Is Pilates an effective tool for the management of kinesiophobia in musculoskeletal disorders?

Table 1 Characteristics of randomized systematic review studies

Ref.	Sample	Sex	Age	Intervention & control groups	Kinesiophobia	Results	Score
Akodu et al[29], 2021	34 patients (45 initially) Nonspecific cervical spine pain (CSP) CSPSE: 17 PE: 14 DIE: 14	Men (42.3%) Women (57.7%)	CSPSE: 47.71 ± 10.02 PE: 47.43 ± 9.22 DIE: 44.93 ± 6.26 There was no pre-set age limit when selecting participants	CSPSE: Cervical spine stabilization exercises PE: Pilates exercises (mat) DIE: Dynamic isometric exercises (control group)	TSK 0, 4, 8 weeks	Significant improvement in TSK in CSPSE & PE No statistically significant differences in PE and DIE, CSPSE at the end of the intervention	8/12
Cruz-Díaz et al[16], 2018	62 patients (64 original) Nonspecific low back pain (LBP) PG: 32 CG: 32	Men (33.9%) Women (66.1%)	18-50 PG: 37.90 ± 8.2 CG: 35.60 ± 6.7	PG: Pilates (ground-mat) CG: Booklet	TSK 0, 6, 12 weeks	Significant improvement in TSK in the PG, compared that CG Significant improvement in TSK in PG at the end of the intervention	8/12
Cruz-Díaz et al[30], 2017	98 patients (132 initially) Nonspecific low back pain PMG: 34 PEG: 34 CG: 34	Men (35.8%) Women (64.2%)	18-50 PMG: 36.94 ± 12.46 PEG: 35.50 ± 11.98 CG: 36.32 ± 10.67	PMG: Pilates mat PEG: Pilates equipment CG: No intervention	TSK 0, 6, 12 weeks	Significant improvement in TSK after the intervention in PMG and PEG, but without significant differences between the three groups at the end of the intervention	9/12
da Luz et al[31], 2014	86 Nonspecific low back pain PMG: 43 PEG: 43	Men (23.2%) Women (76.8%)	18-60 PMG: 43.5 ± 8.6 PEG: 38.8 ± 9.9	PMG: Pilates mat PEG: Pilates equipment	TSK 0, 6 weeks, 6 months	No statistically significant differences in TSK within and between groups at the end of the intervention; significant improvement in TSK 6 months follow-up in Pilates with equipment group (PEG) in relation to Pilates mat group (PMG)	8/12
Miyamoto et al[32], 2013	86 patients Nonspecific low back pain PG: 43 CG: 43	Men (18.6%) Women (81.4%)	18-60 PG: 40.7 ± 11.8 CG: 38.3 ± 11.4	PG: Pilates mat CG: Booklet	TSK 0, 6 weeks, 6 months	No improvement in both groups	8/12

TSK: Tampa Scale of Kinesiophobia.

Table 2 Risk of bias scores of the randomized controlled trials of the systematic review

Ref.	1	2	3	4	5	6	7	8	9	10	11	12	Score	Rate
Akodu et al[29], 2021	?	-	+	-	+	+	+	+	+	+	-	+	8/12	66.6%
Cruz-Díaz et al[16], 2018	+	+	-	-	+	+	+	+	-	+	-	+	8/12	66.6%
Cruz-Díaz et al[30], 2017	+	+	-	-	+	+	+	+	+	+	-	+	9/12	75.0%
da Luz et al[31], 2014	+	+	-	-	+	+	+	+	-	?	+	+	8/12	66.6%
Miyamoto et al[32], 2013	+	+	-	-	+	+	+	+	-	?	+	+	8/12	66.6%

1: Adequacy of randomization; 2: Allocation concealment; 3: Blinding of patients; 4: Blinding of therapists; 5: Blinding of assessors; 6: Description and acceptance of dropout rate; 7: Analysis by randomization group; 8: Reporting of outcome bias; 9: Similar groups at baseline; 10: Avoidance of other interventions; 11: Acceptance of compliance rate; 12: Similar time period for deriving results.

Table 3 Results of the Tampa Scale of Kinesiophobia scale of the studies

Ref.	Baseline MV (SD)	Intermediate measurement, MV (SD)	End of intervention, MV (SD)	Follow-up, MV (SD)	P value, baseline-finish	P value, baseline–follow up
Akodu et al[29], 2021	CSPSE: 40.17 ± 3.16 PE: 40.82 ± 2.44 DIE: 39.73 ± 2.28	4th week CSPSE: 37.38 ± 3.20 PE: 39.46 ± 1.85 DIE: 39.79 ± 2.19	8th week CSPSE: 33.17 ± 3.27 PE: 37.27 ± 1.95 DIE: 38.36 ± 3.36	-	P = 0.072 P = 0.001	-
Cruz-Díaz et al[16], 2018	Mean value PG: 34.50 CG: 34.00	6 th week Mean value PG: 27.50 CG: 33.00	12 th week Mean value PG: 27.50 CG: 32.50	-	P < 0.001	-
Cruz-Díaz et al[30], 2017	PMG: 34.52 ± 4.14 PEG: 36.50 ± 3.92 CG: 33.90 ± 4.23	6th week PMG: 32.23 ± 3.06 PEG: 34.08 ± 4.1 CG: 34.26 ± 3.96	12th week PMG: 31.73 ± 3.24 PEG: 32.00 ± 3.56 CG: 34.10 ± 4.04	-	P < 0.05	-
da Luz et al[31], 2014	PMG: 39.7 ± 8.1 PEG: 39.6 ± 8.0	-	6th week PMG: 35.3 ± 6.6 PEG: 34.1 ± 7.8	6th month PMG: 40.0 ± 9.9 PEG: 34.9 ± 7.9	P > 0.05	P < 0.001
Miyamoto et al[32], 2013	PG: 39.4 ± 6.1 CG: 39.5 ± 7.1	-	6th week PG: 36.3 ± 7.4 CG: 38.1 ± 8.3	6 th month PG: 38.1 ± 7.2 CG: 38.9 ± 7.3	P = 0.20	P = 0.61

MV: Mean value; CSPSE: Cervical spine stabilization exercises; PE: Pilates exercises; DIE: Dynamic isometric exercise; PMG: Pilates mat group; PEG: Equipment-based Pilates; CG: Control group; PG: Pilates group.