Different doses of Pilates-based exercise therapy for chronic low back pain: a randomised controlled trial with economic evaluation

Gisela Cristiane Miyamoto, Katherinne Ferro Moura Franco, Johanna M. van Dongen, Yuri Rafael Dos Santos Franco, Naiane Teixeira Bastos de Oliveira, Diego Diulgeroglo Vicco Amaral, Amanda Nery Castelo Branco, Maria Liliane da Silva, Maurits W. van Tulder, Cristina Maria Nunes Cabral

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OBJECTIVES: To evaluate the effectiveness and cost-utility of the addition of different doses of Pilates to an advice for non-specific chronic low back pain (NSCLBP) from a societal perspective.

DESIGN: Randomised controlled trial with economic evaluation.

SETTING: Physiotherapy clinic in São Paulo, Brazil.

PARTICIPANTS: 296 patients with NSCLBP.

INTERVENTIONS: All patients received advice and were randomly allocated to four groups (n=74 per group): booklet group (BG), Pilates once a week (Pilates group 1, PG1), Pilates twice a week (Pilates group 2, PG2) and Pilates three times a week (Pilates group 3, PG3).

MAIN OUTCOME MEASURES: Primary outcomes were pain and disability at 6-week follow-up.

RESULTS: Compared with the BG, all Pilates groups showed significant improvements in pain (PG1, mean difference (MD)=-1.2, 95% CI -2.2 to -0.3; PG2, MD=-2.3, 95% CI -3.2 to -1.4; PG3, MD=-2.1, 95% CI -3.0 to -1.1) and disability (PG1, MD=-1.9, 95% CI -3.6 to -0.1; PG2, MD=-4.7, 95% CI -6.4 to -3.0; PG3, MD=-3.3, 95% CI -5.0 to -1.6). Among the different doses, PG2 showed significant improvements in comparison with PG1 for pain (MD=-1.1, 95% CI -2.0 to -0.1) and disability (MD=-2.8, 95% CI -4.5 to -1.1). The cost-utility analysis showed that PG3 had a 0.78 probability of being cost-effective at a willingness-to-pay of £20 000 per quality-adjusted life-year gained.

CONCLUSIONS: Adding two sessions of Pilates exercises to advice provided better outcomes in pain and disability than advice alone for patients with NSCLBP; non-specific elements such as greater attention or expectation might be part of this effect. The cost-utility analysis showed that Pilates three times a week was the preferred option.


Original languageEnglish
Pages (from-to)859-868
Number of pages11
JournalBJSM Online
Issue number13
Early online date13 Mar 2018
Publication statusPublished - Jul 2018


  • exercises
  • lower back
  • randomised controlled trial
  • rehabilitation


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