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      Effects of Dynamic Neuromuscular Stabilization/Vojta Therapy on Pain Intensity and Physical Function in Individuals with Low Back Pain: A Systematic Review and Meta-Analysis

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          Abstract

          Background:

          Low back pain (LBP) is a prevalent health issue that imposes heavy burdens on personal health status and social healthcare. Dynamic Neuromuscular Stabilization (DNS)/Vojta therapy has demonstrated effectiveness in managing conditions related to musculoskeletal system. However, its effects on individuals with LBP remain incompletely understood. We aimed to evaluate the effects of DNS/Vojta therapy on pain intensity and physical function in individuals with LBP.

          Methods:

          A search of studies was conducted on several academic databases from inception through April 13, 2023. This study included clinical trials that evaluated the effects of DNS/Vojta therapy on the outcomes in individuals with LBP. The methodological quality of studies was assessed using PEDro scale, Cochrane Collaboration tool, and ROBINS-I scale. Meta-analysis was performed using Review Manager software (RevMan version 5.4.1, The Cochrane Collaboration, 2020).

          Results:

          This systematic review and meta-analysis identified twelve eligible studies, which demonstrated that DNS/Vojta therapy significantly alleviated pain intensity (SMD=−1.09; 95%Cl [−1.74, −0.44]; Z=3.28; P=0.001), reduced disability severity (SMD=−0.91; 95%Cl [−1.48, −0.34]; Z=3.12; P=0.002), and improved quality of life (SMD=1.05; 95%CI [0.14, 1.96]; Z=2.27; P=0.02) in individuals with LBP, while no significant improvements were observed in static and dynamic balance ability or spine flexibility.

          Conclusion:

          DNS/Vojta therapy is a promising approach for providing great benefits for individuals with LBP, particularly in terms of reducing pain intensity and disability severity, and improving quality of life, which is worth further in clinical application.

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          Most cited references56

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          The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials

          Flaws in the design, conduct, analysis, and reporting of randomised trials can cause the effect of an intervention to be underestimated or overestimated. The Cochrane Collaboration’s tool for assessing risk of bias aims to make the process clearer and more accurate
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            ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions

            Non-randomised studies of the effects of interventions are critical to many areas of healthcare evaluation, but their results may be biased. It is therefore important to understand and appraise their strengths and weaknesses. We developed ROBINS-I (“Risk Of Bias In Non-randomised Studies - of Interventions”), a new tool for evaluating risk of bias in estimates of the comparative effectiveness (harm or benefit) of interventions from studies that did not use randomisation to allocate units (individuals or clusters of individuals) to comparison groups. The tool will be particularly useful to those undertaking systematic reviews that include non-randomised studies.
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              Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range

              Background In systematic reviews and meta-analysis, researchers often pool the results of the sample mean and standard deviation from a set of similar clinical trials. A number of the trials, however, reported the study using the median, the minimum and maximum values, and/or the first and third quartiles. Hence, in order to combine results, one may have to estimate the sample mean and standard deviation for such trials. Methods In this paper, we propose to improve the existing literature in several directions. First, we show that the sample standard deviation estimation in Hozo et al.’s method (BMC Med Res Methodol 5:13, 2005) has some serious limitations and is always less satisfactory in practice. Inspired by this, we propose a new estimation method by incorporating the sample size. Second, we systematically study the sample mean and standard deviation estimation problem under several other interesting settings where the interquartile range is also available for the trials. Results We demonstrate the performance of the proposed methods through simulation studies for the three frequently encountered scenarios, respectively. For the first two scenarios, our method greatly improves existing methods and provides a nearly unbiased estimate of the true sample standard deviation for normal data and a slightly biased estimate for skewed data. For the third scenario, our method still performs very well for both normal data and skewed data. Furthermore, we compare the estimators of the sample mean and standard deviation under all three scenarios and present some suggestions on which scenario is preferred in real-world applications. Conclusions In this paper, we discuss different approximation methods in the estimation of the sample mean and standard deviation and propose some new estimation methods to improve the existing literature. We conclude our work with a summary table (an Excel spread sheet including all formulas) that serves as a comprehensive guidance for performing meta-analysis in different situations. Electronic supplementary material The online version of this article (doi:10.1186/1471-2288-14-135) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                Iran J Public Health
                Iran J Public Health
                IJPH
                Iranian Journal of Public Health
                Tehran University of Medical Sciences
                2251-6085
                2251-6093
                September 2024
                : 53
                : 9
                : 1910-1923
                Affiliations
                [1. ]School of Physical Education, Soochow University, Suzhou, 215021, PR China
                [2. ]School of Bioscience and Technology, Weifang Medical University, Weifang, 261053, PR China
                [3. ]Rehabilitation Medicine Department, Xuzhou Rehabilitation Hospital, Xuzhou, 221009, PR China
                [4. ]Rehabilitation Medicine Department, Changzhi People’s Hospital, Changzhi, 046000, PR China
                Author notes
                [* ] Corresponding Author: Email: qxzhang@ 123456suda.edu.cn
                Article
                IJPH-53-1910
                10.18502/ijph.v53i9.16447
                11490336
                39429656
                d142a372-0be6-419b-8a6f-54daea87e384
                Copyright© 2024 Kong et al. Published by Tehran University of Medical Sciences.

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International license. ( https://creativecommons.org/licenses/by-nc/4.0/). Non-commercial uses of the work are permitted, provided the original work is properly cited

                History
                : 19 February 2024
                : 12 April 2024
                Categories
                Review Article

                Public health
                dynamic neuromuscular stabilization,vojta therapy,low back pain,meta-analysis
                Public health
                dynamic neuromuscular stabilization, vojta therapy, low back pain, meta-analysis

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