A Cochrane review [Abstract] 1 included 11 studies with a total of 763 subjects. Four trials comparing individualised home exercise programs with no intervention reported low quality evidence for effects in spinal mobility (relative percentage differences (RPD) from 5% to 50%) and physical function (four points on a 33-point scale). Three trials comparing supervised group physiotherapy with an individualised home-exercise program reported moderate quality evidence for small differences in spinal mobility (RPDs 7.5% to 18%) and patient global assessment (1.46 cm) in favour of supervised group exercises. In one study, a three week inpatient spa-exercise therapy followed by 37 weeks of weekly outpatient group physiotherapy (without spa) was compared with weekly outpatient group physiotherapy alone; there was moderate quality evidence for effects in pain (RPD 18%), physical function (RPD 24%) and patient global assessment (RPD 29%), in favour of the combined spa-exercise therapy. One study compared daily outpatient balneotherapy and an exercise program with only exercise program, and another study compared balneotherapy with fresh water therapy. None of these studies showed significant between-group differences. One study compared an experimental exercise program with a conventional program; statistically significant change scores were reported on nearly all spinal mobility measures and physical function in favour of the experimental program.
The quality of evidence was downgraded by study quality and sparse data on individual physiotherapy modalities.
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