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S. Lafrance1,2, P. Ouellet2, R. Alaoui2, J.-S. Roy3,4, J. Lewis5,6,7, D.H. Christiansen8,9, B. Dubois10, P. Langevin3,4, F. Desmeules1,2
1University of Montreal, School of Rehabilitation Science, Montreal, Canada, 2Maisonneuve-Rosemont Hospital Research Center, Orthopedic Clinical Research Unit, Montreal, Canada, 3Laval University, Department of Rehabilitation, Quebec City, Canada, 4Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada, 5University of Hertfordshire, School of Health and Social Work, Hatfield, United Kingdom, 6Central London Community Healthcare National Health Service Trust, Therapy Department, London, United Kingdom, 7Qatar University, Department of Physical Therapy & Rehabilitation Science, Doha, Qatar, 8Regional Hospital West Jutland University Research Clinic, Department of Occupational Medicine, Herning, Denmark, 9Aarhus University, Department of Clinical Medicine, Aarhus, Denmark, 10The Running Clinic, Quebec City, Canada
Background: Although exercise therapy is consistently recommended in the management of common musculoskeletal disorders (MSKDs), it remains unclear which types of exercise are more effective to treat MSKDs. Common exercise approaches include motor control exercises (MCE) and strengthening exercises. The rationale behind MCE is to focus on specific muscle activation or movements while strengthening exercises are used to address strength deficits to gradually load tendons and contractile tissues. It remains unclear if MCE are more effective than strengthening exercises to treat adults with MSKDs and this has never been systematically appraised for upper or lower extremity MSKDs.
Purpose: To compare the efficacy of MCE to strengthening exercises for adults with upper or lower extremity MSKDs.
Methods: Literature Search
Electronic searches were conducted up to April 2020 in Medline, Embase, Cochrane CENTRAL and CINAHL.
Study Selection
Randomized control trials (RCTs) on the efficacy of MCE compared to strengthening exercises for adults with upper or lower extremity MSKDs were included. MCE were defined as exercises targeting the activation of specific musculature, neuromuscular control exercises, dynamic muscular stabilization exercises, proprioceptive exercises, specific movement or movement control exercises. Strengthening exercises needed to involve a form of resistance without any emphasis on motor control. Two reviewers independently reviewed titles and abstracts to identify trials of interest.
Data Synthesis
RCTs were appraised with the Risk of Bias Tool of the Cochrane Collaboration. Results from trials with similar outcome measures were pooled into meta-analyses. Pooled mean differences (MD) and standardized mean differences (SMD) were calculated using random-effects inverse variance models. Subgroup analyses according to groups of pathologies were performed were also analyzed separately. The GRADE approach was used for grading the quality of evidence and for making final recommendations.
Electronic searches were conducted up to April 2020 in Medline, Embase, Cochrane CENTRAL and CINAHL.
Study Selection
Randomized control trials (RCTs) on the efficacy of MCE compared to strengthening exercises for adults with upper or lower extremity MSKDs were included. MCE were defined as exercises targeting the activation of specific musculature, neuromuscular control exercises, dynamic muscular stabilization exercises, proprioceptive exercises, specific movement or movement control exercises. Strengthening exercises needed to involve a form of resistance without any emphasis on motor control. Two reviewers independently reviewed titles and abstracts to identify trials of interest.
Data Synthesis
RCTs were appraised with the Risk of Bias Tool of the Cochrane Collaboration. Results from trials with similar outcome measures were pooled into meta-analyses. Pooled mean differences (MD) and standardized mean differences (SMD) were calculated using random-effects inverse variance models. Subgroup analyses according to groups of pathologies were performed were also analyzed separately. The GRADE approach was used for grading the quality of evidence and for making final recommendations.
Results: Twenty-one RCTs (n=1,244) were included. Based on moderate quality evidence, MCE leads to greater pain (MD: -0.41 out of 10 points; 95%CI: -0.72 to -0.10; n=626) and disability (SMD: -0.28; 95%CI: -0.43 to -0.13; n=713) reductions when compared to strengthening exercises in the short-term; these differences are not considered clinically important. When excluding trials on osteoarthritis (OA) participants and only evaluating trials with participants with rotator cuff-related shoulder pain, shoulder instability, hip-related groin pain or patellofemoral pain syndrome, there is moderate quality evidence that MCE leads to greater pain (MD: -0.74 out of 10 points; 95%CI: -1.22 to -0.26; n=293) and disability (SMD: -0.40; 95%CI: -0.61 to -0.19; n=354) reductions than strengthening exercises in the short-term and these differences might be clinically important. Based on very-low and moderate quality evidence, no significant differences were reported between the two exercises approaches for pain and disability reduction in the mid-term (p³0.05).
Conclusion(s): MCE leads to statistically greater pain and disability reductions when compared to strengthening exercises among adults with MSKDs in the short-term, but these effects might only be clinically important in non-OA conditions. Inclusion of new trials could change these conclusions.
Implications: Our review suggest that MCE might be prioritized over strengthening exercises for adults with non-OA MSKDs such as rotator cuff-related shoulder pain, shoulder instability, hip-related groin pain or patellofemoral pain syndrome.
Funding, acknowledgements: Dr. Desmeules’ Canadian Institutes of Health Research Program New Investigator Salary and Research Award in Clinical Rehabilitation (201609NCR-375311-130299).
Keywords: Motor control exercices, Strengthening exercices, Peripherals musculoskeletal disorders
Topic: Musculoskeletal: peripheral
Did this work require ethics approval? No
Institution: Hôpital Maisonneuve-Rosemont Research Center
Committee: Hôpital Maisonneuve-Rosemont Ethics Committee
Reason: Systematic review does not require ethics approval
All authors, affiliations and abstracts have been published as submitted.
