STUDY DESIGN: Systematic review and meta-analysis.
OBJECTIVE: This study aims to assess the effectiveness of lumbar segmental stabilization exercise (LSSE) in managing spondylolysis and spondylolisthesis.
SUMMARY OF BACKGROUND DATA: Spondylolysis and spondylolisthesis are spinal disorders associated with lumbar segmental instability. LSSE has shown positive effects in treating these conditions; however, systematic reviews and meta-analyses are lacking.
MATERIALS AND METHODS: A systematic search adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, including studies from the inception of the databases used up to January 2024, was conducted. Disability improvement and pain intensity change were the primary and secondary outcomes, respectively, standardized using Hedges g . Eligible articles underwent independent scrutiny by two authors, who also performed data extraction and quality assessment. Data pooling was accomplished using a random-effects model.
RESULTS: In total, five randomized controlled trials comprising 198 participants were included, revealing a trend effect toward disability improvement in the LSSE group (Hedges g =-0.598, 95% CI: -1.211 to 0.016, P =0.056, I2 =75.447%). When the LSSE was administered as a single treatment, disability improvement became significant (Hedge g =-1.325, 95% CI: -2.598 to -0.053, P =0.041, I2 =80.020%). No significant effect of LSSE on pain reduction was observed (Hedges g =-0.496, 95% CI: -1.082 to 0.090, P =0.097, I2 =73.935%).
CONCLUSIONS: In summary, our meta-analysis suggests that LSSE can potentially improve disability, especially when used as a single treatment. LSSE appears more beneficial in reducing disability than alleviating pain. Future research on different patient groups is needed to understand comprehensively LSSE's effects on other musculoskeletal disorders.
| Discipline Area | Score |
|---|---|
| Rehab Clinician (OT/PT) |  |
| Psychologist | |
| Physician |  |
Physician rater
A lack of long-term results negates the study.
Physician rater
The systematic review showed that lumbar segmental stabilization exercises have a small and favorable effect size in improving disability in patients with lumbar spondylolysis and spondylolisthesis when it is a single exercise intervention and when there are no lumbar flexion exercises involved. There is no effect on pain in this population. When readers interpret the results, they should consider that only 5 studies (n=198) were included in this review and there was data loss in all studies for the final statistical analysis. In addition, there was no analysis of the certainty of the evidence to guide using the information provided by this meta-analysis.
Physician rater
In this review, lumbar segmental stabilisation exercises (LSSE) showed a trend toward improving disability in patients with lumbar spondylolysis and spondylolisthesis, especially when used as a stand-alone treatment. However, LSSE did not show a statistically significant effect on reducing pain. Finally, the substantial heterogeneity, short follow-up, and variable methodological quality of the included studies make the final results inconclusive and warrant further investigation of this intervention.
Rehab Clinician (OT/PT) rater
This study does not provide important details regarding the primary outcome measures such as the scores on the ODI pre and post intervention across studies reviewed.
Rehab Clinician (OT/PT) rater
This systematic review provides important findings; however, the differences in the content of stabilization exercises in the included studies require careful interpretation by clinicians.
Rehab Clinician (OT/PT) rater
It is counterintuitive, as the authors suggest, that The LSSE as a solo treatment performed better than multi-modal treatment. However, many of those multimodal interventions were passive versus active.
, McMaster University