The use of Pilates exercise by physiotherapists to treat people with chronic low back pain

Background: Pilates exercise is recommended as a form of treatment for people with chronic low back pain (CLBP). The definition and application of Pilates exercise, however, varies in the literature. The efficacy of Pilates exercise in reducing disability in people with chronic low back pain is also debated. Moreover, it is unclear whether some people with CLBP may benefit from Pilates exercise more than other people with CLBP. Aim: The aim of this thesis was to investigate the use of Pilates exercise to treat people with CLBP. There were three research questions: (1) How is Pilates exercise defined, and used to treat people with CLBP? (2) How effective is Pilates exercise in reducing disability in people with CLBP? (3) How can people with CLBP be identified who will benefit, or not benefit from Pilates exercise? Methods: Five studies were undertaken to address these research questions, including three systematic reviews, a Delphi survey, and the development of a clinical practice guideline. Conclusion: This doctoral study has contributed to the understanding of the use of Pilates exercise to treat people with CLBP as demonstrated through five peer-reviewed publications (Appendices 1A-E) and development of a clinical practice guideline (Chapter 8). The guideline provided evidence-based recommendations for physiotherapists using Pilates exercise to treat people with CLBP. Recommendations address the three research aims of the thesis regarding the definition and application of Pilates exercise in people with CLBP, the effectiveness of Pilates exercise in treating people with CLBP, and identifying people with CLBP who may benefit, or not benefit from Pilates exercise. Recommendations may be used to guide the use of Pilates exercise by physiotherapists to treat people with CLBP as they have been developed from the highest level and quality of evidence available. The strength of guideline recommendations for clinical practice is limited, however, due the paucity, low level, and variable quality of research evidence available. This means that physiotherapists should use some caution when following recommendations by monitoring client responses closely, and adjusting treatment as indicated. Future research should evaluate the accuracy of recommendations in high quality clinical trials, especially in regards to the proposed definition and application of Pilates exercise and the selection of people with CLBP who may benefit, or not benefit from Pilates exercise. The efficacy of Pilates exercise compared to other treatments, as well as associated risks, and costs also needs further evaluation before stronger recommendations can be made.