Effectiveness of Proprioceptive Neuromuscular Facilitation on Pain Intensity and Functional Disability in Patients with Low Back Pain: A Systematic Review and Meta-Analysis



1 Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran

2 Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran


Background: This systematic review aimed to investigate the effectiveness of proprioceptive neuromuscular facilitation
(PNF) training on back pain intensity and functional disability in people with low back pain (LBP).
Methods: Totally, five electronic databases, including PubMed/Medline (NLM), Scopus, Google Scholar, PEDro, and
Cochrane Central Register of Controlled Clinical Trials were searched up to October 31, 2018. Clinical trials with a
concurrent comparison group (s) that compared the effectiveness of PNF training with any other physical therapy
intervention were selected. Publication language was restricted to English language articles. Methodologic quality was
assessed using the PEDro scale. The measures of continuous variables were summarized as Hedges’s g.
Results: In total, 20 eligible trials were identified with 965 LBP patients. A large effect size (standardized mean difference
[SMD]=-2.14, 95% confidence interval [CI]=3.23 to -1.05) and significant effect were observed favoring the use of PNF
training to alleviate back pain intensity in patients with LBP. Moreover, large effect size and the significant result were
also determined for the effect of PNF training on functional disability improvement (SMD=-2.68, 95% CI=-3.36 to -2.00)
in population with LBP. A qualitative synthesis of results indicated that PNF training can significantly improve sagittal
spine ROM. Statistical heterogeneity analysis showed that there was considerable statistical heterogeneity among the
selected trials for the primary outcomes (I2 ≥ 86.6%).
Conclusion: There is a low quality of evidence and weak strength of recommendation that PNF training has positive
effects on back pain and disability in LBP people. Further high-quality randomized clinical trials regarding long-term
effects of PNF training versus validated control intervention in a clinical setting is recommendable.
Level of evidence: I