Rajpal 2008.
| Methods | Randomised controlled trial performed in the outpatient department of Sardar Bhagwan Singh Post Graduate Institute of Biomedical Sciences and Research, Balawala, Dehradun | |
| Participants | 40 female participantsaged 20 to 30 years with low back pain Settings: not reported Country: India Inclusion criteria: patients with postural low back pain for 3 months; female; in the age range 20 to 30 years; standing pelvic tilt angle of 9º or more; reduced abdominal muscle strength Exclusion criteria: sciatica or any neurological deficit; soft tissue injuries; spinal fractures; disc prolapse; back pain due to structural deformity, infection, tumour |
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| Interventions | 1. Pilates group: participants were given Pilates exercises for 1 month. The exercises were done 10 times with 10 seconds hold in between, daily. The participants were made to lie in crook lying with hip and knee flexed. In this position, the lumbar spine is neither arched up nor flattened against the floor, but is aligned normally with a small gap between the floor and the back. The participants were asked to breathe in deeply and relax all the stomach muscles. While breathing out, the participant draws the lower abdomen inwards as if the umbilicus goes backwards and upwards.The contraction was held for 10 seconds and then relaxed. This exercise was done 10 times daily for 10 days. The participants were made to lie in quadruped/4‐point kneeling position and were allowed to do the same contractions for 10 times daily for next 10 days. The participants were made to sit on an exercise ball with both hands over the pelvis and were made to perform the same contractions and, along with that, were made to extend their leg simultaneously. This exercise was performed 10 times daily for the next 10 days 2. McKenzie group: participants were taught postural correction and re‐education. The participants were told that as a person sits, the spine sooner or later takes a relaxed posture and the lumbar spine moves into a fully flexed position that places stress over the various ligamentous structures. This position is painful if maintained for longer period. The participants were taught how to obtain and maintain the sitting posture for longer periods. To obtain the correct sitting posture, this includes 'slouch‐overcorrect' procedure. The participants were made to sit slouched on a backless chair or stool, allowing the lumbar spine to rest on the ligaments in the fully flexed position and permit head and chin to protrude. Then, slowly moved into the erect sitting posture with the lordosis at its maximum and the head held directly over the spine with the chin pulled up. This sequence was repeated for 3 times daily, 15 to 20 times at each session Once they had mastered this procedure, they were advise to follow this procedure whenever they feel pain and maintain the position. To maintain the correct sitting position, the participants were taught about maintaining the lumbar lordosis in 2 ways: a) actively by conscious control of the lordosis, when sitting on a chair without back rest; and b) passively by using the lumbar support, when sitting on a seat with a back rest. The lumbar roll was used to hold the lumbar spine in a good position while prolonged sitting. The roll was placed at or just above the belt line (area of L3 and L4 vertebrae). This procedure was repeated for 3 times daily, 15 to 20 times at each session. The participants were made to stand and moving the lower part of the spine backwards by tightening the abdominal muscles and tilting the pelvis posteriorly, while at the same time move the upper spine forwards and raising the chest. This procedure was repeated for 3 times daily, 15 to 20 times at each session |
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| Outcomes | 1. Pain: visual analogue scale (VAS) | |
| Notes | No statement about conflicts of interest or funding provided Adverse events: not evaluated |
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| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Review authors' comment: the sequence generation procedure or the method of allocation were not mentioned. The title, abstract and flowchart indicate that it is a RCT |
| Allocation concealment (selection bias) | Unclear risk | Review authors' comment: the sequence generation procedure or the method of allocation were not mentioned. The title, abstract and flowchart indicate that it is a RCT |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | No mention of any attempts to blind the patients |
| Blinding of personnel/care providers (performance bias) All outcomes | High risk | No mention of any attempts to blind the care providers |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | No mention of any attempts to blind the assessors |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | The percentage of withdrawals and dropouts was within the acceptable range |
| Intention‐to‐treat analysis | High risk | Not mentioned |
| Selective reporting (reporting bias) | Low risk | It was clear that the published report included all expected outcomes |
| Group similarity at baseline (selection bias) | Low risk | Patients did not differ in their baseline characteristics, based on the Table 1 |
| Co‐interventions (performance bias) | Unclear risk | Not mentioned |
| Compliance (performance bias) | Unclear risk | There are not enough data |
| Timing of outcome assessments (detection bias) | Low risk | All important outcome assessments for both groups were measured at the same time |