The effects of proprioceptive neuromuscular facilitation in treating chronic low back pain: A systematic review and meta-analysis

Abstract

BACKGROUND: Proprioceptive neuromuscular facilitation (PNF) has been widely used in the clinical treatment of chronic low back pain (LBP) in recent years. However, its role remains controversial and it is unclear whether PNF offers more advantages for patients with chronic LBP. OBJECTIVE: The purpose of this systematic review is to evaluate the evidence on the effect of PNF on pain, waist function, pulmonary function and dynamic balance in patients with chronic LBP. METHODS: Seven English and Chinese electronic databases were searched to identify articles published from 1970 to February 2020. Relevant randomized controlled trials (RCTs) were selected by two independent reviewers to investigate PNF in treatment of chronic LBP. Data extraction was performed by the same reviewers. RESULTS: Twelve eligible trials involving 410 participants were included in this meta-analysis. Compared with the control group, the aggregated results suggested that PNF showed beneficial effects in relieving pain (SMD =-1.17; 95% CI: -1.50 to -0.84; p< 0.00001) and improving waist functional disability (MD =-1.63; 95% CI: -1.89 to -1.37; p< 0.00001). In addition, PNF was shown to have a significant effect on pulmonary function (MD = 0.65; 95% CI: 0.26 to 1.03; p= 0.001). However, the results of the study show that PNF could not significantly improve dynamic balance in patients with chronic LBP compared with the control group (MD =-0.04; 95% CI: -2.16 to 2.08; p= 0.97). A high risk of bias occurred in the areas of blinding (i.e., participants/personnel and outcome assessment). CONCLUSIONS: PNF showed more beneficial effects in pain relief and waist function improvement in patients with chronic LBP in the short term (4 to 8 weeks of intervention) or at 12-week follow-up and also played a positive role in pulmonary function. However, no significant effect of PNF on dynamic balance was found compared with the control group. However, these results have certain limitations, and these conclusions were supported by low-quality data. Therefore, articles that are methodologically reasonable and more authoritative are required to verify the effects. In addition, articles with long-term follow-up and other outcomes are needed to confirm additional findings.