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J Orthop Sports Phys Ther. 2019 Aug 23:1-32. doi: 10.2519/jospt.2019.8839. [Epub ahead of print]

Examination of a Subgroup of Patients With Chronic Low Back Pain Likely to Benefit More From Pilates-Based Exercises Compared to an Educational Booklet.

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Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands.
Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.



Secondary analysis of a randomized controlled trial.


Pilates is recommended for the treatment of chronic low back pain (LBP). Currently, there are potential subgroups of patients with LBP that could potentially benefit more from Pilates. However, these subgroups of patients have not been tested as effect modifiers in a randomized controlled trial.


To investigate whether two previously published classification approaches: updated treatment-based classification system (TBCS) and Pilates subgroup defined by a preliminary clinical prediction rule (CPR) can identify patients with LBP who benefit more from Pilates compared to an educational booklet.


222 patients received advice and were randomly allocated to an educational booklet group who did not receive additional treatment (n=74) or a Pilates group (n=148) who received treatment two or three times a week. At baseline patients were classified using a TBCS into having good prognosis (positive movement control) or not. Similarly using the Pilates CPR patients were classified as having a good (positive) or poor prognosis (negative). The analysis was conducted using interaction terms (interaction between characteristics of the subgroups and effect size of treatment) in linear regression models, considering the changes in pain and disability from baseline to six-week after randomization as dependent variables.


None of the interaction terms for pain and disability were statistically significant. Thus, the effect of treatment (Pilates versus an educational booklet) was similar in all subgroups.


The TBCS and the Pilates CPR were unable to identify subgroups of patients with chronic LBP who are likely to benefit more from Pilates compared to an educational booklet. J Orthop Sports Phys Ther, Epub 23 Aug 2019. doi:10.2519/jospt.2019.8839.


Pilates; low back pain; rehabilitation; subgroup


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