractions of 10 second holds. Plus general exercises from group 2. 30 minute class, twice a week for 8 weeks.

1. Pain on visual analogue scale (VAS) (0–100).

2 Groups:

Both groups improved. Group 1 improved from mean pain scores of 7.25 (SD 0.97) to 2.5 (SD 1.24). Group 2 improved from 8 (SD 1.21) to 4 (SD 1.54).

Inclusion criteria included:

a. Nonspecific LBP with or without leg pain

1. General exercises plus motor control exercises

b. Pain > 3 month duration

There was no significance difference between groups (P = 0.83).

c. Age > 18, < 80

2. N = 29. Exercises involving: lumbar flexion/extension in 4 point kneeling, mini sit up (head and shoulder off floor only), side plank, single leg extension holds in 4 pt kneeling and active prone lumbar extension. Hold times and repetitions based on clinical judgement. 30 minute class, twice a week for 8 weeks.

2. General exercise

Costa 2009 [68]

154 patients recruited from a physical therapy department of an Australian hospital (mean age = 53.7/79% male).

Hospital and home setting

Main outcomes assessed at baseline, 2, 6 and 12 months, include:

1. Average numerical rating scale (NRS) for pain over last week (0–10)

2 Groups:

1. N = 77. 2 sessions a week in 1^st month, 1 session a week in 2^nd month, total of 12 hours, plus daily home based exercise. Stage 1: tailored exercises aimed at multifidus and transversus abdominis muscles. When the patient could achieve 10 repetitions of 10 second holds progressed to stage 2. Stage 2: Integrating contraction of muscles into more advanced function tasks and exercises, based upon individual therapy assessment.

2. Roland-Morris Disability Questionnaire (RMDQ) (0–24)

Inclusion criteria included:

NRS baseline, 2, 6 and 12 months for group 1 was 6.8 (SD 2.1), 4.6 (SD 2.8), 5.0 (SD 2.9), and 5.0 (SD 2.9). Group 2 was 6.6 (SD 2.0), 5.6 (SD 2.6), 5.6 (SD 2.5) and 6.3 (SD 2.3).

a. Nonspecific low back pain localized below the costal margin and above the inferior gluteal folds

1. Motor control exercises

2. Placebo of ultrasound therapy and detuned short-wave therapy

b. Pain ≥ 3 months duration

c. With or without radiculopathy

RMDQ baseline, 2, 6 and 12 months for group 1 was 13.1 (SD 5.0), 9.6 (SD 6.5), 10.3 (SD 7.0) and 11.4 (SD 7.8). Group 2 was 13.4 (SD 4.9), 11.9 (SD 5.9), 12.2 (SD 6.7) and 12.3 (SD 6.4).

d. Age > 18, < 80

2. N=77. 20 minutesdetuned shortwave

diathermy and 5 minutes of detuned ultrasound for 12 sessions over 8 weeks.

No between group difference for pain at 2 and 6 months (P = .053 and P = 0.335). At 12 months group 1 better than 2 for pain by −1.0 (CI 95% -1.9 to −0.1) (P=0.030).

Short term improvement in RMDQ at 2 and 6 months for group 1 compared to 2, (P = 0.003 and P = 0.014). But no difference at 12 months (P = 0.271).

Critchley 2007 [69]

212 patients recruited from primary or secondary care in a UK hospital (mean age = 44.3/36% male).

Hospital and home setting.

Main outcomes at 6, 12 and 18 months include:

1. Roland-Morris Disability Questionnaire (RMDQ) (0–24)

3 Groups:

Inclusion criteria included:

1. N=71. Assessed and treated according to assessment findings. Treatments include combinations of joint mobilizations, manipulations, massage and exercise. Exercises included specific trunk muscle retraining, stretches, and general spinal mobility. Up to 12 sessions of around 30 minutes.

2. Pain on numerical analogue scale (0–100)

1. Usual physiotherapy

At 18 months RMDQ score improved from 11.1 (95% CI 9.6 –12.6) to 6.9 (95% CI 5.3– 8.4) with group 1, 12.8 (95% CI 11.4-14.2) to 6.8 (95% CI 4.9–8.6) with group 2, and 11.5 (95% CI 9.8 –13.1) to 6.5 (95% CI 4.5– 8.6) for group 2.

2. Spinal stabilization classes

a. Low back pain of more than 12 weeks duration

3. Pain management classes

b. With or without leg pain

c. Age > 18

2. N = 72. Tailored to assessment findings and progressed within participants’ ability, working on transversus abdominis and lumbar multifidus muscle training followed by group exercises that challenged spinal stability. Maximum of 8 sessions of 90 minutes supervised exercise.

At 18 months pain improved from 60 (95% CI 54–66) to 39 (95% CI 31–46) for group 1, 67 (95% CI 61–73) to 32 (95% CI 24–40) for group 2 and 59 (95% CI 52–65) to 38 (95% CI 29–47) for group 3.

3. N = 69. A combination of structured back pain education with group general strengthening, stretching, and light aerobic exercises. A maximum of 8 sessions of 90 minutes.

No between group differences were found for RMDQ (P =0.46) or pain.

Ferreira 2007 [70]

240 patients recruited from a physical therapy department from hospitals in Australia (mean age = 53.6/31% male).

Hospital and home setting.

Outcomes at 8 weeks, 6 and 12 months, include:

1. Patient-Specific Functional Scale (PSFS) (3–30)

3 Groups:

Inclusion criteria included:

1. N = 80. Modelled on the ‘Back to Fitness’ program by Klaber

2. Roland-Morris Disability Questionnaire (RMDQ) (0–24)

1. General exercise

Moffet and Frost. 1 hour exercise group, 12 sessions over 8 weeks. Starts with 1 minute warm up followed by stretches and 10 exercises performed for 1 min each. Intensity dictated by patients’ response to exercise. Exercises include: walking/running on spot, sideways trunk curls, side steps/star jumps, press ups, side lying leg raises, prone leg raises, trunk curls, sit to stand, arm circling in 90° of abduction and bridging. Participants also encouraged to exercise at home at least once a day.

3. Average VAS (0–10) for pain over last week

2. Motor control exercise

a. Nonspecific low back pain with or without leg pain

Baseline, 8 weeks, 6 and 12 months scores for PSFS for group 1 were; 10.1 (SD 4.2), 14.4 (SD 6.6), 15.0 (SD 7.4) and 13.9 (SD 7.2). Group 2 were; 10.7 (SD 4.0), 17.7 (SD 6.2), 16.4 (SD 6.6) and 15.7). Group 3 were; 11.2 (SD 4.6), 17.5 (SD 6.8), 17.3 (SD 7.0) and 15.2 (SD 6.8).

3. Spinal manipulation

b. Pain ≥ 3 months duration

c. Age > 18, < 80

2. N = 80. Each patient was trained in contraction of transversus abdominis and multifidus muscles in isolation, by a physical therapist. Ultrasound was used to aid treatment when the therapist deemed appropriate. The contraction was then incorporated into more functional positions and tasks tailored to each patient. Patients were treated for 12 sessions over 8 weeks and encouraged to exercise at home daily.

Baseline, 8 weeks, 6 and 12 months scores for RMDQ for group 1 were; 14.1 (SD 5.5), 9.7 (SD 6.3), 10.1 (SD 7.0) and 9.6 (SD 6.9). Group 2 were; 14.0 (SD 5.3), 7.9 (SD 5.7), 8.4 (SD 6.4) and 8.8 (SD 6.5). Group 3 were; 12.4 (SD 5.7), 7.9 (SD 6.0), 7.7 (SD 6.3) and 9.2 (SD 6.6).

Baseline, 8 weeks, 6 and 12 months scores for VAS for group 1 were; 6.5 (SD 2.1), 4.8 (SD 2.4), 4.8 (SD 2.6) and 5.2 (SD 2.8). Group 2 were 6.3 (SD 2.0), 4.0 (SD 2.5), 4.3 (SD 2.6) and 4.9 (SD 2.9). Group 3 were; 6.2 (SD 2.0), 4.1 (SD 2.6), 4.3 (SD 2.6) and 4.9 (SD 2.7)

3. N = 80.Patiens were treated with spinal manipulations and mobilizations, at the discretion of the therapist, based on physical assessment. 12 sessions over 8 weeks and no exercises given.

At 8 weeks motor control and manipulation performed better than general exercise for PSFS. Adjusted mean difference in PSFS between group 2 and 1; 2.9 (95% CI: 0.9–4.8) (p = 0.004), between group 3 and 1; 2.3 (95% CI: 0.4–4.2) (p = 0.016).

At 6 and 12 months all groups improved from baseline in all 3 outcomes. No apparent between group difference.

Franca 2010 [71]

30 patients recruited from an orthopaedic department in a Brazilian hospital (mean age = 42.0/26.7% men).

Hospital setting.

Main outcomes at 6 weeks:

1. Visual Analogue Scale (VAS) (0-10cm)

2 Groups:

Inclusion criteria included:

1. N=15. 2 x 30 mins sessions a week for 6 weeks. Exercises focused on transversus abdominis and multifidus using the abdominal drawing in manoeuvre. Exercises in 4 point kneeling, crooked lying, prone and in upright positions.

2. Oswestry disability index (ODI) (%)

1. Segmental Stabilization

Both groups significantly improved from baseline. Group 1 improved in pain from 5.94 (SD 1.56) to 0.06 (SD 0.16) and ODI from 17.07 (SD 3.99) to 1.80 (SD 1.26). Group 2 improved pain from 6.49 (SD 1.48) to 2.89 (SD 1.45) and ODI from 17.27 (SD 3.84) to 8.40 (SD 3.13).

2. Superficial Strengthening

a. LBP > 3 months

b. Pain felt between T12 and the gluteal fold

2. N = 15. 2 x 30 mins sessions a week for 6 weeks. Exercises involving sit ups in crook lying, rotating sit ups, reverse sit up/hip flex in crook lying and prone trunk extension.

Group 1 produced significantly better results for pain and ODI than group 2.

Franca 2012 [72]

30 patients recruited from an orthopaedic department in a Brazilian hospital (mean age = 41.8/ sex not defined).

Hospital setting.

Main outcomes at 6 weeks:

1. Visual Analogue Scale (VAS) (0-10cm)

2 Groups:

Inclusion criteria included:

1. N = 15. 2 x 30 mins sessions a week for 6 weeks. Exercises focused on transversus abdominis and multifidus using the abdominal drawing in manoeuvre. Exercises in 4 point kneeling, crooked lying, prone and in upright positions. 3 series of 15 repetitions of each exercise.

2. Oswestry disability index (ODI) (%)

1. Segmental Stabilization

Both groups significantly improved from baseline. Group 1 improved in pain from 5.94 (SD 1.56) to 0.06 (SD 0.16) and ODI from 17.07 (SD 3.99) to 1.80 (SD 1.26). Group 2 improved in pain from 6.35 (SD 1.51) to 3.15 (SD 1.20) and ODI from 18.73 (SD 3.61) to 9.20 (SD 4.09).

a. LBP > 3 months

2. Trunk and hamstring stretches

b. Pain felt between T12 and the gluteal fold

2. N = 15. 2 x 30 mins sessions a week for 6 weeks. Stretches involving knee hugs, hamstring stretches in supine, kneeling on heels and chest to thighs, global stretches of posterior muscles. 2 series of 4 minutes were performed, with 1 minute of resting interval.

Group 1 produced significantly better results for pain and ODI than group 2.

Gladwell 2006 [73]

49 patients from doctor surgeries and word of mouth in England, UK. (mean age = 42.1/22% male)

Home and class setting.

Main outcomes at base line and 6 weeks:

1. Roland Morris pain rating visual analogue scale (RMVAS) (0–10)

2 Groups:

Inclusion criteria included:

1. N=24. Continued with normal activity and pain relief.

1. Control of normal activity.

2. N=25. 6 x 1 hour Pilates class a week. Plus 2 x 30 minute sessions at home a week. Exercises involved initial teaching of recruitment of transversus abdominis, progressing onto recruitment during side plank, crook lying leg slides, bridging, supine leg lifts, 4 point kneeling leg extension slides, prone thoracic flexion, sitting lumbar flexion, sitting trunk rotation, crook lying arms circles, crook lying knee circles.

2. Oswestry disability index (ODI) (%)

2. Pilates

a. Pain located below the scapulas and above the cleft of the buttocks

Group 1, RMVAS changed from 2.4 (SD 0.9) at baseline to 2.4 (SD 0.8) at 6 weeks, and ODI improved from 24.1 (SD 13.4) at baseline to 18.1 (SD 13.0) at 6 weeks.

b. Pain > 12 weeks

c. Age > 18, < 60

Group 2 improved RMVAS from 2.7 (SD 0.9) to 2.2 (SD 0.9) and ODI from 19.7 (SD 9.8) to 18.1 (SD 11.2).

No significance difference between interventions was found.

Inani 2013 [74]

30 patients recruited from physiotherapy department of a hospital in India (mean age =30.4/66.7% male).

Department and home setting.

Main outcomes at baseline and at 3 months include:

1. Oswestry disability index (ODI) (%)

2 Groups:

Inclusion criteria included:

1. N = 15. Short wave diathermy and lumbar traction. Teaching of isometric contraction of transversus abdominis and multifidus. Progressing onto contractions whilst holding static positions and progressing further into exercises, for example; hip flexion, extension, adduction and abduction in lying, side lying, standing or sitting. Duration of isometric holds, frequency and repetition not defined. Exact number of contact session also not defined.

2. Visual Analogue Scale (VAS) (0-10cm)

1. Core stabilization

Both groups significantly improved in outcomes. Group 1 ODI improved from 38 (SD 13) to 8.8 (SD 4.7) and VAS from 6.3 (SD 1.8) to 1.4 (SD 0.9). Group 2 improved ODI from 43 (SD 11) to 16 (SD 6.5) and VAS from 7 (SD 1.6) to 2.3 (SD 1.1).

2. Conventional exercises

a. Non specific low back pain

b. Age > 20, < 50

2. N = 15. Short wave diathermy and lumbar traction as group 1. General exercises include; general stretches, abdominal hollowing, isometric lumbar extension, bridges, graded flexion and extension exercises. Duration of holds, frequency and repetition not defined. Exact number of contact session also not defined.

There were significantly greater improvements in pain (p = 0.0018) and disability (p = 0.0309) for group 1 over 2

Javadian 2012 [43]

30 patients recruited in Iran, location not defined (age and sex not defined)

Class setting.

Main outcomes at baseline and at 3 months include:

2 Groups:

Inclusion criteria included:

1. N = 15. 15 minute warm up of cycling and general stretches of hip musculature, hamstring and calf. Stabilization exercises included isometric contraction of deep muscles of the lumbar spine in supine, bridging, kneeling, sitting and standing. Progressed onto Swiss ball and wobble board. Duration of isometric holds, frequency and repetition not defined. Routine exercises included single and double knee to chest, bridging, lower limb raises, supine cycling, heel slides, leg slides and crunches. Repetitions not defined.

1. Visual Analogue Scale (VAS) (0-100mm)

1. Stabilization exercises plus routine exercises

2. Oswestry disability index (ODI) (%)

a. LBP > 3 months

Both groups significantly improved in outcomes. Group 1 improved in VAS from 45.06 (SD 4.15) to 18.41 (SD 2.15) and ODI from 43.84 (SD 5.55) to 16.83 (3.45). Group 2 improved in VAS from 47.73 (SD 3.82) to 9.58 (SD 1.56) and ODI from 45.80 (SD 6.64) to 5.16 (SD 2.16).

2. Routine exercises

b. Age > 18, < 45

c. At least 1 positive from the following:

1. Painful arc during flexion and return from flexion

2. Gower’s sign

3. Instability Catch

The control group improved more than the intervention group, but not significantly.

d. Negative straight leg raise

2. N = 15. 15 minutes warm up as group 1, and routine exercises as group 1.

c. Positive prone instability test

Total number of classes over the 3 months not defined.

Kumar 2010 [75]

141 patients recruited from a rehabilitation department of an India hospital (mean age = 35.1/64.5% male)

Rehabilitation department setting.

Main outcomes at baseline and 6 months.

1. Visual Analogue Scale (VAS) (0-10cm)

1. N = 69. Ultrasound 5 minutes, Short wave diathermy 15 minutes, plus lumbar strengthening exercises. These included 10 repetitions of; prone lying leg elevation, prone lying chest elevation and supine bridging. 20 sessions lasting approximately 40 minutes.

2. Quality of life health survey (SF-36) (36–151)

2 Groups:

Inclusion criteria included:

Group 1 improved in pain by 2.87 (SD 0.15) and group 2 improved by 3.95 (SD 0.26).

1. Conventional treatment

a. LBP of any duration

Group 1 improved in SF-36 by 10.70 (SD 5.9) and group 2 improved by 24.6 (SD 7.6).

2. Dynamic muscular stabilization techniques

b. Age > 20, < 40

2. N = 72. 20 sessions of one on one dynamic muscular stabilization exercise. Isometric abdominal drawing in manoeuvre in crook lying, progressing onto contraction holds with leg lifts. Progressing onto positions of sitting, 4 point kneeling, standing, supine and kneeling. Progressing onto functional high speed exercises, at the discretion of the therapist.

Patients were not allowed to have pain relief during the study period.

Macedo 2012 [76]

172 patients were recruited by general practitioners or from a physical therapy department waiting list in Australia (mean age = 49.1/48.8% male).

Class and home setting.

Outcome taken at baseline, 2 months, 6 months and 12 months include:

1. N = 86. 2 sessions a week in 1^st month, 1 session a week in 2^nd month, total of 12 hours, plus daily home based exercise. Plus 2 booster sessions at 4 and 10 months. Stage 1: tailored exercises aimed at multifidus and transversus abdominis muscles. When the patient could achieve 10 repetitions of 10 second holds progressed to stage 2. Stage 2: Integrating contraction of muscles into more advanced function tasks and exercises, based upon individual therapy assessment. Patients advised to do 30 minutes per week in 1^st month, and 60 minutes a week in 2^nd month.

1. Average numerical rating scale (NRS) for pain over last week (0–10)

2 Groups:

2. Roland-Morris Disability Questionnaire (RMDQ) (0–24)

1. Motor control exercises

Group 1 pain scores at baseline, 2, 6 and 12 months were 6.1 (SD 1.9), 4.1 (SD 2.5), 4.1 (SD 2.5) and 3.7 (SD 2.7).

Inclusion criteria included:

Group 2 pain scores were; 6.1 (SD 2.1), 4.1 (SD 2.5), 4.1 (SD 2.7) and 3.7 (SD 2.6).

2. Graded activity

a. Chronic nonspecific low back pain

b. duration > 3 months

Group 1 RMDQ at baseline, 2, 6 and 12 months were; 11.4 (SD 4.8), 7.5 (SD 6.4), 8.0 (SD 7.1) and 7.4 (SD 6.7). Group 2 RMDQ were; 11.2 (SD 5.3), 8.0 (SD 6.5), 8.6 (SD 6.8) and 8.0 (SD 6.9).

c. age > 18, < 80

2. N = 86. Same class duration, frequency and home exercises as group 1. The programme included individualized and submaximal exercises working on generalized (whole body) exercises without consideration of specific muscle activity. It was aimed at ignoring illness behaviours and reinforcing wellness behaviours. Cognitive behavioural principles were used to help the participants overcome the natural anxiety associated with pain and activities.

There were no significant differences between treatment groups at any of the time points.

Marshall 2013 [77]

64 patients were recruited via community advertising in Australia (mean age = 36.2/62.5% male).

Exercise class setting.

Outcomes taken at baseline, 2 months and 6 months include:

1. Visual Analogue Scale (VAS) (0-10cm)

2 Groups:

1. N = 32. 50–60 minutes, 3 x a week for 8 weeks. The teaching of the isometric abdominal drawing in manoeuvre, with biofeedback pressure transducer under lumbar spine. Working in side lying, prone lying positions with upper and lower limb exercises. Including warm and cool down with whole body stretches.

2. Oswestry disability index (ODI) (%)

VAS for group 1 at baseline was 3.6 (SD 2.1). Difference at 2 and 6 months from baseline were; −1.9 (CI 95% −2.6 to −1.2) and −1.6 (CI 95% -14.2 to −6.7). VAS for group 2 at baseline was 4.5 (SD 2.5). Difference at 2 and 6 months from baseline were; − 0.8 (CI 95% −1.5 to −0.1) and −1.2 (CI 95% −1.9 to −0.6).

1. Specific trunk exercises

Inclusion criteria included:

2. Stationary cycling

a. Pain between the costal margins and inferior gluteal folds

b. Age > 18, < 50

2. N = 32. 50–60 minutes, 3 x a week for 8 weeks. Stationary bike, with variation in seated/standing positions, resistance and cadence with warm up and down and whole-body stretching.

ODI for group 1 at baseline was 25.4 (SD 11.2). Difference at 2 and 6 months from baseline were; −10.4 (CI 95% −14.2 to −6.7) and −10.4 (CI 95% −14.0 to −6.8). ODI for group 2 at baseline was 24.0 (SD 11.9). Difference at 2 and 6 months from baseline were; −3.9 (CI 95% −7.8 to 0) and −5.9 (CI 95% −9.5 to −2.4).

c. Duration > 3 months

VAS significantly lower at 2 months for group 1 (p<0.05). ODI scores also significantly lower in group 1 at 2 months (p=0.019). Between group differences were no longer observed at 6 months.

Moon 2013 [78]

21 patients recruited from a rehabilitation outpatient clinic in Korea (mean age = 28.5/66.7% male).

Class setting.

Outcomes taken at baseline at and 8 weeks include:

2 Groups:

1. Visual Analogue Scale (VAS) (0–100)

Inclusion criteria included:

1. N=11. 60 minute class, twice a week for 8 weeks. 15 minute warm up of stretches and 10 minute warm down, same in both groups. All exercises were performed with the abdominal drawing in manoeuvre and included crook lying, knee lifts, leg slides, straight leg raises, plank, 4 point kneeling leg lifts and alternate leg and arm lifts, bridging on Swiss ball, sitting on chair and Swiss ball, prone lying, side plank, wall sits with Swiss ball, 4 point kneeling pelvic tilts, sit up with Swiss ball (number of exercises and duration of hold not defined).

2. Oswestry disability index (ODI) (%)

1. Stabilization exercise

Group 1 baseline pain score was 33.5 (SD 18.4) and group 2 was 34.2 (SD 17.1). Baseline ODI group 1 was 14.7 (SD 2.9) and group 2 15.5 (SD 4.3)

2. Dynamic strengthening exercises

a. Non specific LBP.

b. Pain > 3 months

c. Without nerve root pain

At 8 weeks group 1 improved in VAS by

16.7 (SD 7.0) and group 2 by 14.1 (SD 8.2). Group 1 improved ODI by 6.1 (SD 1.9) and group 2 by 3.6 (SD 1.5).

2. N = 10. 60 minute class, twice a week for 8 weeks. 15 minute warm up of stretches and 10 minute warm down, same in both groups. Exercises performed included crook lying, bridging, mini sit ups, sit ups, twisting sit ups, knee to chest, prone leg extension, prone spine extensions, 4 point kneeling leg lifts, and alternate leg and arm lifts (number of exercises and duration of hold not defined).

No significant difference between groups at 8 weeks for pain (p=0.66) or ODI (p=0.07).

Rasmussen-Barr 2009 [45]

71 patients recruited from a private outpatient physiotherapy clinic in Sweden (mean age = 38.5/49.3% male).

Class and home setting.

Main outcomes taken at baseline, 8 weeks, 6, 12 and 36 months include:

1. N = 36. Weekly exercise class for 8 weeks, lasting 45 minutes. Treatment included instruction on deep muscles of lumbar spine and isometric contraction of transversus abdominis with and multifidus by the abdominal drawing in manoeuvre. Bio-feedback was used. The class progressed to performing the exercise in different postural positions. Progression was based upon pain response (exact postural positions, duration of hold and repetitions not defined). Patients encourage of perform exercise at home daily for 15 minutes.

2 Groups:

1. Oswestry disability index (ODI) (%)

Inclusion criteria included:

2. Visual Analogue Scale (VAS) (0–100)

1. Graded exercise

Group 1 baseline ODI score was 20 (25th/75th percentiles 12/26). Changes in score compared to baseline at 8 weeks, 6, 12 and 36 months were −7 (−15/-4), −9 (−19/-2), −10 (−20/-2) and −11 (−23/-4) respectively.

2. Daily walks

a. Mechanically induced LBP

b. > 8 weeks duration

Group 2 baseline ODI score was 22 (14/28) and changes in score compared to baseline at 8 weeks, 6, 12 and 36 months were −4 (−10/0), −4 (−10/0), −2 (−12/2) and −6 (−14/0) respectively.

c. ≥ 1 pain free period in last year

2. N = 35. Patients had 1 x 45 minute appointment at the start of the 8 weeks, and at the end. Instructed to take 30 minutes of walking a day at fastest pace possible without increasing pain (2 x 15 minutes allowed). Also a general home exercise plan provided, with no follow up instruction provided (exact exercises not defined).

d. Pain below the costal margin and above the inferior gluteal folds.

Group 1 baseline VAS score was 32 (25th/75th percentiles 18/59). Changes in score compared to baseline at 8 weeks, 6, 12 and 36 months were −15 (−31/-8), −15.5 (−30/-3.5), −12 (−34.5/-3) and −14 (−40/-4.5) respectively.

e. No leg pain

f. Working

Group 2 baseline VAS score was 38 (23/62) and changes in score compared to baseline at 8 weeks, 6, 12 and 36 months were −8 (−19/-1), −9 (−24/0), −12 (−22/0) and −12 (−23/-2) respectively.

g. Age > 18, < 60

Significant improvement in ODI with group 1 over group 2 (p=0.003). No between groups difference in pain was found.

Rhee 2012 [44]

42 patients recruited in Seoul, Korea (mean age = 50.2/50% male).

Class and home setting.

Main outcomes taken at baseline and at 4 weeks include:

1. Million Visual Analogue Scale (MVAS) (0–150)

1. N = 21. Supervised spinal stabilization exercises 3 times a week over a 4-week period, plus 5 x a week home exercises. Exercise involved abdominal drawing in manoeuvre in 5 different positions; prone, prone with leg and arm lifts, 4 point kneeling leg and arm lifts, crook lying mini sit ups, crook lying mini twist sit ups. Duration of hold and repetitions not defined.

2. Oswestry disability index (ODI) (%)

2 Groups:

Inclusion criteria included:

Both groups significantly improved for MVAS score (p<0.01). Group 1 improved from 42.70 (SD 13.80) to 32.81 (SD 10.85). Group 2 improved from 33.26 (SD 15.27) to 23.42 (SD 13.43)

1. Spinal stabilization exercises

a. Recurrent LBP

2. Control

b. At least 1 previous episode

Both groups significantly improved for ODI score (p<0.001). Group 1 improved from 27.76 (SD 12.11) to 25.29 (SD 12.59) and group 2 improved from 17.29 (SD 9.15) to 12.52 (SD 8.50).

c. Age > 21

d. No leg pain

2. N = 21. Provided with an education/advice booklet.

Sung 2013 [33]

46 patients recruited in Cleveland, Ohio (mean age 50.4/47.8% male).

Class and home setting.

Main outcomes taken as baseline and at 4 weeks include:

1. Oswestry disability index (ODI) (%)

2 Groups:

1. N = 21. Class setting for 20 minutes, 1 x a week for 4 weeks. Plus at home daily for 20 minutes. Exercise involved abdominal drawing in manoeuvre in 5 different positions; prone, prone with leg and arm lifts, 4 point kneeling leg and arm lifts, crook lying mini sit ups, crook lying mini twist sit ups. 5 second holds 2 x 15 reps.

Group 1 significantly improved from 24.89 (SD 11.89) to 17.73 (SD 11.75) (p = 0.03). Group 2 improved from 26.69 (SD 8.65) to 24.46 (SD 8.87) (p = 0.40).

Inclusion criteria included:

1. Core stabilization exercise

a. LBP > 2 months

2. Spinal flexibility exercise

b. Age > 21

No statistically significant difference between groups.

c. No leg pain

2. N = 25. Class setting for 20 minutes, 1 x a week for 4 weeks. Plus at home daily for 20 minutes. Exercise involved; single and double knee to chest in supine, 4 point kneeling flexion stretch, sitting flexion stretch and standing side flexion stretch. 5 second holds 2 x 15 reps.

Unsgaard-Tondel 2010 [79]

109 patients recruited from general practitioners, physical therapist and advertisements at a hospital in Norway (mean age = 40.0/30.3% male).

Local fitness centre, physical therapy department of hospital and home setting.

Main outcomes taken at baseline, 8 weeks and 1 year include:

3 Groups:

1. Numerical rating scale (NRS) for current pain (0–10)

2. Oswestry disability index (ODI) (%)

1. N=36. 1 x 40 minutes one on one treatment at physical therapy department for 8 weeks. Teaching of isometric contraction of transversus abdominis with the use of ultrasound machine for feedback, initially in crook lying. Progression of exercises were individualized, but incorporated the isometric contraction of the local muscles. Participants were encouraged to perform the exercises at home, 10 contractions of 10 second holds 2 – 3 x a day.

NRS for group 1 at baseline, 8 weeks and 1 year was; 3.31 (SD 1.42), 1.76 (SD 1.54) and 2.01 (SD 1.94). Group 2; 3.61 (SD 1.75), 2.34 (SD 2.26) and 2.70 (SD 2.22). Group 3; 3.30 (SD 1.74), 2.73 (SD 2.32) and 2.66 (SD 2.03).

1. Motor control exercises

Inclusion criteria included:

2. Sling exercises

a. LBP > 3 months

3. General exercises

b. Age > 19, < 60

c. Pain > 2, < 10 Numeric Pain Rating Scale (NPRS) (0–10

ODI for group 1 at baseline, 8 weeks was; 19.44 (SD 8.38) and 12.78 (SD 7.62). Group 2; 22.28 (SD 11.22) and 16.18 (SD 10.88). Group 3; 20.84 (SD 9.43) and 17.75 (SD 9.63).

2. N=36. 1 x 40 minutes one on one treatment at physical therapy department for 8 weeks. Unloading elastic bands were attached to the pelvis to help participants maintain the neutral spine position through a range of leg and arm positions and movements. Progression of exercises were individualized, but generally was achieved through reducing the elastic band support. The number of repetitions and sets was individualized.

No between group difference for pain 8 weeks (p=0.19) or 1 year p = 0.42) and no between group difference for ODI at 8 week (p = 0.21)

3. N=37. Local fitness centre classes of 2 – 8 patients for 1 hour, 1 x a week for 8 weeks. General trunk strengthening and stretching exercises. For example resisted trunk flexion, extension and rotation. 10 repetitions, in 3 sets.

Wang 2012 [80]

60 patients recruited from an outpatient rehabilitation department in a Chinese hospital (mean age = 38.6/58.3% male).

Class setting in rehabilitation centre.

Main outcomes taken at baseline and at 12 weeks include:

1. Visual Analogue Scale (VAS) (0–10)

2 Groups:

1. N = 32. 40 minutes, 3 x a week for 12 weeks. 5 minute warm up. 30 minutes of exercises including; control of neutral spine alignment in sitting, prone, bridging, leg lifts, double knee flexion and reverse bridge. 5 minute warm down. Increasing difficulty as appropriate (exact details of exercises and progression not defined).

1. Core stability exercises

Inclusion criteria included:

2. Oswestry disability index (ODI) (%)

2. Control of conventional exercise

VAS improved in group 1 from 5.52 (SD 3.46) to 2.15 (SD 1.58) and in group 2 from 5.11 (SD 2.78) to 2.92 (2.13).

a. LBP > 3 months

b. Age > 19, < 60

c. Pain reproduced by movement

ODI improved in group 1 from 33.11 (SD 5.73) to 15.34 (SD 7.65), and in group 2 from 30.42 (SD 7.44) to 19.18 (SD 10.21).

2. N = 28. 40 minutes, 3 x a week for 12 weeks. 5 minute warm up. 30 minutes of exercises including; sit ups, straight leg raises, bilateral straight leg raises, prone trunk extension. Then 5 minute warm down. Gradually increasing difficulty over 12 weeks (exact details of exercises and progression not defined).

Significant difference in favour of group 1 for VAS (p = 0.036) and ODI (p = 0.027) at 8 weeks.