Effectiveness of the pilates method in patients with chronic neck pain: a systematic review with meta-analysis.

BACKGROUND: Evidence suggests that patients with Chronic Neck Pain (CNP) benefit from exercise therapy, including Pilates. However, research on Pilates for CNP has not been comprehensively reviewed. This systematic review with meta-analysis aims to investigate the effectiveness of Pilates in comparison to other exercises and control interventions in the management of patients with chronic neck pain.[2] METHODS: A search for studies was conducted in six electronic databases from their inception to January 2024. Randomized controlled trials focusing on Pilates and other exercises for CNP and assessing pain, disability, and other secondary outcomes (e.g., range of motion, posture, strength, and quality of life) were included. Two authors independently screened the titles and abstracts of each article, extracted data, assessed methodological quality using the PEDro scale, and evaluated the certainty of evidence with the GRADE system. The exclusion criteria included non-randomized studies, [3]studies not published in English, studies without a control group, and those not specifically assessing Pilates or comparator interventions for CNP. Range of motion, posture, and strength were assessed using goniometers or inclinometers for joint mobility, handheld dynamometers or equivalent devices for muscle strength, and photographic analysis for posture. For the quantitative analysis, random-effects meta-analyses were conducted, and pooled data were analyzed using mean differences (MDs) and 95% Confidence Intervals (95% CI). RESULTS: Eight studies (n = 439 participants) were included. Five studies (n = 125) compared Pilates with other exercises and/or control groups, while three studies (n = 314) compared Pilates only with a control group. Regarting the pain outcomes,compared to other exercise interventions (six studies), low-certainty evidence suggests a modest reduction in pain favoring other exercises immediately post-treatment (MD: 0.50; 95% CI: 0.18 to 0.83; I² = 29%). In contrast, compared to control groups, very low-certainty evidence from five studies indicates a clinically significant reduction in pain post-treatment favoring the Pilates group (MD: − 1.49; 95% CI: − 1.78 to − 1.20; I² = 90%), and moderate-certainty evidence from two studies suggests continued improvement at follow-up (MD: − 2.54; 95% CI: − 3.28 to − 1.80; I² = 53%). Morover, the disability outcomes, In terms of disability (six studies), low-certainty evidence suggests no statistically significant difference between Pilates and other exercise interventions post-treatment (MD: − 1.31; 95% CI: − 0.47 to 2.16; I² = 0%). Compared to control groups, low to moderate-certainty evidence from five studies shows improvement in disability for the Pilates group both immediately after treatment (MD: − 3.73; 95% CI: − 4.80 to − 2.66; I² = 58%) and at follow-up (two studies) (MD: − 5.64; 95% CI: − 7.87 to − 3.41; I² = 0%). CONCLUSION: Based on current evidence, other forms of exercise may be more effective than Pilates in reducing pain immediately post-intervention. However, Pilates demonstrates greater benefits than control interventions, particularly at follow-up. In terms of disability, Pilates does not show superior clinical improvement compared to other exercise modalities, although it outperforms control conditions. Further high-quality randomized trials with larger samples and standardized outcome assessments are needed to strengthen these findings. SYSTEMATIC REVIEW REGISTRATION NUMBER: Prospero CRD42023462993.