Table 2.

Systematic reviews and meta-analyses investigating the effect of MCE on low back pain.

Source/intervention vs control	Outcomes				Result, MD (95% CI)	Interpretations
	Scale	Duration	Sample size	Group number		Effect	P1	P2	Heterogeneity	I2	Quality of evidence	Effect size	Other
Owen et al. (5)
Stabilization vs no treatment
Pain			1062	39	−1.31 (−1.75 to −0.87)*	Favors stabilization	<0.001						SUCRAs of 80%
Disability			1062	39	−1.13 (−1.53 to −0.74)*	Favors stabilization	<0.001						SUCRAs of 80%
Mental health			1062	39	−0.78 (−1.49 to −0.07)*	Favors stabilization	0.031						SUCRAs of 50%
Bernard et al. (25)
PFMT + exercise vs exercise
Pain	VAS		157	4	−0.61 (−0.91 to −0.31)	Favors MCE	<0.0001		Low	0%	Very low
Disability	ODI		157	4	−0.87 (−3.21 to 1.46)	Comparable	0.46		High	77%
Byström et al. (13)
MCE vs general exercise
Pain	0–100	6–16 wk	529	6	−7.80 (−10.95 to −4.65)	Favors MCE
Pain	0–100	4–8 mo	523	3	−6.06 (−10.94 to −1.18)	Favors MCE
Pain	0–100	8–15 months	632	4	−3.10 (−7.03 to 0.83)	Comparable
Disability	0–100	6–16 wk	480	5	−4.65 (−6.20 to −3.11)	Favors MCE
Disability	0–100	4–8 mo	523	3	−4.86 (−8.59 to −1.13)	Favors MCE
Disability	0–100	8–15 mo	523	3	−4.72 (−8.81 to −0.63)	Favors MCE
MCE vs spinal manual therapy
Pain	0–100	6–16 wk	633	3	−1.32 (−6.30 to 3.65)	Comparable
Pain	0–100	4–8 mo	586	2	−2.31 (−7.85 to 3.22)	Comparable
Pain	0–100	8–15 mo	633	3	−0.43 (−5.47 to 4.62)	Comparable
Disability	0–100	6–16 wk	633	3	−6.12 (−11.94 to −0.30)	Favors MCE
Disability	0–100	4–8 mo	586	2	−5.27 (−9.52 to −1.01)	Favors MCE
Disability	0–100	8–15 mo	633	3	−5.76 (−9.21 to −2.32)	Favors MCE
MCE vs minimal intervention
Pain	0–100	6–16 wk	500	2	−12.48 (−19.04 to −5.93)	Favors MCE
Pain	0–100	4–8 mo	500	2	−10.18 (−16.64 to −3.72)	Favors MCE
Pain	0–100	8–15 mo	500	2	−13.32 (−19.75 to −6.90)	Favors MCE
Disability	0–100	6–16 wk	541	3	−9.00 (−15.28 to −2.73)	Favors MCE
Disability	0–100	4–8 mo	500	2	−5.62 (−10.46 to −0.77)	Favors MCE
Disability	0–100	8–15 mo	500	2	−6.64 (−11.72 to −1.57)	Favors MCE
MCE vs multimodal PT
Pain	0–100	4–8 mo	499	4	−14.20 (−21.23 to −7.16)	Favors MCE
Disability	0–100	4–8 mo	656	2	−12.98 (−19.49 to −6.47)	Favors MCE
Gomes-Neto et al. (24)
STE vs general exercise
Pain	0–10		603	8	−1.03 (−1.79 to −0.27)	Favors stabilization	0.008	<0.00001	High	86%
Disability	ODI		209	5	−5.41 (−8.34 to −2.49)	Favors stabilization	0.0003	0.0002	High	82%
Disability	RMDQ		310	2	−0.75 (−2.26 to 0.75)	Comparable effect	0.33	0.95	Low	0%
STE vs manual therapy
Pain	0–10		358	3	−0.38 (−0.98 to 0.22)	Comparable effect	0.22	0.75	Low	0%
Disability			358	3	−0.17 (−0.38 to 0.03)*	Comparable effect	0.10	0.58	Low	0%
Luomajoki et al. (18)
MCE vs control intervention
Pain		Post-treatment	541	9	−0.39 (−0.73 to −0.04)*	Favors MCE	0.03	0.23	Low	29%,
Pain		12-mo FU	366	5	−0.27 (−0.62 to 0.09)*	Comparable effect	0.14	0.02	High	75%
Disability		Post-treatment	642	11	−0.38 (−0.68 to −0.09)*	Favors MCE	0.01	0.47	Low	0%		Small
Disability		12-mo FU	425	6	−0.37 (−0.69 to −0.04)*	Favors MCE	0.03	0.09	Moderate	58%		Small
Macedo et al. (14)
MCE vs other exercises
Pain	0–100	0–3 mo	82	2	5.74 (−3.34 to 14.82)	Comparable effect	0.22	0.93	Low	0%	Moderate
Pain	0–100	3–12 mo	33	1	−1.20 (−18.24 to 15.84)	Comparable effect	0.89				Low
Disability	0–100	0–3 mo	116	2	−0.84 (−8.72 to 7.04)	Comparable effect	0.83	0.28	Low	15%	Moderate
Disability	0–100	3–12 mo	33	1	−6.70 (−22.80 to 9.40)	Comparable effect	0.41				Low
Disability	0–100	> 12 mo	83	1	5.70 (−1.38 to 12.78)	Comparable effect	0.11				Low
MCE vs manual therapy
Pain	0–100	0–3 mo	58	1	9.0 (−1.56 to 19.56)	Comparable effect	0.095				Low
Disability	0–100	0–3 mo	85	1	4.0 (−3.38 to 11.38)	Comparable effect	0.29				Low
Disability	0–100	>12 mo	85	1	3.70 (−4.10 to 11.50)	Comparable effect	0.35				Low
MCE + MM vs MM
Pain	0–100	0–3 mo	41	1	−9.3 (−20.41 to 1.81)	Comparable effect	0.10				Very low
Disability	0–100	0–3 mo	41	1	−2.4 (−4.87 to 0.07)	Comparable effect	0.057				Very low
Niederer et al. (23)
MCE vs no additional exercise
Current pain		3 wk	2137	17	−0.15 (−0.28 to −0.02)*	Favors MCE	0.03	0.02	Moderate	47%	Moderate	Larger
Current pain		6 wk	1875	18	−0.15 (−0.24 to −0.06)*	Favors MCE	0.002	0.70	Low	0%	Moderate	Larger
Current pain		6 mo	1692	16	−0.19 (−0.28 to −0.09)*	Favors MCE	0.0002	0.55	Low	0%	High	Larger
Characteristic pain		3 wk	2137	17	−0.19 (−0.35 to −0.04)*	Favors MCE	0.01	0.0005	High	61%	Moderate	Larger
Characteristic pain		6 wk	1835	17	−0.26 (−0.38 to −0.14)*	Favors MCE	< 0.0001	0.15	Low	27%	High	Larger
Characteristic pain		6 mo	1692	16	−0.25 (−0.38 to −0.11)*	Favors MCE	0.0003	0.07	Moderate	36%	Moderate	Larger
Disability		3 wk	2137	17	−0.24 (−0.33 to −0.15)*	Favors MCE	<0.00001	0.44	Low	1%	High	Larger
Disability		6 wk	1835	17	−0.27 (−0.40 to −0.13)*	Favors MCE	<0.0001	0.04	Moderate	41%	High	Larger
Disability		6 mo	1692	16	−0.25 (−0.39 to −0.11)*	Favors MCE	0.0004	0.04	Moderate	41%	Moderate	Larger
Niederer & Mueller (19)
MCE vs control intervention
Pain			1210	13	−0.46 (−0.78 to −0.14)*	Favors MCE	0.004	<0.00001	High	86%	Low- to-moderate
Disability			7311	12	−0.44 (−0.80 to −0.09)*	Favors MCE	0.01	<0.00001	High	88%	Low- to-moderate
Saragiotto et al. (10)
MCE vs other exercises
Pain	0–100	0–3 mo	872	13	−7.53 (−10.54 to −4.52)	Favors MCE	<0.00001	0.05	Moderate	43%		Small	No clinical importance
Pain	0–100	3–12 mo	588	6	−2.98 (−6.96 to 0.99)	Comparable effect	0.14	0.90	Low	0%	High
Pain	0–100	>12 mo	643	5	−2.69 (−6.90 to 1.53)	Comparable effect	0.21	0.76	Low	0%	High
Disability	0–100	0–3 mo	794	11	−4.82 (−6.95 to −2.68)	Favors MCE	<0.00001	0.03	Moderate	50%	Low quality	Small	No clinical importance
Disability	0–100	3–12 mo	588	6	−2.88 (−6.92 to 1.15)	Comparable effect	0.16	0.58	Low	0%	High
Disability	0–100	>12 mo	570	4	−0.71 (−4.87 to 3.45)	Comparable effect	0.74	0.81	Low	0%	High
Mental health	0–100	0–3 mo	269	2	−0.75 (−3.33 to 1.83)	Comparable effect	0.57	0.62	Low	0%	Moderate
MCE vs manual therapy
Pain	0–100	0–3 mo	282	3	−4.36 (−9.52 to 0.81)	Comparable effect	0.098	0.55	Low	0%	Moderate
Pain	0–100	3–12 mo	485	4	−7.05 (−14.20 to 0.11)	Comparable effect	0.054	0.08	Moderate	55%	Moderate
Pain	0–100	>12 mo	406	4	−3.67 (−9.28 to 1.94)	Comparable effect	0.20	0.64	Low	0%	High
Disability	0–100	0–3 mo	282	3	−2.79 (−6.60 to 1.02)	Comparable effect	0.15	0.69	Low	0%	Moderate
Disability	0–100	3–12 mo	485	4	−3.28 (−6.97 to 0.40)	Comparable effect	0.08	0.41	Low	0%	High
Disability	0–100	>12 mo	406	4	−3.40 (−7.87 to 1.07)	Comparable effect	0.14	0.79	Low	0%	High
MCE vs minimal intervention
Pain	0–100	0–3 mo	291	4	−10.01 (−15.67 to −4.35)	Favors MCE	0.00053	0.19	Moderate	37%	Moderate	Medium	Clinically important
Pain	0–100	3–12 mo	348	4	−12.61 (−20.53 to −4.69)	Favors MCE	0.0018	0.08	Moderate	56%	Low	Medium	Clinically important
Pain	0–100	>12 mo	279	3	−12.97 (−18.51 to −7.42)	Favors MCE	<0.00001	0.95	Low	0%,	Moderate-	Medium	Clinically important
Disability	0–100	0–3 mo	332	5	−8.63 (−14.78 to −2.47)	Favors MCE	0.0060	0.004	High	74%	Very low	Small	No clinical importance
Disability	0–100	3–12 mo	348	4	−5.47 (−9.17 to −1.77)	Favors MCE	0.0038	0.25	Low	28%	Moderate	Small	No clinical importance
Disability	0–100	>12 mo	279	3	−5.96 (−9.81 to −2.11)	Favors MCE	0.0024	0.39	Low	0%	Moderate	Small	No clinical importance
MCE vs exercise + EP agents
Pain	0–100	0–3 mo	68	2	−30.18 (−35.32 to −25.05)	Favors MCE	<0.00001	0.44	Low	0%	Low	Large	Clinically important
Pain	0–100	3–12 mo	179	2	−19.39 (−36.83 to −1.96)	Favors MCE	0.029	0.029	High	95%	Very low	Small	No clinical importance
Smith et al. (21)
MCE vs control intervention
Pain	0–100	0–3 mo			−7.93 (−11.74 to −4.12)	Favors MCE†			High	67%	High		No clinical importance
Pain	0–100	3–12 mo			−6.10 (−10.54 to −1.65)	Favors MCE†			Moderate	50%	High		No clinical importance
Pain	0–100	> 12 months			−6.39 (−10.14 to −2.65)	Favors MCE†			Moderate	45%	High		No clinical importance
Disability	0–100	0–3 mo			−3.61 (−6.53 to −0.70)	Favors MCE†			High	83%	High		No clinical importance
Disability	0–100	3–12 months			−2.31 (−5.85 to 1.23)	Comparable effect			High	65%
Disability	0–100	> 12 mo			−3.92 (−7.25 to −0.59)	Favors MCE†			Moderate	56%	High		No clinical importance
Wang et al. (12)
MCE vs general exercise
Pain	0–10	0–3 mo	290	4	−1.29 (−2.47 to −0.11)	Favors MCE	0.03	0.0002	High	85%
Pain	0–10	>12 mo	284	3	−0.32 (−0.87 to 0.23)	Comparable effect	0.25	0.60	Low	0%
Disability	ODI	0–3 mo	256	4	−7.14 (−11.64 to 2.65)	Favors MCE	0.002	0.0007	High	82%
Zhang et al. (22)
MCE vs other treatments
Pain		Post-treatment	1489	20	−0.43 (−0.66 to −0.20)*	Favors MCE	0.0003	<0.00001	High	76%	Very low	Small
Pain		6-mo FU	826	6	−0.18 (−0.32 to −0.04)*	Favors MCE	0.01	0.32	Low	14%	Moderate	Small
Pain		12-mo FU	802	7	−0.08 (−0.22 to 0.06)*	Comparable effect	0.25	0.69	Low	0%	High
Pain		24-mo FU	802	7	−0.25 (−0.61 to 0.11)*	Comparable effect	0.18	0.26	Low	20%	Low
Disability		Post-treatment	1437	19	−0.39 (−0.64 to −0.13)*	Favors MCE	0.003	<0.00001	High	80%	Very low	Small
Disability		6-mo FU	826	6	−0.13 (−0.26 to 0.01)*	Comparable effect	0.08	0.43	Low	0%	High
Disability		12-mo FU	820	6	−0.13 (−0.27 to 0.01)*	Comparable effect	0.07	0.98	Low	0%	High
Disability		24-mo FU	126	2	−0.11 (−0.47 to 0.24)*	Comparable effect	0.53	0.60	Low	0%	Very low
Hayden et al. (17)
CS vs minimal treatment
Pain	0–100		2476	61	−13.4 (−17.2 to −9.6)	Favors CS;							No clinical importance
Disability	0–100		2320	56	−6.6 (−9.0 to −4.3)	Favors CS;							No clinical importance
Searle et al. (20)
STE vs other interventions
Pain			1343	12	−0.47 (−0.77 to −0.18)*	Favors stabilization†		< 0.01	High	83.2%		Small
Zhang et al. (72)
CST vs control intervention
Pain			144	4	−0.89 (−1.94 to 0.16)*	Comparable effect	0.1		High	88%

P1 values in bold indicate significant effect. P1 indicates difference of outcomes and P2 indicates differences in heterogeneity between intervention and control groups.

*Values are standard mean difference (95% CI); ^†indicates significant effect.

CS, core strengthening; CST, core strength training; EP, electrophysical; MCE, motor control exercise;MM, medical management; mo, months; ODI, Oswestry Disability Index; PFMT, Pelvic floor muscles training; PT, physical therapy; RMDQ, Roland-Morris Disability Questionnaire; STE, stabilization exercise; SUCRA, surface under cumulative ranking; VAS, visual analogue scale; wk, weeks.