A systematic review and meta-analysis on the efficacy of physiotherapy intervention in management of lumbar prolapsed intervertebral disc

OBJECTIVE: The objective of this meta-analysis and systematic review is to analyze the efficacy of physiotherapy interventions in management of lumbar prolapsed intervertebral disc (PIVD). METHOD: Randomized controlled trials (RCTs) were searched in PubMed and Cochrane Library using related keywords and advanced option, from commencement to January 2019. Quality of researches was assessed by PEDro scoring. Risk of bias and homogeneity were assessed using Cochrane risk of bias tool and I(2)value, respectively. Meta-analysis of included study was done using “Review manager (Software, version 5.3).” RESULTS: Eleven RCTs were included in this systematic review. Six RCTs were excluded from meta-analysis due to insufficient data availability. Meta-analysis reveals significant decrease in pain (P = 0.001, mean difference (MD) −0.91; 95% confidence interval (CI) −0.35 to −1.48) and disability (P < 0.0001; MD −5.76; 95%CI; −3.18 to −8.34) with moderate heterogeneity (I2=40%; P = 0.17, I2=54%; P = 0.09, respectively). There was non-significant improvement in straight leg raise (SLR), P = 0.07; MD 7.96; 95%CI; −0.59–16.51 with moderate heterogeneity (I2=56%; P = 0.11). CONCLUSION: Physiotherapy interventions are effective in management of lumbar PIVD. Physiological and biomechanical factors such as correction of the displaced disc, opening of the foramina, increase in intervertebral space, and reduction in herniation size with negative intradiscal pressure may be possible mechanisms.