Gisela Cristiane Miyamoto

Efficacy of the Pilates method for pain and disability in patients with chronic nonspecific low back pain: a systematic review with meta-analysis

Objective To systematically review the available evidence on the efficacy of the Pilates method in patients with chronic nonspecific low back pain. Method Searches were performed in MEDLINE, EMBASE, PEDro, SciELO, LILACS, CINAHL and CENTRAL in March 2013. Randomized controlled trials that tested the effectiveness of the Pilates method (against a nontreatment group, minimal intervention or other types of interventions) in adults with chronic low back pain were included regardless the language of publication. The outcome data were extracted from the eligible studies and were combined using a meta-analysis approach. Results The searches identified a total of 1,545 articles. From these, eight trials were considered eligible, and seven trials were combined in the meta-analysis. The comparison groups were as follows: Pilates versus other types of exercises (n=2 trials), and Pilates versus no treatment group or minimal intervention (n=4 trials) for short term pain; Pilates versus minimal intervention for short-term disability (n=4).We determined that Pilates was not better than other types of exercises for reducing pain intensity. However, Pilates was better than a minimal intervention for reducing short-term pain and disability (pain: pooled mean difference=1.6 points; 95% CI 1.4 to 1.8; disability: pooled mean difference=5.2 points; 95% CI 4.3 to 6.1). Conclusions Pilates was better than a minimal intervention for reducing pain and disability in patients with chronic low back pain. Pilates was not better than other types of exercise for short-term pain reduction.

Efficacy of the addition of interferential current to Pilates method in patients with low back pain: a protocol of a randomized controlled trial

BackgroundChronic low back pain is one of the four most common diseases in the world with great socioeconomic impact. Supervised exercise therapy is one of the treatments suggested for this condition; however, the recommendation on the best type of exercise is still unclear. The Pilates method of exercise is effective in reducing pain and disability in these patients, as well as the analgesia promoted by interferential current. Currently, the literature lacks information on the efficacy of the association of these two techniques in the short- and medium-term than performing one of the techniques isolated. The objective of this study will be to evaluate the efficacy of adding interferential current to the Pilates method exercises for the treatment of patients with chronic nonspecific low back pain in the short- and medium-term.Methods/DesignThis study will be a randomized controlled trial with two arms and blinded evaluator, conducted at an outpatient Physical Therapy Department in Brazil. Patients with nonspecific chronic low back pain and pain equal to or greater than 3 in the Pain Numerical Rating Scale (0/10) will be randomly assigned to one of two groups: Group with active interferential current + Pilates (n = 74) will be submitted to the active interferential current associated to the modified Pilates exercises, and Group with sham interferential current + Pilates (n = 74) will be submitted to the sham interferential current associated with the modified Pilates exercises during 18 sessions. The outcomes pain intensity, pressure pain threshold, general and specific disability, global perceived effect and kinesiophobia will be evaluated by a blinded assessor at baseline, six weeks and six months after randomization.DiscussionBecause of the study design, blinding of the participants and the therapists involved in the study will not be possible. The results of this study could contribute to the process of clinical decision- making for the improvement of pain and disability in participants with nonspecific chronic low back pain.Trial registrationClinicalTrials.gov NCT01919268

Effectiveness and Cost-Effectiveness of Different Weekly Frequencies of Pilates for Chronic Low Back Pain: Randomized Controlled Trial

Background The Pilates method has been recommended to patients with low back pain, but the evidence on effectiveness is inconclusive. In addition, there is still no evidence for the cost-effectiveness of this method or for the ideal number of sessions to achieve the highest effectiveness. Objective The aim of this study will be to investigate the effectiveness and cost-effectiveness of the Pilates method with different weekly frequencies in the treatment of patients with nonspecific low back pain. Design This is a randomized controlled trial with blinded assessor. Setting This study will be conducted at a physical therapy clinic in São Paulo, Brazil. Participants Two hundred ninety-six patients with nonspecific low back pain between the ages of 18 and 80 years will be assessed and randomly allocated to 4 groups (n=74 patients per group). Intervention All groups will receive an educational booklet. The booklet group will not receive additional exercises. Pilates group 1 will follow a Pilates-based program once a week, Pilates group 2 will follow the same program twice a week, and Pilates group 3 will follow the same program 3 times a week. The intervention will last 6 weeks. Measurements A blinded assessor will evaluate pain, quality-adjusted life-years, general and specific disability, kinesiophobia, pain catastrophizing, and global perceived effect 6 weeks, 6 months, and 12 months after randomization. Limitations Therapists and patients will not be blinded. Conclusions This will be the first study to investigate different weekly frequencies of treatment sessions for nonspecific low back pain. The results of this study will contribute to a better definition of treatment programs for this population.

Is Interferential Current Before Pilates Exercises More Effective Than Placebo in Patients With Chronic Nonspecific Low Back Pain?: A Randomized Controlled Trial

OBJECTIVE To determine whether interferential current (IFC) before Pilates exercises is more effective than placebo in patients with chronic nonspecific low back pain. DESIGN Two-arm randomized controlled trial, with a blinded assessor, and 6 months follow-up. SETTING Clinic of a school of physical therapy. PARTICIPANTS The random sample consisted of patients (N=148) of both sexes, with age between 18 and 80 years and chronic nonspecific low back pain. In addition, participants were recruited by disclosure of the treatment in the media. INTERVENTIONS Patients were allocated into 2 groups: active IFC + Pilates or placebo IFC + Pilates. In the first 2 weeks, patients were treated for 30 minutes with active or placebo IFC. In the following 4 weeks, 40 minutes of Pilates exercises were added after the application of the active or placebo IFC. A total of 18 sessions were offered during 6 weeks. MAIN OUTCOME MEASURES The primary outcome measures were pain intensity, pressure pain threshold, and disability measured at 6 weeks after randomization. RESULTS No significant differences were found between the groups for pain (0.1 points; 95% confidence interval, -0.9 to 1.0 points), pressure pain threshold (25.3kPa; 95% confidence interval, -4.4 to 55.0kPa), and disability (0.4 points; 95% confidence interval, -1.3 to 2.2). However, there was a significant difference between baseline and 6-week and 6-month follow-ups in the intragroup analysis for all outcomes (P<.05), except pressure pain threshold in the placebo IFC + Pilates group. CONCLUSIONS These findings suggest that active IFC before Pilates exercise is not more effective than placebo IFC with respect to the outcomes assessed in patients with chronic nonspecific low back pain.

Alongamento muscular segmentar melhora função e alinhamento do joelho de indivíduos com síndrome femoropatelar: estudo preliminar

INTRODUCTION: Patellofemoral syndrome (PFS) is a common painful knee disorder and for its treatment, quadriceps femoris strengthening exercises are normally used; however, few studies in the literature investigate the direct effects of stretching exercises. OBJECTIVE: In order to fill this gap, the objective of this study was to evaluate the effects of segmental stretching exercises on the treatment of patients with PFS. METHODS: Twelve PFS patients with right foot dominance and mean age of 20 years were evaluated. The following functional variables were assessed, before and after treatment: Q angle, pain intensity, knee functional injury level (Lysholm scale), joint position sense (JPS) at 40 and 50 degrees of knee flexion and total work and concentric torque of quadriceps femoris and hamstring muscles at 60 and 180 degrees/sec. After initial evaluation, bilateral segmental stretching exercises for hamstring, triceps surae and quadriceps femoris muscles were performed, with 30-second duration and 10 repetitions on each muscle. Data obtained before and after treatment were analyzed by t test for dependent samples (α < 0.05). RESULTS: All variables showed significant difference after treatment (p < 0.05), except extensor muscular torque and total work at 60 degrees/sec, extensor and flexor total work at 180 degrees/sec and JPS at 40 and 50 degrees of knee flexion. CONCLUSION: Based on these results, we can state that segmental stretching exercises treatment improves major PFS signals and symptoms of patients, such as alignment, pain and knee function.

Can demographic and anthropometric characteristics predict clinical improvement in patients with chronic non-specific low back pain?

OBJECTIVE To identify potential prognostic factors that may predict clinical improvement of patients treated with different physical therapy interventions in the short-term. METHODS This is a prospective cohort study. A total of 616 patients with chronic non-specific low back pain treated with interventions commonly used by physical therapists were included. These patients were selected from five randomized controlled trials. Multivariate linear regression models were used to verify if sociodemographic characteristics (age, gender, and marital status), anthropometric variables (height, body mass, and body mass index), or duration of low back pain, pain intensity at baseline, and disability at baseline could be associated with clinical outcomes of pain intensity and disability four weeks after baseline. RESULTS The predictive variables for pain intensity were age (β=0.01 points, 95% CI=0.00 to 0.03, p=0.03) and pain intensity at baseline (β=0.23 points, 95% CI=0.13 to 0.33, p=0.00), with an explained variability of 4.6%. Similarly, the predictive variables for disability after four weeks were age (β=0.03 points, 95% CI=0.00 to 0.06, p=0.01) and disability at baseline (β=0.71 points, 95% CI=0.65 to 0.78, p=0.00), with an explained variability of 42.1%. CONCLUSION Only age, pain at baseline and disability at baseline influenced the pain intensity and disability after four weeks of treatment. The beta coefficient for age was statistically significant, but the magnitude of this association was very small and not clinically important.

Different doses of Pilates-based exercise therapy for chronic low back pain: a randomised controlled trial with economic evaluation

Objectives To evaluate the effectiveness and cost-utility of the addition of different doses of Pilates to an advice for non-specific chronic low back pain (NSCLBP) from a societal perspective. Design Randomised controlled trial with economic evaluation. Setting Physiotherapy clinic in São Paulo, Brazil. Participants 296 patients with NSCLBP. Interventions All patients received advice and were randomly allocated to four groups (n=74 per group): booklet group (BG), Pilates once a week (Pilates group 1, PG1), Pilates twice a week (Pilates group 2, PG2) and Pilates three times a week (Pilates group 3, PG3). Main outcome measures Primary outcomes were pain and disability at 6-week follow-up. Results Compared with the BG, all Pilates groups showed significant improvements in pain (PG1, mean difference (MD)=−1.2, 95% CI −2.2 to −0.3; PG2, MD=−2.3, 95% CI −3.2 to −1.4; PG3, MD=−2.1, 95% CI −3.0 to −1.1) and disability (PG1, MD=−1.9, 95% CI −3.6 to −0.1; PG2, MD=−4.7, 95% CI −6.4 to −3.0; PG3, MD=−3.3, 95% CI −5.0 to −1.6). Among the different doses, PG2 showed significant improvements in comparison with PG1 for pain (MD=−1.1, 95% CI −2.0 to −0.1) and disability (MD=−2.8, 95% CI −4.5 to −1.1). The cost-utility analysis showed that PG3 had a 0.78 probability of being cost-effective at a willingness-to-pay of £20 000 per quality-adjusted life-year gained. Conclusions Adding two sessions of Pilates exercises to advice provided better outcomes in pain and disability than advice alone for patients with NSCLBP; non-specific elements such as greater attention or expectation might be part of this effect. The cost-utility analysis showed that Pilates three times a week was the preferred option. Trial registration number NCT02241538, Completed.

Cost-effectiveness of exercise therapy in the treatment of non-specific neck pain and low back pain: a systematic review with meta-analysis

Objective To investigate the cost-effectiveness of exercise therapy in the treatment of patients with non-specific neck pain and low back pain. Design Systematic review of economic evaluations. Data sources The search was performed in 5 clinical and 3 economic electronic databases. Eligibility criteria for selecting studies We included economic evaluations performed alongside randomised controlled trials. Differences in costs and effects were pooled in a meta-analysis, if possible, and incremental cost-utility ratios (ICUR) were descriptively analysed. Results Twenty-two studies were included. On average, exercise therapy was associated with lower costs and larger effects for quality-adjusted life-year (QALY) in comparison with usual care for subacute and chronic low back pain from a healthcare perspective (based on ICUR). Exercise therapy had similar costs and effect for QALY in comparison with other interventions for neck pain from a societal perspective, and subacute and chronic low back pain from a healthcare perspective. There was limited or inconsistent evidence on the cost-effectiveness of exercise therapy compared with usual care for neck pain and acute low back pain, other interventions for acute low back pain and different types of exercise therapy for neck pain and low back pain. Conclusions Exercise therapy seems to be cost-effective compared with usual care for subacute and chronic low back pain. Exercise therapy was not (more) cost-effective compared with other interventions for neck pain and low back pain. The cost-utility estimates are rather uncertain, indicating that more economic evaluations are needed. Registration PROSPERO, CRD42017059025.

Comparison of satisfaction, motivation, flexibility and delayed onset muscle soreness between modern Pilates method and unstable Pilates method

The aim of our study was to compare the satisfaction and motivation for the practice of exercise, flexibility and delayed onset muscle soreness (DOMS) in healthy participants after exercises in two types of the Pilates method. For this, 50 healthy participants performed a session of exercises of modern Pilates and other of unstable Pilates. We evaluated the outcomes for satisfaction and motivation after sessions, posterior flexibility of the torso and lower extremities (sit-and-reach box) before and after each session, and DOMS 24, 48 and 72 hours after each session (Numeric Pain Rating Scale). Results showed no statistically significant difference between both types of Pilates for satisfaction and motivation, flexibility and DOMS 72 hours after the session (p>;0.05). Regarding the DOMS we observed statistically significant difference between the two types 24 hours (difference between the means: -0.7; 95%CI: -1.5 to 0.0) and 48 hours (difference between means: -0.8; 95%CI: -1.4 to -0.2) after the session, with greater pain in unstable Pilates. As a conclusion, both categories of Pilates showed the same level of satisfaction and motivation and similar flexibility gain. However, unstable Pilates caused more DOMS after 24 and 48 hours, but this difference was not clinically relevant.| The aim of our study was to compare the satisfaction and motivation for the practice of exercise, 427 flexibility and delayed onset muscle soreness (DOMS) in healthy participants after exercises in two types of the Pilates method. For this, 50 healthy participants performed a session of exercises of modern Pilates and other of unstable Pilates. We evaluated the outcomes for satisfaction and motivation after sessions, posterior flexibility of the torso and lower extremities (sit-andreach box) before and after each session, and DOMS 24, 48 and 72 hours after each session (Numeric Pain Rating Scale). Results showed no statistically significant difference between both types of Pilates for satisfaction and motivation, flexibility and DOMS 72 hours after the session (p>0.05). Regarding the DOMS we observed statistically significant difference between the two types 24 hours (difference between the means: -0.7; 95%CI: -1.5 to 0.0) and 48 hours (difference between means: -0.8; 95%CI: -1.4 to -0.2) after the session, with greater pain in unstable Pilates. As a conclusion, both categories of Pilates showed the same level of satisfaction and motivation and similar flexibility gain. However, unstable Pilates caused more DOMS after 24 and 48 hours, but this difference was not clinically relevant.

Comparación de la satisfacción, motivación, flexibilidad y dolor muscular tardío entre el método Pilates moderno y el método Pilates inestable

The aim of our study was to compare the satisfaction and motivation for the practice of exercise, flexibility and delayed onset muscle soreness (DOMS) in healthy participants after exercises in two types of the Pilates method. For this, 50 healthy participants performed a session of exercises of modern Pilates and other of unstable Pilates. We evaluated the outcomes for satisfaction and motivation after sessions, posterior flexibility of the torso and lower extremities (sit-and-reach box) before and after each session, and DOMS 24, 48 and 72 hours after each session (Numeric Pain Rating Scale). Results showed no statistically significant difference between both types of Pilates for satisfaction and motivation, flexibility and DOMS 72 hours after the session (p>;0.05). Regarding the DOMS we observed statistically significant difference between the two types 24 hours (difference between the means: -0.7; 95%CI: -1.5 to 0.0) and 48 hours (difference between means: -0.8; 95%CI: -1.4 to -0.2) after the session, with greater pain in unstable Pilates. As a conclusion, both categories of Pilates showed the same level of satisfaction and motivation and similar flexibility gain. However, unstable Pilates caused more DOMS after 24 and 48 hours, but this difference was not clinically relevant.| The aim of our study was to compare the satisfaction and motivation for the practice of exercise, 427 flexibility and delayed onset muscle soreness (DOMS) in healthy participants after exercises in two types of the Pilates method. For this, 50 healthy participants performed a session of exercises of modern Pilates and other of unstable Pilates. We evaluated the outcomes for satisfaction and motivation after sessions, posterior flexibility of the torso and lower extremities (sit-andreach box) before and after each session, and DOMS 24, 48 and 72 hours after each session (Numeric Pain Rating Scale). Results showed no statistically significant difference between both types of Pilates for satisfaction and motivation, flexibility and DOMS 72 hours after the session (p>0.05). Regarding the DOMS we observed statistically significant difference between the two types 24 hours (difference between the means: -0.7; 95%CI: -1.5 to 0.0) and 48 hours (difference between means: -0.8; 95%CI: -1.4 to -0.2) after the session, with greater pain in unstable Pilates. As a conclusion, both categories of Pilates showed the same level of satisfaction and motivation and similar flexibility gain. However, unstable Pilates caused more DOMS after 24 and 48 hours, but this difference was not clinically relevant.