Supplemental Digital Content is Available in the Text.Longer stabilisation exercise durations and intervention frequencies of 2.5 times per week led to the largest symptom reductions in low back pain.

Good postural control is considered to be a key component of an active lifestyle, and numerous studies have investigated the Center of Pressure (CoP) as a way of identifying motor deficits. However, the optimal frequency range for assessing CoP variables and the effect of filtering on the relationships between anthropometric variables and CoP are unclear. The aim of this work is to show the relationship between anthropometric variables and different ways of filtering the CoP data. CoP was measured in 221 healthy volunteers using a KISTLER force plate in four different test conditions, both mono and bipedal. The results show no significant changes in the existing correlations of the anthropometric variable values over different filter frequencies between 10 Hz and 13 Hz. Therefore, the findings with regard to anthropometric influences on CoP, with a reasonable but less than ideal filtering of the data, can be applied to other study settings.

ObjectiveTo investigate the effects of individualised exercise interventions consisting with or without combined psychological intervention on pain intensity and disability in patients with chronic non-specific low back pain.DesignSystematic review with meta-analysis and meta-regression.Data sourcesFive databases (PubMed, Cochrane Central, EMBASE, Clarivate Web of Science, and Google Scholar) were searched up to 31 March 2021.Selection criteriaRandomised controlled trials were eligible if they included participants with chronic non-specific low back pain, compared at least one individualised/personalised/stratified exercise intervention with or without psychological treatment to any control / comparator group, and if they assessed at least pain intensity or disability as outcome measure.ResultsFifty-eight studies (n = 9099 patients, 44.3 years, 56% female) compared individualised to other types of exercise (n = 44; 62%), usual care (n = 16; 23%), advice to stay active, or true controls. The remaining studies had passive controls.At short-term follow-up, low-certainty evidence for pain intensity (SMD -0.33 [95%CI -0.47 to -0.18]) and very low-certainty evidence for disability (−0.16 [-0.30 to -0.02]) indicates effects of individualised exercise compared to other exercises. Very low-certainty evidence for pain intensity (−0.35; [-0.53 to - 0.17])) and low-certainty evidence for disability (−0.12; [-0.22 to -0.02]) indicates effects compared to passive controls.At long-term follow-up, moderate-certainty evidence for pain intensity (−0.14 [-0.23 to -0.06]) and disability (−0.23 [-0.33 to -0.12]) indicates effects compared to passive controls exercises.All findings stayed below the threshold for minimal clinically important difference (MCID). Certainty of evidence was downgraded mainly due to evidence of risk of bias, publication bias and inconsistency that could not be explained. Sensitivity analyses indicated that the effects on pain, but not on disability (always short-term and versus active treatments) were robust. Sub-group analysis of pain outcomes suggested that individualised exercise treatment is probably more effective in combination with psychological interventions (−0.32 [-0.51 to -0.14]), a clinically important differenceConclusionWe found very low to moderate-certainty evidence that individualised exercise is effective for treatment of chronic non-specific low back pain. Individualised exercise seems superior to other active treatments and sub-group analysis suggests that some forms of individualised exercise (especially motor-control based treatments) combined with behavioural therapy interventions enhances the treatment effect. Certainty of evidence was higher for long-term follow-up. In summary, individualised exercise can be recommended from a clinical point of view.

Objective: To investigate the effectiveness and mechanisms of a multimodal treatment including perturbation exercise directly applied in health care. Methods: A pragmatic, matched cohort study was conducted. Participants from the intervention group had chronic or recurrent low back pain and participated in a 12-week back pain prevention program. Coaches were trained to deliver multimodal care. Controls (usual care) were matched from a multi-center RCT. Outcomes were pain, disability, isokinetic trunk strength (extension/flexion) and balance (center of pressure trace). A Bayesian, sequential analysis along 8 matching procedures and moderation/mediation analyses incorporating the biopsychological avoidance-endurance model were conducted. Median values with highest posterior density intervals (HPDI) from baseline-adjusted analyses are presented. Results: Over 12 weeks, intervention and control experienced a similar decrease in pain and disability, which led to negligible average treatment effects for pain (0.5 HPDI95% [-3.6; 4.6]) and disability (1.5 HPDI95% [-2.3; 5.4]) for the intervention. Changes in functional strength and balance showed small but favorable effects for the intervention group, in particular for trunk extension (-4.1 Nm HPDI95% [-18.2, 10.0]) and monopedal stances (standardized score: 0.49 HPDI95% [0.13, 0.79]). Depression was higher in drop-outs and decreases in pain and disability were associated with decreases in depression. Distress-endurance subgroups experienced higher baseline pain and disability and showed the highest reductions in both parameters upon completion of the intervention. Conclusion: Multimodal treatments for low back pain without tailoring are possibly less effective in the context of health care than their efficacy in RCTs suggests. Targeting distress-endurance subgroups with a multimodal treatment approach is probably an effective strategy in treatment tailoring.