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Pilates for Low Back Pain: Complete Republication of a Cochrane Review

Yamato, Tiê P., MSc; Maher, Christopher G.; Saragiotto, Bruno T., MSc; Hancock, Mark J., PhD; Ostelo, Raymond W.J.G.‡,§; Cabral, Cristina M.N., PhD; Costa, Luciola C. Menezes, PhD; Costa, Leonardo O.P., PhD∗,¶

doi: 10.1097/BRS.0000000000001398

Study Design. Systematic review.

Objective. To determine the effects of the Pilates method for patients with nonspecific acute, subacute, or chronic low back pain.

Summary of Background Data. The Pilates method is one of the most common forms of intervention based on exercise used for treating patients with low back pain. However, its effectiveness is not well established.

Methods. We conducted searches on CENTRAL, MEDLINE, EMBASE, CINAHL, PEDro, and SPORTDiscus up to March 2014. We included randomized controlled trials examining the effectiveness of Pilates in patients with acute, subacute, or chronic nonspecific low back pain. The outcomes evaluated were pain, disability, function, and global impression of recovery. Two independent reviewers screened for potentially eligible studies, assessed risk of bias, and extracted the data. We evaluated the overall quality of evidence using the GRADE approach and treatment effect sizes were described using mean differences and 95% confidence intervals.

Results. Searches retrieved 126 trials, of which 10 were included in the review (n = 510 participants). Seven studies were considered to have low risk of bias, and three were considered at high risk of bias. When compared to minimal intervention, Pilates reduces pain at short and intermediate term with low- to moderate-quality evidence and medium effect sizes. For disability, there is also a significant difference in favor to Pilates with low- to moderate-quality evidence and small effect size for short term and medium effect size for intermediate term compared with minimal intervention. It is unclear whether Pilates is better than other exercises for short-term pain, but there is low-quality evidence that Pilates reduces pain at intermediate term. For disability, there is moderate-quality evidence that there is no significant difference between Pilates and other exercises in either the short term or the intermediate term.

Conclusion. There is low- to moderate-quality evidence that Pilates is more effective than minimal intervention with most of the effect sizes being considered medium. However, there is no conclusive evidence that Pilates is superior to other forms of exercises.

Level of Evidence: 1

Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia

Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia

Department of Health Sciences, EMGO Institute for Health and Care Research, VU University, Amsterdam, Netherlands

§Department of Epidemiology and biostatistics, VU University medical centre, Amsterdam, Netherlands

Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.

Address correspondence and reprint requests to Tiê P. Yamato, MSc, Level 13, 321 Kent Street/Sydney NSW 2000 Australia; E-mail:

Received 9 November, 2015

Accepted 28 November, 2015

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants.

Copyright © 2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.