Effectiveness of Proprioceptive Neuromuscular Facilitation on Pain Intensity and Functional Disability in Patients with Low Back Pain: A Systematic Review and Meta-Analysis

Abstract

Background: This systematic review aimed to investigate the effectiveness of proprioceptive neuromuscular facilitation<br />(PNF) training on back pain intensity and functional disability in people with low back pain (LBP).<br />Methods: Totally, five electronic databases, including PubMed/Medline (NLM), Scopus, Google Scholar, PEDro, and<br />Cochrane Central Register of Controlled Clinical Trials were searched up to October 31, 2018. Clinical trials with a<br />concurrent comparison group (s) that compared the effectiveness of PNF training with any other physical therapy<br />intervention were selected. Publication language was restricted to English language articles. Methodologic quality was<br />assessed using the PEDro scale. The measures of continuous variables were summarized as Hedges's g.<br />Results: In total, 20 eligible trials were identified with 965 LBP patients. A large effect size (standardized mean difference<br />[SMD]=-2.14, 95% confidence interval [CI]=3.23 to -1.05) and significant effect were observed favoring the use of PNF<br />training to alleviate back pain intensity in patients with LBP. Moreover, large effect size and the significant result were<br />also determined for the effect of PNF training on functional disability improvement (SMD=-2.68, 95% CI=-3.36 to -2.00)<br />in population with LBP. A qualitative synthesis of results indicated that PNF training can significantly improve sagittal<br />spine ROM. Statistical heterogeneity analysis showed that there was considerable statistical heterogeneity among the<br />selected trials for the primary outcomes (I2 ≥ 86.6%).<br />Conclusion: There is a low quality of evidence and weak strength of recommendation that PNF training has positive<br />effects on back pain and disability in LBP people. Further high-quality randomized clinical trials regarding long-term<br />effects of PNF training versus validated control intervention in a clinical setting is recommendable.<br />Level of evidence: I