اثربخشی تمرین کنترل حرکتی بر بیماران مبتلا به اختلالات کمردرد غیر متمرکز و کنترل حرکت: یک بررسی سیستماتیک و متاآنالیز Effectiveness of movement control exercise on patients with non-specific low back pain and movement control impairment: A systematic review and meta-analysis

INTRODUCTION Low back pain (LBP) is a common condition that affects most people at some point in their lives, with up to a 84% lifetime prevalence (Airaksinen et al., 2006). The prevalence depends on factors such as sex, age, educational level and occupation (Delitto et al., 2012). It results in significant health and socioeconomic problems, being associated with work absenteeism, disability and high costs, both for patients and society (Saragiotto et al., 2016b). From 85% to 95% of affected LBP patients no pathoanatomic cause can be identified (Hoy et al., 2010) and they are designated as suffering from non-specific low back pain (NSLBP). One proposed mechanism driving NSLBP is movement control impairment (MVCI). The latter is defined as an alteration of the spinal alignment and movement pattern in a specific direction (Sahrmann, 2002, Harris-Hayes and Van Dillen, 2009). It has been suggested that it is a clinical feature of patients with NSLBP (O’Sullivan, 2005). This impairment occurs secondary to the presence of pain and can be due to abnormal tissue loading, lack of proprioceptive awareness and, possibly, the lack of a withdrawal reflex motor response (O’Sullivan, 2005). Other circumstances, such as psychological, social and neurophysiological factors, could contribute to reinforce this disorder (O’Sullivan, 2005). Patients exhibiting MVCI demonstrate clinical features that can be screened with the aid of various clinical tests, e.g. the movement control test battery, based on descriptions by Sahrmann (Sahrmann, 2002), Van Dillen et al. (Van Dillen et al., 2009) and by Luomajoki et al. (Luomajoki et al., 2007, Luomajoki et al., 2008). Based on this principle, treatment aimed at restoring movement control, correcting movement patterns and avoiding pain-provoking postures could benefit patients with MVCI. In this review, such intervention is called ‘movement control exercise’ (MVCE).