Predictive factors for progression through the difficulty levels of Pilates exercises in patients with low back pain: a secondary analysis of a randomized controlled trial

A qualitative systematic review of the views, experiences and perceptions of Pilates-trained physiotherapists and their patients

OBJECTIVES

A review of qualitative studies exploring Pilates-trained physiotherapists and their patients' perspectives and experiences of Pilates, aiming to improve practice and provide a deeper insight into the way this method is being utilized along with its effects on participants.

DESIGN

Qualitative evidence synthesis using meta-ethnography.

DATA SOURCES

A comprehensive search strategy, limited to English language articles, was conducted to MEDLINE (PubMed), EMBASE, CINAHL, PEDro and Cochrane Central for the period of January 2000 (inception) to June 2020. This was supplemented by identification of Grey literature through Google Scholar, website searching and reference lists.

STUDY SELECTION

Qualitative studies reporting experiences and perceptions of patients' or Pilates-trained physiotherapists' regarding the efficacy of Pilates for the management of chronic musculoskeletal conditions. After a process of exclusion, eight studies were included in the synthesis.

DATA EXTRACTION

The textual data were analysed by a qualitative software program. Studies were critically appraised independently by two reviewers.

DATA SYNTHESIS

Articles were synthesized using a technique of meta-ethnography. Three themes emerged from the process of reciprocal translation: (1) Benefits of the Pilates approach; (2) most effective ways to utilize and most beneficial parameters and (3) risks, precautions, contraindications and indications.

CONCLUSION

This is the first qualitative evidence synthesis of practitioners' and patients' perspectives of Pilates. Findings support evidence for the various benefits of this approach and provide fresh insight into the way this method can be practiced to maximize efficiency and focus on the patients' needs.

KEY RECOMMENDATIONS

Pilates-trained physiotherapists identified that Pilates can be tailored to individual requirements, preferences and needs, to promote self-management to facilitate clinical and cost-effective care.

Fear-avoidance beliefs are associated with exercise adherence: secondary analysis of a randomised controlled trial (RCT) among female healthcare workers with recurrent low back pain

Background

Exercise is recommended for the treatment and management of low back pain (LBP) and the prevention of chronicity. Exercise adherence has been only modest in intervention studies among people with musculoskeletal pain. Fear-avoidance beliefs (FABs) are known to affect exercise adherence.

The purpose was twofold: to examine which bio-psycho-social factors contributed to exercise adherence during a 6-month neuromuscular exercise intervention among female healthcare workers with recurrent LBP, and to investigate how exercising affects FABs at 6 and 12 months’ follow-up.

Methods

Some 219 healthcare workers aged 30–55 years with mild-to-moderate re-current non-specific LBP were originally allocated into: 1) exercise, 2) counselling, 3) combined exercise and counselling, and 4) control groups. In the present secondary analysis, groups 1 and 3 (exercise only and exercise+counselling) were merged to be exercisers and groups 2 and 4 were merged to be non-exercisers. Baseline variables of the exercise compliers (≥24 times over 24 weeks; n = 58) were compared to those of the non-compliers (< 1 time/week, 0–23 times; n = 52). The effects of the exercise programme on FABs were analysed by a generalised linear mixed model according to the intention-to-treat principle (exercisers; n = 110 vs non-exercisers; n = 109) at three measurement points (baseline, 6, and 12 months). A per-protocol analysis compared the more exercised to the less exercised and non-exercisers.

Results

A low education level (p = 0.026), shift work (p = 0.023), low aerobic (p = 0.048) and musculoskeletal (p = 0.043) fitness, and high baseline physical activity-related FABs (p = 0.019) were related to low exercise adherence. The exercise programme reduced levels of both physical activity- and work-related FABs, and there was a dose response: FABs reduced more in persons who exercised ≥24 times compared to those who exercised 0–23 times.

Conclusion

Healthcare workers who had lower education and fitness levels, worked shifts, and had high physical activity-related FABs had a lower adherence to the 6-month neuromuscular exercise programme. Exercising with good adherence reduced levels of FABs, which have been shown to be linked with prolonged LBP. Motivational strategies should be targeted at persons with low education and fitness levels and high FABs in order to achieve better exercise adherence.