Table 14 Results of different exercise types compared to control interventions for pain and disability. Motor Control Exercises (MCE)

Byström et al. (2013) [48]

AMSTAR-2 Moderate

Pain:

NRS, VAS

Disability:

ODI, RMDQ

Follow-up:

Short-term: > 6 wks ≤ 4 mo

Intermediate: > 4 and ≤ 8 mo

Long-term: > 8 and ≤ 15 mo

MCE > GE

Short-term (7 trials)

WMD = -7.89 (95%CI -10.95;-4.65) Intermediate (7 trials)

WMD = -6.06 (95%CI -10.94; -1.18)

MCE = MT

All time periods (3 trials)

MCE > MI

Short-term (2 trials)

WMD = -12.48 (95%CI -19.04; -5.93)

Intermediate (2 trials)

WMD = -10.18 (95%CI 16.64; -3.72)

Long-term (2 trials)

WMD = -13.32 (95%CI 19.75; -6.90)

MCE > MM-PT

Intermediate (4 trials)

WMD = -14.20 (95%CI -21.23; -7.16)

MCE > GE

Short-term (7 trials)

WMD = -4.65 (95%CI -6.20; -3.11)

Intermediate (7 trials)

WMD = -4.86 (95%CI -8.59; -1.13)

Long-term (7 trials)

WMD = -4.72 (95%CI -8.81;—0.63)

MCE > MT

Short-term (3 trials)

WMD = -6.12 (95%CI -11.94; -0.30)

Intermediate (3 trials)

WMD = -5.27 (95%CI -9.52; -1.01)

Long-term (3 trials)

WMD = -5.76 (95%CI -9.21; -2.32)

MCE > MI

Short-term (3 trials)

WMD = -9.00 (95%CI 15.28; -2.73)

Intermediate (3 trials)

WMD = -5.62 (95%CI -10.46; -0.77)

Long-term (3 trials)

WMD = -6.64 (95%CI -11.72; -1.57)

MCE > MM-PT

Intermediate (4 trials)

WMD = -12.98 (95%CI -19.49; -6.47)

MCE seem to be superior to several other treatments. More studies are needed to investigate subgroups.

Elbayomy et al. (2018) [51]

AMSTAR-2 Low

Pain:

VAS

Disability:

RMDQ

Follow up:

Shortterm: ≤ 3 mo from randomization

Intermediate term: between 3 and 12 mo

Long-term: ≥ 12 mo from randomization

CE > GE

Short-term (15 trials)

MD = -1.18 (95%CI 1.68; -0.67)

Intermediate (8 trials)

MD = -0.92 (95%CI -1.5; -0.35)

Long-term (5 trials)

MD = -0.11 (95%CI -0.52; 0.31)

CE = MT

Short-term (2 trials)

MD = 0.39 (95%CI -0.98; 0.20)

Intermediate (3 trials)

MD = -0.55 (95%CI -1.39; 0.29)

Long-term (2 trials)

MD = -0.26 (95%CI -0.87; 0.35)

CE > MI

Short-term (2 trials)

MD = -1.26 (95%CI -1.85; -0.67)

Intermediate (4 trials)

MD = -1.25 (95%CI -2.01; -0.49)

Long-term (3 trials)

MD = -1.3 (95%CI -1.85; -0.74)

CE > MM-PT

Short-term (6 trials)

MD = -0.35 (95%CI -0.99; 0.29)

CE > GE

Short-term (14 trials)

SMD = -0.98 (95%CI -1.46; -0.50)

Intermediate (8 trials)

SMD = -0.59 (95%CI -1.03; -0.15)

Long-term (4 trials)

SMD = -0.04(95%CI -0.21; 0.12)

CE = MT

Short-term (2 trials)

SMD = -0.12 (95%CI -0.40; 0.16)

Intermediate (3 trials)

SMD = -0.09 (95%CI -0.31; 0.12)

Long-term (3 trials)

SMD = -0.07 (95%CI -0.27; 0.13)

CE > MI

Short-term (3 trials)

SMD = -0.66 (95%CI -1.08; -0.24)

Intermediate (4 trials)

SMD = -0.37 (95%CI -0.75; 0.02)

Long-term (3 trials)

SMD = -0.29 (95%CI -0.73; 0.14)

CE > MM-PT

Short-term (3 trials)

SMD = -0.5 (95%CI -0.87; -0.13)

CE reduced pain and disability at short and intermediate term more than GE, level of evidence from low to moderate. Low evidence support that CE reduce disability more than MT. No clinically important difference between CE and MT. Low to moderate evidence suggest CE has significant effect on pain more than MI at all follow-up periods and on disability at short-term.

Ferreira et al. (2006) [49]

AMSTAR-2 Low

Pain:

VAS

Disability:

RMDQ

Follow up:

Short-term: ≤ 3 mo

Intermediate term: ≥ 3 and ≤ 12 mo

Long-term: ≥ 12 mo

MCE > UC

Short-term (2 trials)

ES = -21 (95%CI -32; -9)

Intermediate (2 trials)

ES = -24 (95%CI -38; -1)

MCE = MT

Short-term / Long-term (2 trials)

NR in text

MCE + Educ > MM

Short-term (2 trials)

ES = -11 (95%CI -13; -9)

Intermediate (2 trials)

ES = -11 (95%CI -18; -5)

Long-term (1 trial)

ES = -9 (95%CI -15; -3)

MCE + UC = UC

Short-term (3 trials): NR

MCE = MT

Short-term (2 trials)

ES = -5 (95%CI -12; 1)

Intermediate term (2 trials)

ES = -9 (95%CI -16; -2)

MCE = MT

Short/ long-term (2 trials)

NR in text

MCE + Educ > MM

Short-term (2 trials)

ES = -20 (95%CI -27; -13)

Intermediate (2 trials)

ES = -4 (95%CI -7; -1)

MCE + Educ = MM

Long-term (1 trial)

ES = -3 (95%CI -6; 0)

MCE + UC = UC

Short-term (3 trials): NR

The authors suggest that specific stabilization exercise is an effective treatment option for many forms of spinal pain. It is not clear if the improvements in pain and disability are associated with changes in the pattern of muscle activation.

Gomes-Neto et al. (2017) [52]

AMSTAR-2 Moderate

Pain:

VAS

Disability:

RMDQ

Follow up:

Post-intervention

MCE > GE

Baseline to study end (8 trials)

WMD = -1.03 (95%CI -1.79; 0.27)

MCE = MT

Baseline to study end (3 trials)

WMD = -0.38 (95%CI -0.98; 0.22)

MCE > GE

Baseline to study end (4 trials)

WMD = -5.41 (95%CI -8.34; -2.49)

MCE = MT

Baseline to study end (3 trials)

WMD = -0.17 (95%CI -0.38; 0.03)

Based on relatively low-quality data that led to a high risk of bias. Additional research is required to ascertain the positive effects of MCE over time.

Henao & Bedoya (2016) [40]

AMSTAR-2 low

Pain:

VAS

Disability:

ODI, RMDQ

Follow-up:

Short-term: post-intervention (6–8 wks)

Intermediate term: 3 mo

Long-term: > 6 mo

MCE = GE

No difference between MCE and GE in short or long-term (1 trial)

MCE = GE

No difference between MCE and GE in short or long-term (1 trial)

Although there are no differences between MCE and GE concerning pain and disability in people in chronic LBP there is uncertainty as to whether there is consensus in defined exercise protocols of MCE and GE. It is necessary to develop an exercise protocol that demonstrates evidence that favors optimal lumbo-pelvic stability.

Luomajoki et al. (2018) [53]

AMSTAR-2 Moderate

Pain:

VAS, NRS

Disability:

ODI, RMDQ

Follow-up:

Short-term: post-intervention

Long-term: ≥ 12 mo

MvCE > control

Short-term (9 trials)

SMD = -0.39 (95%CI -0.69; -0.04)

Long-term (5 trials)

SMD = -0.27 (95%CI -0.62; -0.09)

MvCE > control

Short-term (11 trials)

SMD = -0.38 (95%CI -0.68; -0.09)

Long-term (6 trials)

SMD = 0.37 (95%CI -0.61; 0.04)

MvCE may be more effective in disability in the short and long-term compared to other interventions. Pain was reduced through MvCE treatment in short but not in long-term.

Macedo et al. (2009) [54]

AMSTAR-2 Moderate

Pain:

VAS

Disability:

ODI

Follow up:

Short term: ≤ 3 mo

Intermediate term: > 3 and < 12 mo

Long term: ≥ 12 mo

MCE = GE

All time intervals

Short term (4 trials)

Intermediate (3 trials)

Long term (3 trials)

MCE > MT

Intermediate (4 trials)

WMD = -5.7 (95%CI -10.7; -0.8)

MCE > MI

Short-term (7 trials)

WMD = -14.3 (95%CI -20.4; -8.1)

Intermediate (7 trials)

WMD = -13.6 (95%CI -22.4; -4.1)

Long-term (7 trials)

WMD = -14.4 (95%CI -23.1; -5.7)

MCE > GE

Short-term (5 trials)

WMD = -5.1 (95%CI -8.7; -1.4)

MCE > MT

Intermediate (4 trials)

WMD = -4.0 (95%CI -7.6; -0.4)

MCE > MI

Long-term (7 trials)

WMD = -10.8 95%CI (-18.7; -2.8)

MCE is more effective than MI and add benefit to another form of intervention in reducing pain and disability in LBP. The optimal implementation of MCE is unclear. Future trials need to study dosage parameters, feedback and subgroups.

Niederer & Mueller (2020) [55]

AMSTAR-2 Moderate

Pain:

NRS, VAS

Disability:

ODI, RM

Follow-up:

Short-term: ≥ 1 < 3 mo

Intermediate term: > 3 ≤ 12 mo

Long term > 12 mo

MCE > Inactive, passive or other exercise

Overall (13 trials)

SMD = -0.46 (95%CI -0.78; -0.14)

MCE > GE

Short-term (3 trials)

SMD = -0.53 (95%CI -1.20; -0.14)

Intermediate (6 trials)

SMD = -0.23 (95%CI -0.46; 0.01)

Long-term (3 trials)

SMD =- 0.29 (95%CI -0.56; -0.01)

MCE = Inactive, passive

Short-term (3 trials)

SMD = -0.03 (95%CI -1.88; 0.03)

Intermediate and long-term

No difference

MCE > Inactive, passive or other exercise

Overall (12 trials)

SMD = -0.44 (95%CI -0.88; -0.09)

MCE = GE

Short-term (4 trials)

SMD = 0.45 (95%CI -1.51; 0.60)

Intermediate (5 trials)

SMD = -0.16 (95%CI -0.37; -0.04)

Long-term (3 trials)

SMD = -0.25 (95%CI -0.59; 0.10)

MCE = Inactive, passive

Short-term (4 trials)

SMD = -0.82 (95%CI -1.59; 0.04)

Intermediate and Long-term

No difference

MCE lead, with low to moderate quality evidence, to a sustainable improvement in pain intensity and disability in chronic non-specific LBP compared to an inactive or passive control group or compared to other exercises.

Saragiotto et al. (2016) [16]

AMSTAR-2 High

Pain:

VAS

Disability:

RMDQ

Follow-up:

Short-term: 4–10 wks

Intermediate term: 3–6 mo

Long-term: 12–36 mo

MCE > GE

Short-term (13 trials)

MD = -7.53 (95%CI -10.54; -4.52)

MCE = GE

Intermediate and Long-term

No difference

MCE = MT

No difference at any time point

MCE > MI

Short-term

MD = -10.01 (95%CI -15.67; -4.35) intermediate

MD = -12.61 (95%CI -20.53; -4.69)

Long-term

MD = -12.97 (95%CI -18.51; -7.42)

MCE > GE + EPA

Short-term

MD = -30.18 (95%CI -35.32; -25.05)

Intermediate

MD = -19.39 (-36.83; -1.96)

MCE > GE

Short-term (11 trials)

MD = -4.82 (95%CI -6.95; -2.68)

MCE = GE

Intermediate and Long-term

No difference

MCE = MT

No difference at any time point

MCE > MI

Short-term

MD = -8.63(95%CI -14.78; -2.47)

Intermediate

MD = -5.47, (95%CI -9.17; -1.77)

Long-term

MD = -5.96 (95%CI -9.81; -2.11)

MCE > GE and EPA

Short-term

MD = -20.83 (95%CI -28.07; -13.59)

Intermediate

MD = -11.5 (95%CI -20.69; -2.31)

MCE probably provides better improvements in pain, function and global impression of recovery than MI at all follow-up periods. MCE may provide slightly better improvements than exercise and EPA for pain, disability, global impression of recovery and the physical component of QoL in the short/intermediate term. There is probably little or no difference between MCE and MT for all outcomes and follow-up periods.

Smith et al. (2014) [56]

AMSTAR-2 High

Pain:

VAS

Disability:

RMDQ

Follow-up:

Short-term: ≤ 3 mo

Intermediate term: > 3 and < 12 mo

Long term: ≥ 12 mo

MCE > Any treatment/control

Short-term (22 trials)

MD = -7.93 (95%CI -11.74; -4.12)

Intermediate (22 trials)

MD = -6.10 (95%CI -10.54; -1.65)

Long-term (22 trials)

MD = -6.39 (95%CI -10.14; -2.65)

MCE > GE

Short-term

MD = -7.75 (95%CI -12.23; -3.27)

Intermediate

MD = -4.24 (95%CI -8.27; -0.21)

MCE = GE

Long-term

MD = -3.06 (95%CI -6.74; 0.63)

MCE > Any treatment/control

Short-term (24 trials)

MD = -3.61 (95%CI -6.53 to -0.70)

Long-term (24 trials)

MD = -3.92 (95%CI -7.25 to -0.59)

MCE = Any treatment/control

Intermediate no difference

MD = -2.31 (95%CI -5.85; 1.23)

MCE > GE

Short-term

MD = -3.63 (95%CI -6.69; -0.58)

Intermediate

MD = -3.56 (95%CI -6.47; -0.66)

MCE = GE

Long-term

No difference

MCE improve LBP symptoms, but are no better than any other form of active exercise in the long-term.

Wang et al. (2012) [57]

AMSTAR-2 Low

Pain:

VAS, NRS

Disability:

RM, ODI

Follow-up:

Short term: < 3 mo

Intermediate: 6 mo

Long term: ≥ 12 mo

MCE > GE

Short-term

MD = -1.29 (95%CI -2.47; -0.11)

MCE = GE

No difference at intermediate or long-term

MCE > GE

Short-term

MD = -7.14 (95%CI -11.64; -2.65)

MCE = GE

No difference at intermediate or long-term

Compared to GE, MCE is more effective in decreasing pain and may improve physical function in patients with chronic LBP in the short-term but not in long-term.

Zhang et al. (2021) [58]

AMSTAR2

High

Pain

NRS, VAS

Disability

RMDQ, ODI

QLBPDSQ

Follow up

Posttreatment

Intermediate 6 mo Long-term 12 and 24 mo

MCE > other exercises

Posttreatment (11 trials)

WMD = -0.65 (95%CI -1.05; -0.25)

MCE = other exercises

Intermediate 6 months (2 trials)

WMD = -0.09 (95%CI -0.31; 0.14)

Long-term 12 mo (3 trials)

WMD = -0.13 (95%CI -0.32; 0.06)

MCE = MT

Posttreatment (4 trials)

WMD = -0.06 (95%CI -0.26, 0.13)

Intermediate 6 mo (2 trials)

WMD = 0.25 (95%CI -0.48; 0.01)

Long-term 12 mo (1 trial)

WMD = 0.00 (95%CI -0.33; 0.33)

Long term 24 mo (1 trial)

WMD = -0.08 (95%CI -0.54; 0.38)

MCE > MI

Posttreatment (4 trials)

WMD = -0.44 (95%CI -0.78, -0.09)

MCE = MI

Intermediate 6 mo (2 trials)

WMD = -0.23 (95%CI -0.49; 0.04)

Long-term 12 mo (1 trial)

WMD = 0.04 (95%CI -0.31; 0.22)

Long-term 24 mo (1 trial)

WMD = -0.50 (95%CI -1.06; 0.07)

MCE > other exercises

Posttreatment (11 trials)

WMD = -0.56 (95%CI -0.98; -0.18)

MCE = other exercises

Intermediate 6 mo (2 trials)

WMD = -0.16 (95%CI -0.39; 0.07)

Long-term 12 mo (2 trials)

WMD = -0.10 (95%CI -0,33; 0.13)

MCE = MT

Posttreatment (4 trials)

WMD = 0.12 (95%CI -0.10, 0.35)

Intermediate 6 mo (2 trials)

WMD = -0.07 (95%CI -0.30; 0.16)

Long-term 12 mo (2 trials)

WMD = -0.16 (95%CI -0.39; 0.08)

Long-term 24 mo (1 trial)

WMD = -0.19 (95%CI -0.66; 0.27)

MCE > MI

Posttreatment (4 trials)

WMD = -0.70 (95%CI -1.40, -0.01)

MCE = MI

Intermediate 6 mo (2 trials)

WMD = -0.15 (95%CI -0.41; 0.12)

Long-term 12 mo (2 trial)

WMD = -0.12 (95%CI -0.38; 0.14)

Long-term 24 mo (1 trial)

WMD = -0.00 (95%CI -0.56; 0.56)

Low to very low quality of evidence supported that MCE resulted in a reduction of pain and disability posttreatment than other treatments for NSCLBP.