Diaphragmatic Training for Nonspecific Low Back Pain: A Systematic Review and Meta-analysis.
Hai Wei Li, Chen Jia, Yu Xiang Yang et al.
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In 30 seconds
This systematic review and meta-analysis assessed randomized trials of diaphragmatic training, alone or alongside other therapies, in adults with nonspecific low back pain. Thirteen studies involving 626 participants were included. Compared with control interventions, training likely reduced pain intensity (standardized mean difference=-0.60; 95% confidence interval=-0.86 to -0.34; 11 trials, n=465) and improved functional disability (standardized mean difference=-0.71; 95% confidence interval=-0.90 to -0.53; 9 trials, n=469), both with moderate-certainty evidence. Evidence for changes in diaphragmatic thickness was very uncertain.
Key findings
- Pain intensity was likely lower with diaphragmatic training than control interventions (standardized mean difference=-0.60; 95% confidence interval=-0.86 to -0.34; 11 trials, n=465).
- Functional disability likely improved with training (standardized mean difference=-0.71; 95% confidence interval=-0.90 to -0.53; 9 trials, n=469).
- Evidence for changes in diaphragmatic thickness was of very low certainty.
- Subgroup analyses suggested better pain outcomes typically occurred with 2-3 sessions/wk.
Why it matters
The review synthesizes randomized-trial evidence that diaphragmatic training may benefit both pain and function in adults with nonspecific low back pain. The moderate certainty of these findings makes the approach relevant as a possible component of rehabilitation, while the very uncertain evidence on diaphragm thickness cautions against treating that measure as an established outcome of training.
What to keep in mind
Evidence for diaphragmatic thickness was of very low certainty. The authors state that trials with longer follow-up are needed to clarify effects on thickness and the influence of training parameters.