Mind-Body Exercise Performed by Physical Therapists for Reducing Pain and Disability in Low Back Pain: A Systematic Review With Meta-analysis.

Only 8 trials met criteria, and 7 of them were Pilates. No tai chi trials qualified and only one yoga trial was included, so the findings cannot be generalised to other mind-body exercises. Three of the 8 trials came from the same research group, raising concerns about repeatability and generalisability. All studies enrolled patients with chronic LBP (over 3 months); nothing here applies to acute or subacute presentations. Several samples were heavily weighted toward women over 45, limiting generalisability to younger or male patients. No study blinded participants, and 5 of 8 trials had moderate or high risk of bias on at least one domain. Heterogeneity was high (I² 80–96%) in most pooled analyses, and GRADE certainty was very low for both pain and disability. The search was limited to publications from December 2010 to June 2020, so both older and newer evidence is excluded. Inclusion required authors to explicitly state that a physical therapist delivered the intervention, which may have excluded relevant trials that did not report this detail.

Authors declare no competing interests. The work was supported by NIH extramural funding (as listed in the publication types).

Do not read the large long-term point estimates (SMD −0.60 for pain, −1.05 for disability) as proof of a lasting benefit. Both confidence intervals cross zero, so the data are compatible with no effect at all. The authors' conclusion that Pilates is 'more effective in the long term for pain' is not supported by their own confidence intervals. Also, 7 of 8 trials were Pilates, so these results cannot be extended to yoga, tai chi, or other mind-body exercises.