title: Sling exercise for chronic low back pain: a systematic review and meta-analysis.
abstract: BACKGROUND
  Trials on sling exercise (SE), commonly performed to manage chronic low back pain (LBP), yield conflicting results. This study aimed to review the effects of SE on chronic LBP.
  
  
  METHODS
  The randomized controlled trials comparing SE with other treatments or no treatment, published up to August 2013, were identified by electronic searches. Primary outcomes were pain, function, and return to work. The weighted mean difference (WMD) and 95% confidence interval (CI) were calculated, using a random-effects model.
  
  
  RESULTS
  Risk of bias was rated as high in 9 included trials, where some important quality components such as blinding were absent and sample sizes were generally small. We found no clinically relevant differences in pain or function between SE and other forms of exercise, traditional Chinese medical therapy, or in addition to acupuncture. Based on two trials, SE was more effective than thermomagnetic therapy at reducing pain (short-term: WMD -13.90, 95% CI -22.19 to -5.62; long-term: WMD -26.20, 95% CI -31.32 to -21.08) and improving function (short-term: WMD -10.54, 95% CI -14.32 to -6.75; long-term: WMD -25.75, 95% CI -30.79 to -20.71). In one trial we found statistically significant differences between SE and physical agents combined with drug therapy (meloxicam combined with eperisone hydrochloride) but of borderline clinical relevance for pain (short-term: WMD -15.00, 95% CI -19.64 to -10.36) and function (short-term: WMD -10.00; 95% CI -13.70 to -6.30). There was substantial heterogeneity among the two trials comparing SE and thermomagnetic therapy; both these trials and the trial comparing SE with physical agents combined with drug therapy had serious methodological limitations.
  
  
  CONCLUSIONS
  Based on limited evidence from 2 trials, SE was more effective for LBP than thermomagnetic therapy. Clinically relevant differences in effects between SE and other forms of exercise, physical agents combined with drug therapy, traditional Chinese medical therapy, or in addition to acupuncture could not be found. More high-quality randomized trials on the topic are warranted.
authors.affiliation: Second School of Clinical Medical, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
authors.forename: Yu-Shan
authors.initials: YS
authors.lastname: Yue
authors.affiliation: Institute of Literature in Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
authors.forename: Xu-Dong
authors.initials: XD
authors.lastname: Wang
authors.affiliation: First School of Clinical Medical, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Xie
authors.affiliation: Applied Health Science Department, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Zhong-Han
authors.initials: ZH
authors.lastname: Li
authors.affiliation: Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.
authors.forename: Bing-Lin
authors.initials: BL
authors.lastname: Chen
authors.affiliation: Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.
authors.forename: Xue-Qiang
authors.initials: XQ
authors.lastname: Wang
authors.affiliation: Second School of Clinical Medical, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhu
mesh_terms: D002908:Chronic Disease; D015444:Exercise; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation / Q000628:therapy*