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

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