PAIN+ CPN

QUESTION: In people with chronic non-specific low back pain, what is the effect of high-intensity Pilates exercise compared with low-intensity Pilates exercise on pain, disability, patient-specific function, kinesiophobia and isometric hip strength?

DESIGN: Randomised trial with concealed allocation, blinded assessors and intention-to-treat analysis.

PARTICIPANTS: One hundred and sixty-eight people with chronic non-specific low back pain and aged between 18 and 60 years.

INTERVENTIONS: Participants were allocated to undertake 1-hour sessions of clinical Pilates at either high-intensity or low-intensity, twice per week for 6 weeks.

OUTCOME MEASURES: The primary outcomes were the numerical pain scale and the Roland Morris Disability Questionnaire at the end of the 6-week intervention period. The secondary outcomes were the Patient-Specific Functional Scale, the Tampa Scale for Kinesiophobia and isometric hip strength at 6 weeks. Pain and disability were also re-measured 6 and 12 months after the intervention.

RESULTS: The two Pilates regimens had negligible differences in effects on all outcomes at the end of the intervention period. At 6 and 12 months, the between-group differences in pain intensity were still negligible but the confidence intervals around those estimates spanned from around no effect to a worthwhile benefit (= 1.4) from low-intensity Pilates compared with high-intensity Pilates: 6-month MD 0.6 (95% CI -0.2 to 1.4) and 12-month MD 0.8 (95% CI 0.0 to 1.6). The effect on disability remained negligible at 6 and 12 months. Adverse events were less common in the low-intensity group: absolute risk reduction 0.20 (95% CI 0.10 to 0.31).

CONCLUSION: High-intensity and low-intensity Pilates had very similar effects on pain, disability and other outcomes in people with chronic non-specific low back pain. Physiotherapists should endorse low-intensity Pilates exercises for managing chronic non-specific low back pain because the effects on most outcomes are very similar to high-intensity Pilates exercise but there are fewer side effects.

REGISTRATION: RBR-2d2vb9.

Rehab Clinician (OT/PT) rater

Providing one of two homogeneous interventions to very heterogeneous groups results in no differences. From this study, it is quite possible that neither was effective. More likely that different intensity would suit different people, and people would be expected to progress resulting in a change in the best intensity for them. Surely, we can move beyond a one-size-fits-all approach, as suggested in the conclusions.

Rehab Clinician (OT/PT) rater

Here we face once again the mantra of a condition that is defined as a symptom: chronic non-specific low back pain. What is established is that exercise may be considered a nuanced and, at times, independent variable. This appears demonstrated in this study.

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