Summary of treatment effects, 95% weighted mean difference, 95% standardised mean difference (SMD), clinical relevance, number needed to treat (NNT) and GRADE summary of findings among studies included in systematic review of MCT for symptomatic LDH
| Analyses | Weighted mean difference (95% CI) | Standardised mean difference (95% CI) | Clinical significance improvement based on achieving MCID | NNT* | No. of studies | No. of participants | I2 (%) | P value of Q test | Power of meta-analysis using SMD (%) | Certainty of evidence (reason for downgrading) |
| PATIENTS WHO DID NOT UNDERGO SURGERY | ||||||||||
| MCT versus other forms of exercises | ||||||||||
| Pain | ||||||||||
| Short-term (<3 months) | No data available | |||||||||
| Intermediate-term (3 to <12 months) | −7.30 (−14.38 to 0.22) | −0.50 (−1.00 to 0.00) | Not achieved | 4 | 1 | 63 | ̶ | ̶ | ̶ | Ø |
| Long-term (≥12 months) | −8.20 (−13.75 to 2.65) | −0.71 (−1.22, to 0.20) | Not achieved | 3 | 1 | 63 | ̶ | ̶ | ̶ | Ø |
| Functional status | ||||||||||
| Short-term (<3 months) | 1.30 (−3.17 to 5.77) | 0.21 (−0.51 to 0.93) | Not achieved | 8 | 1 | 30 | ̶ | ̶ | ̶ | Ø |
| Intermediate-term (3 to <12 months) | 0.45 (−5.44 to 6.34) | 0.04 (−0.46 to 0.53) | Not achieved | 44 | 1 | 63 | ̶ | ̶ | ̶ | Ø |
| Long-term (≥12 months) | −6.72 (−10.60 to 2.84) | −0.83 (−1.35 to 0.31) | Not achieved | 2 | 1 | 63 | ̶ | ̶ | ̶ | Ø |
| MCT versus other physical therapist-led interventions | ||||||||||
| Pain | ||||||||||
| Short-term (<3 months) | −28.85 (−40.04 to 17.66)† | −1.43 (−2.41 to 0.46) | Achieved | 1 | 2 | 69 | 28.6 | 0.237 | 99.82 | Low (risk of bias and imprecision) |
| Intermediate-term (3 to <12 months) | No data available | |||||||||
| Long-term (≥12 months) | No data available | |||||||||
| Functional status | ||||||||||
| Short-term (<3 months) | −21.79 (−27.06 to 16.53) | −1.98 (−2.57 to 1.40) | Achieved | 1 | 2 | 69 | 0.0 | 0.800 | 100 | Low (risk of bias and imprecision) |
| Intermediate-term (3 to <12 months) | No data available | |||||||||
| Long-term (≥12 months) | No data available | |||||||||
| MCT versus surgery | ||||||||||
| Pain | ||||||||||
| Short-term (<3 months) | No data available | |||||||||
| Intermediate-term (3 to <12 months) | No data available | |||||||||
| Long-term (≥12 months) | No data available | |||||||||
| Functional status | ||||||||||
| Short-term (<3 months) | No data available | |||||||||
| Intermediate-term (3 to <12 months) | No data available | |||||||||
| Long-term (≥12 months) | No data available | |||||||||
| PATIENTS WHO HAD UNDERGONE SURGERY | ||||||||||
| MCT versus other forms of exercises | ||||||||||
| Pain | ||||||||||
| Short-term (<3 months) | −8.40 (−13.15 to 3.66) | −1.15 (−2.12 to 0.17) | Not achieved | 2 | 4 | 168 | 52.1 | 0.099 | 100 | Very low (risk of bias, inconsistency and imprecision) |
| Intermediate-term (3 to <12 months) | −9.92 (−19.09 to 0.76) | −0.56 (−1.20 to 0.08) | Not achieved | 3 | 2 | 100 | 59 | 0.118 | 78.82 | Very low (risk of bias, inconsistency and imprecision) |
| Long-term (≥12 months) | −4.00 (−14.49 to 6.49) | −0.20 (−0.73 to 0.33) | Not achieved | 9 | 1 | 56 | ̶ | ̶ | ̶ | Ø |
| Functional status | ||||||||||
| Short-term (<3 months) | −4.95 (−6.76 to 3.13) | −0.95 (−1.32 to 0.58) | Not achieved | 2 | 3 | 124 | 0.0 | 0.726 | 100 | Low (risk of bias and imprecision) |
| Intermediate-term (3 to <12 months) | −3.75 (−6.36 to 1.14) | −0.77 (−1.32 to 0.22) | Not achieved | 2 | 1 | 56 | ̶ | ̶ | ̶ | Ø |
| Long-term (≥12 months) | −11.66 (−14.10 to 9.22) | −2.49 (−3.19 to 1.78) | Achieved | 1 | 1 | 56 | ̶ | ̶ | ̶ | Ø |
| MCT versus other physical therapist-led interventions | ||||||||||
| Pain | ||||||||||
| Short-term (<3 months) | No data available | |||||||||
| Intermediate-term (3 to <12 months) | −5.88 (−20.63 to 8.87) | −0.26 (−0.94 to 0.43) | Not achieved | 7 | 2 | 130 | 60.8 | 0.110 | 32.68 | Very low (risk of bias, inconsistency and imprecision) |
| Long-term (≥12 months) | −0.12 (−7.88 to 10.24) | −0.005 (−0.39 to 0.38) | Not achieved | 354 | 1 | 105 | ̶ | ̶ | ̶ | Ø |
| Functional status | ||||||||||
| Short-term (<3 months) | −6.63 (−8.09 to 5.17) | −2.30 (−2.96 to 1.64) | Not achieved | 1 | 1 | 60 | ̶ | ̶ | ̶ | Ø |
| Intermediate-term (3 to <12 months) | −2.22 (−10.52 to 6.07) | −0.14 (−0.75 to 0.48) | Not achieved | 13 | 2 | 130 | 52.7 | 0.146 | 22.04 | Very low (risk of bias, inconsistency and imprecision) |
| Long-term (≥12 months) | −0.12 (−10.10 to 9.86) | 0.08 (−0.31 to 0.46) | Not achieved | 22 | 1 | 105 | ̶ | ̶ | ̶ | Ø |
| MCT versus surgery | ||||||||||
| Pain | ||||||||||
| Short-term (<3 months) | No data available | |||||||||
| Intermediate-term (3 to <12 months) | No data available | |||||||||
| Long-term (≥12 months) | −1.20 (−13.66 to 11.26) | −0.05 (−0.57 to 0.47) | Not achieved | 35 | 1 | 57 | ̶ | ̶ | ̶ | Ø |
| Functional status | ||||||||||
| Short-term (<3 months) | No data available | |||||||||
| Intermediate-term (3 to <12 months) | No data available | |||||||||
| Long-term (≥12 months) | −5.80 (−15.99 to 4.39) | −0.30 (−0.82 to 0.23) | Not achieved | 6 | 1 | 57 | ̶ | ̶ | ̶ | Ø |
| MCT versus minimal intervention, self-management or no intervention | ||||||||||
| Pain | ||||||||||
| Short-term (<3 months) | −19.50 (−41.77 to 2.76) | −1.83 (−2.40 to 1.26) | Achieved | 1 | 2 | 68 | 93.5 | 0.00 | 72.2 | Very low (risk of bias, inconsistency and imprecision) |
| Intermediate-term (3 to <12 months) | 5.03 (−3.84 to 13.90) | 0.21 (−0.16 to 0.59) | Not achieved | 8 | 1 | 110 | ̶ | ̶ | ̶ | Ø |
| Long-term (≥12 months) | 1.18 (−7.88 to 10.24) | 0.05 (−0.33 to 0.42) | Not achieved | 35 | 1 | 110 | ̶ | ̶ | ̶ | |
| Functional status | ||||||||||
| Short-term (<3 months) | −8.66 (−11.64 to 5.67) | −1.34 (−1.87 to 0.81) | Not achieved | 2 | 2 | 68 | 0.0 | 0.376 | 99.97 | Very low (risk of bias, inconsistency and imprecision) |
| Intermediate-term (3 to <12 months) | 1.44 (−8.00 to 10.88) | 0.06 (−0.32 to 0.43) | Not achieved | 30 | 1 | 110 | ̶ | ̶ | ̶ | Ø |
| Long-term (≥12 months) | 1.18 (−7.88 to 10.24) | −0.01 (−0.39 to 0.36) | Not achieved | 177 | 1 | 110 | ̶ | ̶ | ̶ | Ø |
*NNT is calculated based on SMD.
†Means that the changes meet the minimal clinically important difference threshold.
Ø, impossible; CI, compatibility interval; MCID, minimal clinically important differences; MCT, motor control training.