Kumar 2009.
| Methods | Randomised controlled trial | |
| Participants | 30 hockey players included Inclusion criteria: male hockey players from Sports Authority of India (SAI), Lucknow, aged 18 to 28 years, who were diagnosed clinically by a physician with no neurological involvement but having symptomatic (overuse, overload or overstretching) non‐specific subacute or chronic low back pain Exclusion criteria: no neurological involvement |
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| Interventions | After group allocations, respective participants were treated either with conventional or dynamic muscular stabilisation treatment. Both the treatments were given as individual treatment by the same physiotherapist with the same intensity and capacity on alternate day for 35 days. The duration of each individual treatment session was about 40 minutes per day. The participants were not allowed to receive any other treatment, including pain killers. Dynamic muscular stabilisation treatment (DMST): in DMST, muscles with direct attachment to the lumbar spinal segment stabilise the joints "neutral zone" and prevent excessive deflection. Exercise is given in 4 stages in the following order: (i) 1st week: isolation and facilitation of target muscles. Verbal instruction such as drawing in and hollowing the lower abdomen, drawing the naval up and in toward the spine, or feeling the muscle tighten at the waist. From the beginning the patient learns to breathe normally while activating or holding the muscular contraction. The patient is in supine hook lying position and instructed to perform abdominal hollowing (in which the patient is instructed to make the lower abdomen cave in) or abdominal bracing (in which the patient is instructed to contract the abdominals by actively flaring out laterally in the region of the waist just above the iliac crest). (ii) 2nd week: training of trunk stabilisation under static conditions of increased load. The patient's position and concentration pattern are the same as the first week; the individual is then asked to hold the position while load is added via the weight of the lower limbs being moved passively into a loaded position. (iii) 3rd week: development of trunk stabilisation during slow controlled movement of the lumbar spine. Once stability is trained through static procedure, the movement of the trunk will optimise the activation of the supporting muscle. The first step is to produce and explore lumbopelvic movement and learn abdominal hollowing or bracing in a variety of positions: sitting, quadruped, standing, supine, kneeling and inclination by degree to control loading. (iv) 4th and 5th weeks: lumbar stabilisation during high‐speed and skilled movement. High‐speed phasic exercises are recommended to the patient along with abdominal hollowing or bracing in a variety of positions. Conventional treatment: ultrasound, short‐wave diathermy (SWD) and lumber strengthening exercises. Ultrasound (US): for the purpose of this study as a treatment for a chronic condition, a frequency of 1 MHz was used rather than 3 MHz, which penetrates least and is absorbed superficially. Continuous pattern ultrasound is recommended for use in chronic conditions at intensity 1.2 W/cm2 for a period of 8 minutes for 18 sittings in 18 alternate days. Ultrasound equipment was used from Medichem Electronics, which has international standard certification. Short‐Wave Diathermy. SWD is a deep heating modality used in relieving pain. It is also used to enhance flexibility and blood flow and reduce inflammation. Short‐wave forms are used for selected patients without neurological lesion. Continuous mode of SWD is used for 15 minutes with 18 sittings in 18 alternate days. The SWD was used from Medichem Electronics, which has international standard certification. Lumbar strengthening exercises. The uses of lumbar strengthening exercises (LSE) are well documented, including spinal extension exercises and trunk extensor muscles exercises. LSEs were done for 10 repetitions each exercise per sitting on alternate days. |
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| Outcomes | Pain (NRS 0 to 10) | |
| Notes | — | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | The participants were randomly assigned equally into 2 groups by a lottery method |
| Allocation concealment (selection bias) | High risk | No mention of allocation concealment |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | No mention of any attempts to blind the participants |
| Blinding of personnel/care provider (performance bias) All outcomes | High risk | No mention of any attempts to blind the care provider. |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | No mention of any attempts to blind the assessor |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | The percentage of withdrawals and dropouts was within the acceptable rate |
| Intention‐to‐treat analysis | High risk | No mention of intention‐to‐treat analysis |
| Selective reporting (reporting bias) | Low risk | No previous protocol or trial registration, but 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 |
| Co‐interventions (performance bias) | Unclear risk | Not reported |
| Compliance (performance bias) | Low risk | Compliance was considered similar for both groups |
| Timing of outcome assessment (detection bias) | Low risk | All important outcome assessments for both groups were measured at the same time |