Elsevier

Manual Therapy

Volume 8, Issue 2, May 2003, Pages 80-91
Manual Therapy

Systematic review
A systematic review of physiotherapy for spondylolysis and spondylolisthesis

https://doi.org/10.1016/S1356-689X(02)00066-8Get rights and content

Abstract

The purpose of this systematic review was to assess the evidence concerning the effectiveness of physiotherapy intervention in the treatment of low back pain related to spondylolysis and spondylolisthesis. A literature search of published and unpublished articles resulted in the retrieval of 71 potential studies on the subject area. Fifty-two of the 71 articles were studies, and these studies were reviewed using preset relevance criteria. Given the inclusion and exclusion criteria chosen for this systematic review, there were very few acceptable studies and only two studies met the relevance criteria for the critical appraisal. Both studies provide evidence to suggest that specific exercise interventions, alone or in combination with other treatments, have a positive effect on low-back pain due to spondylolysis and spondylolisthesis; however, the type of exercise used was different in the two studies. In this review, very few prospective studies were found that examined the efficacy of physiotherapy on the topic area; therefore, few conclusions can be made, and further research is warranted.

Introduction

A systematic review is an evaluation of existing literature using a research format. As such it constitutes research; it poses a question, identifies a population and draws a sample (Magee 1998). Published and unpublished studies are assembled using explicit searching methods, and a predetermined protocol of evaluation is used with inclusion and exclusion criteria (Jefferson & Deeks 1999, p 225). Research papers are read selectively and critically, measurements are analysed, and conclusions are drawn based on the scientific merit of the research findings. It is hoped that the findings of a systematic review will help guide practitioners in prescribing effective interventions for their patients (de Vet et al. 1997) and provide insight into future research directions.

When doing a systematic literature review, large randomized controlled trials (RCTs) are sought, as they provide the strongest evidence (Stein & Cutler 1996; Magee 1998). Internal validity of the study, with an RCT, is enhanced as extraneous factors are controlled, and as randomization of subjects reduces selection bias (Portney & Watkins 2000, p 167). Valid and reliable measures, as well as valid, reliable, and sensitive measurements and instruments insure that data are accurate and meaningful (Warren 1994). In addition, having outcomes measured by independent (blinded) observers, or by the patients themselves, further enhance the validity of the study. To control for confounders and to assess the external validity of the study, inclusion and exclusion criteria should be clearly stated and details provided on the study population. Among these details, such things as agreement to participate, attrition and the reasons for subjects being lost to follow-up must be included. In treatment studies, pretreatment clinical signs and symptoms have to be documented, and treatment interventions explained in enough detail to allow for replication of the study (Magee 1998).

The purpose of the present systematic review was to examine research studies assessing the efficacy of physiotherapy interventions in the treatment of low-back pain related to spondylolysis and spondylolisthesis.

Section snippets

The Problem

Low-back pain has become a significant health problem and continues to be a major expense to the healthcare system (Linton et al. 1989; Cherkin et al. 1998). Segmental instability of the lumbar spine is a potential cause of low-back pain, and particularly, in children and adolescents, may be the result of spondylolysis and/or spondylolisthesis (Fritz et al. 1998). Spondylolysis is a defect or break in the narrow portion of the vertebral bone, lying between the superior and inferior articular

Methods and materials

The process of systematic reviewing involves thorough detective work aimed at identifying all studies on a specific topic. Studies are chosen based on preset criteria that may include, for example, study design, type of experimental intervention and specific outcome measures. For this review, the literature was searched for published studies and unpublished studies on physiotherapy interventions in treating spondylolysis and spondylolisthesis. Two independent investigators screened the titles

Discussion

In this systematic review, few prospective studies were found that addressed the question of the efficacy of physiotherapy interventions in the treatment of low-back pain related to spondylolysis and spondylolisthesis. The strict criteria established for inclusion and exclusion criteria, as well as the requirement for a prospective study, eliminated many potential studies for review.

The two studies that did meet our criteria were both randomized controlled trials and each study provided

Conclusion

Systematic reviews in physiotherapy are used to assess the literature to determine the efficacy of treatment. In this review, very few prospective studies were found that examined the efficacy of physiotherapy on the topic area. The two studies undergoing critical appraisal were both initially rated as weak. Despite this, there is evidence suggesting that special trunk stabilizing exercises have a positive effect on low-back pain related to spondylolysis and spondylolisthesis. There was also

Acknowledgements

The authors would like to acknowledge the assistance of librarian Sandra Shores, BA, MLS, Reference Librarian, John W. Scott Health Sciences Library at the University of Alberta. Her assistance in the search component of this systematic review was invaluable. The authors would also like to thank Trevor McNeely, MA, English Professor Brandon University for his review of the manuscript.

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