Table 17 Results of different exercise types compared to control interventions for pain and disability. Sling exercises

Lee et al. (2014) [66]

AMSTAR-2

Low

Pain:

VAS, NRS

Pain domain of Qualeffo-41

Disability:

ODI, Physical domain of Qualeffo-41

Follow-up:

Post-intervention 1–3 mo

Sling = general exercise

SE is no more effective/efficacious in reducing pain compared with general exercise (3 trials)

Sling > manipulation

SE is more effective than manipulation

Sling = general exercise

SE is no more effective/efficacious in improving disability compared with other forms of exercise (2 trials)

As sling therapy studies are based on a small number of trials, we cannot draw conclusions about the therapeutic effects of sling exercise. When segmental stabilizing exercise and individually designed programs are added to sling exercise, it increases the effectiveness of sling exercise at improving low back pain. This should be the focus of future studies

Yue et al. (2014) [65]

AMSTAR-2

High

Pain:

VAS, NRS

Disability:

ODI, M-ODI

JOA

Follow-up:

Short-term: between 1 day to 8 wks (9 studies)

Intermediate term: 2 wks to 12 wks (3 studies)

Long-term 5 wks to 14 mo (6 studies)

SE = other exercise

Short-term:

MD = -7.30 (95% CI -14.86; 0.25)

No sign diff other time points

SE = traditional Chinese medical therapy

No sign diff short-term

SE > thermomagnetic therapy

Short-term: (2 trials)

WMD = -13.90 (95% CI -22.19; -5.62)

Long-term:

WMD = -26.20 (95% CI-31.32; -21.08)

SE and acupuncture = acupuncture

Short-term:

WMD = -6.30 (95% CI -16.85; -4.25)

SE > physical agents combined with drugs therapy (1 trial)

WMD = -15.0. (95%CI -19.64; -10.36)

SE > other exercise

Intermediate term:

MD = -8.81 (95% CI -13.82;-3.80)

No sign diff short-term

SE > thermomagnetic therapy

Short-term:

MD = -10.54 (95% CI -14.32;-6.75)

Long-term:

MD = -25.75 (95% CI -30.79;-20.71)

SE > physical agents combined with drugs therapy (1 trial)

Long-term:

WMD = -10.00. (95%CI -13.70; -6.30)

Based on limited evidence from two trials, SE was more effective for LBP than thermomagnetic therapy. Clinically relevant differences in effects between SE and other forms of exercise, physical agents combined with drug therapy, traditional Chinese medical therapy, or in addition to acupuncture could not be found. More high-quality randomized trials on the topic are warranted.

Drummond et al. (2021) [17]

AMSTAR-2

Moderate

Pain:

VAS, NRS

Disability:

ODI

Follow-up:

 ≤ 3 mo

SE = general exercise (2 trials)

MD = 0.14 (95% CI -0.58; 0.89)

SE > motor control training /lumbar stabilization (3 trials)

MD = -4.13 (95% CI -7.82; -0.45)

SE > no treatment (2 trials)

MD = -1.05 (95% CI -2.82; -0.71)

SE and modalities > modalities

(2 trials)

MD = -1.19 (95% CI -1.48; -0.89)

SE = general exercise (1 trial)

MD = 3.02 (95%CI -2.44; 8.47)

SE > motor control training/ lumbar stabilization (2 trials)

MD = -3.19 (95% CI -4.63; -1.76)

SE > no treatment

One study demonstrated a significant difference favoring SE (p < 0.05)

SE and modalities = modalities (2 trials)

MD = -6.67 (95% CI -17.25; 3.92)

The overall level of evidence ranged from very low to moderate. Sling exercise therapy is effective in reducing pain and disability. Because sling exercise demonstrated comparable outcomes with common active interventions, it provides an opportunity to implement pain-free exercises based on the patient’s initial functional level early in the plan of care.