SYSTEMATIC REVIEW
The e ec i eness o hip in e en ions in pa ien s wi h
low-back pain: A sys ema ic e iew and me a-analysis
Luis Ceballos-Lai a
a,
*, Elena Es 
ebanez-de-Miguel
b
, Jose Jes
us Jim
enez-Rejano
c
,
Elena Bueno-G acia
b
, Sand a Jim
enez-del-Ba io
a
a
Clinical Resea ch G oup in Heal h Sciences o Su ge y. Depa men o Su ge y, Oph halmology, O o hinola yngology and Physical
The apy, Facul y o Heal h Sciences, Uni e si y o Valladolid, So ia, Spain
b
Depa men o Physia y and Nu se y, Facul y o Heal h Sciences, Uni e si y o Za agoza, Za agoza, Spain
c
Depa men o Physical The apy, Uni e si y o Se illa, Se illa. Spain
Recei ed 22 Ma ch 2022; ecei ed in e ised o m 8 Ma ch 2023; accep ed 27 Ma ch 2023
A ailable online 5 Ap il 2023
Abs ac
Backg ound: Low-back pain (LBP) may be di ec ly o indi ec ly ela ed o impai men s om he
hip join .
Objec i e: To e alua e he e ec i eness o hip in e en ions on pain and disabili y in pa ien s
wi h LBP in he sho -, medium-, and long- e m.
Me hods: PubMed,Coch aneLib a y,PED o,Webo Science, and SCOPUS da abases we e sea ched
in No embe 2022. Randomized con olled ials in ol ing hip- a ge ed in e en ions compa ed o
specific low back in e en ions in pa ien s wi h LBP we e selec ed. The ou comes we e pain in ensi y
and disabili y. The quali y o he s udies was assessed wi h he isk o bias ool. GRADE was used o
a e he ce ain y o e idence. Me a-analyses we e conduc ed using andom e ec s models.
Resul s: A o al o 2581 s udies we e sc eened. Eigh we e included in he me a-analysis in ol -
ing 508 pa ien s wi h LBP. The esul s p o ided e y low ce ain y ha bo h hip s eng hening
and hip s e ching imp o ed pain (MD = -0.66; 95% CI -0.86, -0.48; I
2
:0%) (MD = -0.55; 95% CI
-1.02, -0.08) and disabili y (SMD = -0.81; 95% CI -1.53, -0.10; I
2
: 80%) (SMD = -1.03; 95% CI -1.82,
-0.25) in he sho - e m, espec i ely. No benefi s we e ound in he medium- o long- e m. The
isk o bias, he e ogenei y, and imp ecision o he esul s downg aded he le el o e idence.
Conclusions: Ve y low ce ain y e idence sugges a posi i e e ec o hip s eng hening in isola-
ion o combined wi h specific low back exe cise and hip s e ching combined wi h specific low
back exe cise o dec easing pain in ensi y and disabili y in he sho - e m, in pa ien s wi h LBP.
Sys ema ic e iew egis a ion numbe : PROSPERO CRD42022303173
© 2023 Associação B asilei a de Pesquisa e Pós-G aduação em Fisio e apia. Published by Else ie
España, S.L.U. All igh s ese ed.
KEYWORDS
Disabili y e alua ion;
Hip join ;
Low back pain;
Me a-analysis;
Sys ema ic e iew
* Co esponding au ho a : Calle Uni e sidad S/N, 42002, Campus Duques de So ia, So ia, Spain.
E-mail: [email p o ec ed] (L. Ceballos-Lai a).
Social media: MU_OMPT_UIC (L. Ceballos-Lai a)
h ps://doi.o g/10.1016/j.bjp .2023.100502
1413-3555/© 2023 Associação B asilei a de Pesquisa e Pós-G aduação em Fisio e apia. Published by Else ie España, S.L.U. All igh s ese ed.
B azilian Jou nal o Physical The apy 27 (2023) 100502
B azilian Jou nal o
Physical The apy
h ps://www.jou nals.else ie .com/b azilian-jou nal-o -physical- he apy
In oduc ion
Low Back Pain (LBP) is one o he majo causes o pain and
disabili y in adul s and a common eason o seeking medical
ca e.
1,2
LBP is expe ienced by 80% o he popula ion a leas
once du ing hei li e ime.
3,4
The p e alence o LBP is g adu-
ally inc easing and is highe among emales in all age
g oups.
5
LBP can be classified based on symp oms du a ion
in acu e, sub-acu e, o ch onic LBP,
6
o acco ding o diagno-
sis, in which app oxima ely 90% o pa ien s wi h LBP a e ca -
ego ized as non-specific LBP, meaning ha he e iology is
no known.
2
The lumba spine is in e connec ed o he pel is and hips,
so LBP may be di ec ly o indi ec ly ela ed o impai men s
om adjacen s uc u es. Some s udies ound ha an exces-
si e amoun o an e io pel ic il is used o compensa e a
lack o hip ex ension, and ha limi ed hip ex ension also
al e s he mo o ac i a ion o he lumba spine.
710
In addi-
ion, se e al au ho s, concluded ha pa ien s wi h LBP
o en p esen hip pain and mo ning s i ness,
11
a educ ion
o bo h passi e and ac i e hip o a ion ange o mo ion,
1217
and/o hip ex enso muscle weakness.
18
Exe cise he apy is he mos ecommended in e en ion
o LBP. Bu , he e is no clea e idence on which ype o
exe cise is mo e e ec i e,
19
and he e ec s a e small o
mode a e. Based on he in e connec ion o he lumbopel ic
s uc u es wi h he hip, in e en ions a ge ing he hip o
he addi ion o hip- a ge ed in e en ions o specific low
back in e en ions may p o ide be e benefi s o pa ien s
wi h LBP. Two sys ema ic e iews and me a-analysis
add essed his opic and epo ed conflic ing esul s abou
he e ec i eness o adding hip in e en ions o specific low
back ea men s.
20,21
Since he publica ion o hese e iews,
new andomized con olled ials (RCTs) ha e been pub-
lished in his field.
The e o e, he aim o his sys ema ic e iew wi h me a-
analysis was o in es iga e he e ec i eness o hip- a ge ed
in e en ions, in isola ion o in combina ion wi h LBP in e -
en ions, compa ed o specific low back in e en ions o
imp o e pain and disabili y in pa ien s wi h LBP.
Me hods
S udy design
The p o ocol o his sys ema ic e iew was egis e ed in he
In e na ional P ospec i e Regis e o Sys ema ic Re iews
(PROSPERO) wi h he egis a ion numbe CRD42022303173.
This sys ema ic e iew ollowed he P e e ed Repo ing
I ems o Sys ema ic Re iews and Me a-analysis (PRISMA)
s a emen and Coch ane ecommenda ions.
22
Sea ch s a egy
The bibliog aphical sea ch was conduc ed in PubMed (MED-
LINE), Physio he apy E idence Da abase (PED o), Scopus;
Coch ane Lib a y, and Web o Science (WOS) om incep ion
o 20 No embe 2022. The Popula ion, In e en ion, Com-
pa ison, Ou come, and S udy design (PICOS) amewo k was
used o define he sea ch s a egy. Medical Subjec s Head-
ings (MeSH) we e used as he keywo ds in he sea ch
s a egy: back pain, low back pain, scia ica, low back ache,
mechanical low back pain, hip, hip join , pain measu emen ,
disabili y e alua ion, and clinical ial. The s a egies used
o each da abase a e shown in Supplemen a y ma e ial 
Table S.1. Scopus da abase was included as a ool o sea ch-
ing g ay li e a u e, and a hand sea ch o he e e ence lis o
he included s udies was pe o med. Sea ches we e limi ed
o s udies in English, F ench, and Spanish.
Eligibili y c i e ia and s udy selec ion
The included s udies me he PICOS c i e ia: 1) Popula ion:
adul s diagnosed wi h LBP; 2) In e en ion: hip- a ge ed
conse a i e in e en ions applied in isola ion o combined
wi h specific low back in e en ions; 3) Compa ison: specific
low back in e en ions in isola ion defined as he use o any
physical in e en ion (manual he apy, massage he apy,
exe cise he apy, he mo he apy, elec o he apy, o o he
he apy) ha a ge ed he low back specifically and no he
hip join ; 4) Ou comes consis ed o pain in ensi y and dis-
abili y; 5) S udy design: RCTs.
S udies we e excluded i hey: 1) we e ials conduc ed
wi h animals, cada e s, o simula o s; 2) included pa ici-
pan s wi h auma ic inju ies o a e su gical in e en ions;
3) he in e en ion was applied o he whole body; 4) he
ou come a iables epo ed we e no he ou comes o in e -
es o we e no measu ed using a alid and eliable ins u-
men .
A e esul s o sea ches we e e ie ed, e e ences we e
expo ed o Mendeley desk op, and duplica es we e
emo ed. Two e iewe s independen ly (LC and SJ) assessed
he i le and abs ac o each e e ence o de e mine po en-
ial eligibili y. The same independen e iewe s assessed
po en ial ull ex s. A hi d au ho (EE) esol ed he disc ep-
ancies be ween he wo e iewe s. Th ee au ho s o o iginal
pape s we e con ac ed by e-mail o cla i y eligibili y c i e-
ia. The in e - a e ag eemen was calcula ed using he
Cohen’s kappa coe ficien .
23
Da a ex ac ion
The wo au ho s independen ly ex ac ed he da a om he
iden ified s udies using he s anda dized p ocess adap ed
om he Coch ane Collabo a ion. Ex ac ed in o ma ion
included: 1) cha ac e is ics o he s udy popula ion; 2)
aspec s o he in e en ion pe o med; 3) ou come meas-
u es; 4) esul s; and 5) ollow-up pe iod. The hi d assesso
esol ed any disag eemen s. Da a we e analyzed using a
quali a i e syn hesis and, whene e possible, using a quan i-
a i e syn hesis (me a-analysis).
Risk o bias and ce ain y o he e idence
Two assesso s assessed he quali y o he s udies using he
Coch ane Risk o Bias ool. The Coch ane Risk o Bias ool
de e mines he po en ial bias and he in e nal alidi y o
he s udies and classifies hem as “low”,“unclea ”,o
“high” isk based on 7 c i e ia.
24
This ool has shown o be
eliable o e alua ing he quali y o s udies and assessing
isk o bias. Funnel plo asymme y o assess publica ion bias
in he me a-analyses was no conduc ed in his s udy
2
L. Ceballos-Lai a, E. Es 
ebanez-de-Miguel, J.J. Jim
enez-Rejano e al.
because he me a-analyses p esen ed did no mee he ule
o a leas 10 ials.
The GRADEp o GDTwas used o de elop a summa y o he
findings. This classifica ion ca ego izes he e idence as
“high”,“mode a e”,“low”,o “ e y low”and allows
esea che s and clinicians o disce n he impo ance o he
esul s. The ce ain y o e idence o he me a-analysis was
downg aded acco ding o he p esence o he ollowing: isk
o bias (downg aded by one le el o wo le els i mo e han
25% o 50% o he pa icipan s we e om s udies wi h poo
o ai me hodological quali y: lack o alloca ion conceal-
men , andom alloca ion and/o sample size calcula ion,
pa icipan , and pe sonnel blinding, blinding o ou come
assesso s), inconsis ency o esul s (downg aded by one le el
i he e was significan he e ogenei y ega ding ou come
measu emen o in e en ion, o i he I
2
alue was 50%,
and wo le els i he I
2
was 75%),
25,26
indi ec ness o e i-
dence (downg aded by one le el i di e en popula ions,
in e en ions, o compa a o s we e included), and imp eci-
sion (downg aded by one le el i ewe han 100 pa icipan s
we e included in he compa ison, and wo le els when he
sample sizes we e 30 indi iduals).
2628
Single andomized
ials we e conside ed inconsis en and imp ecise and p o-
ided “low ce ain y”e idence. This could be u he down-
g aded o “ e y low”ce ain y e idence i he e was also a
high isk o bias.
24,29
Da a syn hesis and analysis
The quan i a i e syn hesis o he esul s was conduc ed acco d-
ing o he ou comes conside ed: pain in ensi y and disabili y.
When s udies used di e en ools o assess he same ou come,
he au ho s pe o med in e se a iance me hods.
Sepa a e analyses we e pe o med o pain in ensi y and
disabili y. When s udies epo ed pain da a on a scale o he
han 0 o 10 (e.g., 0 o 100) we ans o med he da a in o a
0 o10scale.
30
Time poin s o assessmen conside ed we e
sho - e m (o pos in e en ion), medium- e m (6
mon hs), and long- e m (12 mon hs). Mean, s anda d de i-
a ion (SD), and sample size a each ime poin we e
ex ac ed o each g oup. Ou comes we e analyzed based
on he pos -in e en ion means and SDs by calcula ing he
mean di e ence (MD) when s udies used he same scale o
s anda dized mean di e ence (SMD) when s udies used di -
e en scales, wi h 95% CIs. Significance was se a a P alue
<0.05. The minimum clinically impo an change (MCID) on
pain in ensi y was s a ed as 1.5.
31
Fo disabili y, he
be ween-g oup e ec s size was used o classi y he e ec
es ima es as small (SMD a leas 0.2 bu less han 0.5),
medium (SMD om 0.5 o less han 0.8), o la ge (SMD 0.8
o g ea e ).
32
Da a we e combined o me a-analysis using a minimum
o wo ials assessed as clinically homogeneous. T ials we e
conside ed clinically homogeneous i he e was a common
in e en ion and ou come. When a h ee-a m s udy was
included, he da a om he con ol g oup we e di ided.
33
Random-e ec me a-analysis was pe o med when he com-
bina ion o in e en ion e ec s could inco po a e an
assump ion ha he s udies a e no all es ima ing he same
in e en ion e ec .
34
A esea che analysed da a using Re Man 5.4 so wa e.
Resul s
Li e a u e sea ch and sc eening
Eigh s udies we e included in he quali a i e and quan i a-
i e syn hesis. One s udy was excluded due o lack o in o -
ma ion abou he compa ison g oup.
35
The desc ip ion o
he selec ion p ocess is shown in he PRISMA flowcha dia-
g am (Fig. 1). The ag eemen be ween e iewe s was calcu-
la ed by kappa wi h a alue o 0.9.
Cha ac e is ics o included s udies
A o al o 8 RCTs we e included comp ising 508 pa ien s wi h
LBP. The sample size anged om 24 o 80 pa ien s.
Mos s udies included pa ien s wi h LBP o a leas 6
weeks,
36
o 3 mon hs.
3740
All he s udies included pa ien s
wi h LBP olde han 18.
3643
Conce ning he LBP diagnosis, 3
s udies included pa ien s wi h non-specific LBP,
36,38,39
one
s udy included pa ien s wi h mechanical LBP,
41
and 3 s udies
did no speci y he LBP diagnosis.
40,42,43
The sociodemo-
g aphic and clinical cha ac e is ics o he pa icipan s in
each s udy a e shown in Table 1.
The hip- a ge ed in e en ion g oup (hip- a ge ed in e -
en ion) in each ial consis ed o di e en hip in e en-
ions. Se en s udies added hip- a ge ed in e en ions o
specific low back in e en ions,
3639,4143
and only one
applied hip ea men in isola ion.
40
Fou s udies combined
hip s eng hening wi h specific low back exe cise,
3638,42
one applied hip abduc o s eng hening in isola ion,
40
one
s udy combined hip join s e ching wi h specific low back
exe cise,
38
and 3 s udies applied hip join mobiliza ion and
s eng hening plus specific low back in e en ion.
39,41,43
Specific low back in e en ion g oups (con ol) we e
mainly based on lumba s abiliza ion exe cises in all 8 s ud-
ies.
3643
Table 1 shows he ea men s applied in he hip and
low-back g oups.
In o ma ion on he du a ion o he sessions, he numbe
o sessions pe week, and he o al numbe o sessions a e
p esen ed in he Supplemen a y ma e ial - Table S.2. The
sessions du a ion anged om 20 o 60 min,
3739,42,43
he
mos common equency was 23 sessions pe
week,
3740,42,43
and mos o he s udies pe o med a o al
numbe o sessions be ween 18 and 24.
37,38,40,42
Th ee s ud-
ies did no epo ed he equency, du a ion, and/o he
o al numbe o sessions.
36,41,43
Ou come measu es
The ou comes conside ed in his me a-analysis we e pain
in ensi y and disabili y. Se en s udies assessed pain in en-
si y. Fi e s udies used he isual analogue scale (VAS),
3640
and 2 used he nume ic pain a ing sco e (NPRS).
41,43
Disabil-
i y was measu ed o all he s udies. Six s udies used he
Oswes y Disabili y Index (ODI),
3638,4143
and 2 used he
Roland Mo is Ques ionnai e.
39,40
All he s udies assessed he ou come a iables a baseline
and a e he in e en ion (sho - e m).
3643
Two s udies
assessed he medium- and long- e m esul s a 6 mon hs and
a 12 mon hs o ollow-up, espec i ely.
39,43
3
B azilian Jou nal o Physical The apy 27 (2023) 100502
S udy quali y and isk o bias
All RCTs included in his e iew showed a high isk o selec-
ion bias and epo ing. Mos o he s udies co ec ly pe -
o med he andom sequence gene a ion, bu he
concealmen alloca ion was only pe o med in 3. No s udy
blinded he pa icipan s o he apis ( his i em is expec ed
in conse a i e non-pha macological in e en ions). The
Coch ane isk-o -bias ool esul s a e shown in Fig. 2.
Syn hesis o esul s
Pain in ensi y
Pain in ensi y was measu ed in 7 s udies a e he in e -
en ion,
3641,43
and in 2 s udies a 6 and 12 mon hs o ollow-
up.
39,43
Hip s eng hening + specific low back exe cise
e sus specific low back
Ve y low ce ain y e idence showed ha hip s eng hening
plus specific low back exe cise p o ide s a is ically signifi-
can bu clinically unimpo an imp o emen in pain in en-
si y compa ed o specific low back in e en ion
(MD = 0.66; 95% CI 0.86, 0.48; I
2
: 0%; 3 s udies, 153 pa -
icipan s) (Fig. 3A).
Hip join s e ching + specific low back exe cise
e sus specific low back
Ve y low ce ain y e idence showed ha hip join s e ching
plus specific low back exe cise p o ide s a is ically significan
bu clinically unimpo an imp o emen in pain in ensi y com-
pa ed o specific low back in e en ion (MD = 0.55; 95% CI
1.02, 0.08; 1 s udy, 32 pa icipan s) (Fig. 3A).
Hip abduc o s eng hening e sus specific low back
in e en ion
Ve y low ce ain y e idence showed ha hip abduc o
s eng hening p o ide s a is ically significan bu clinically
unimpo an imp o emen in pain in ensi y compa ed o
specific low back in e en ion (MD = 0.93; 95% CI 1.67,
0.19; 1 s udy, 24 pa icipan s) (Fig. 3A).
Hip join mobiliza ion and hip
s eng hening + specific low back in e en ion
e sus specific low back in e en ion
Ve y low ce ain y e idence showed ha hip join mobiliza-
ion and hip s eng hening plus specific low back
Fig. 1 PRISMA flowcha .
4
L. Ceballos-Lai a, E. Es 
ebanez-de-Miguel, J.J. Jim
enez-Rejano e al.
Table 1 Sociodemog aphic and clinical cha ac e is ics o he pa icipan s.
Pa icipan s In e en ion Ou come ( ool) Follow-up
Au o (yea ) N (sex a io) Mean age (SD) Diagnosis Low-back g oup Hip g oup
Hip s eng hening + specific low back exe cise e sus specific low back in e en ion
Lee and Kim 2015 68 CG: 50.0 (11.4); 59.38
(17.3)
EG: 54.9 (10.6); 61.0
(13.2)
CLBP Lumba s abiliza ion
exe cises (n= 37)
Lumba s abiliza ion
exe cises + hip
s eng hening (n= 31)
-Pain (VAS)
-Disabili y (ODI)
Kendall e al. 2015 80 (38 M/42 F) CG: 33 (33.4)
EG: 41 (37.4)
NSLBP Lumbopel ic exe cises
(n= 40)
Lumbopel ic
exe cises + hip
s eng hening (n= 40)
- Pain (VAS)
- Disabili y (ODI)
Jeong e al. 2015 40 (0 M/40 F) CG: 41.2 (6.7)
EG: 41.2 (5.5)
CLBP Lumba s abiliza ion
exe cises (n= 20)
Lumba s abiliza ion
exe cises + glu eus
muscles s eng hening
(n= 20)
-Disabili y (ODI)
Kim and Yim 2020 66 (34 M/32 F) CG: 47.7 (8.5)
EG: 47.0 (9.4)
NSLBP Lumba s abiliza ion
exe cises (n= 10)
Lumba s abiliza ion
exe cises + hip
s eng hening (n= 22)
-Pain (VAS)
-Disabili y (ODI)
Hip join s e ching + specific low back exe cise e sus specific low back in e en ion
Kim and Yim B 2020 66 (34 M/32 F) CG: 47.7 (8.5)
EG: 47.5 (9.7)
NSLBP Lumba s abiliza ion
exe cises (n= 10)
Lumba s abiliza ion
exe cises + hip s e ch-
ing (n= 24)
-Pain (VAS)
-Disabili y (ODI)
Hip (abduc o ) s eng hening e sus specific low back in e en ion
Abou azeli e al. 2021 24 (0 M/24 F) CG: 39.0 (5.9)
EG: 38.8 (5.8)
CLBP Lumba s abiliza ion
exe cises (n= 12)
Hip abduc o s eng h-
ening (n= 12)
-Pain (VAS)
-Disabili y (RMQ)
Hip join mobiliza ion & hip s eng hening + specific low back in e en ion e sus specific low back in e en ion
Bade e al. 2017 84
(50 M/34 F)
CG: 48.1 (2.4)
EG: 44.8 (2.3)
MLBP Guideline-o ien ed low
back ea men (n= 39)
Guideline-o ien ed low
back ea men + hip
s eng hening and hip
mobiliza ions (n= 45)
-Pain (NPRS)
-Disabili y (ODI)
Fukuda e al. 2021 70 (33 M/37 F) CG:35.2 (12.5)
EG:40.2 (12.4)
CNSLBP Lumba s abiliza ion
exe cises + manual
he apy (n= 35)
Lumba s abiliza ion
exe cises + manual
he apy + hip s eng h-
ening (n= 35)
-Pain (VAS)
-Disabili y (RMQ)
Medium- e m
(6 mon hs)
Long- e m (12 mon hs)
Bu ns e al. 2021 76 (29 M/47 F) CG:40.2 (19.9)
EG:39.0 (18.0)
LBP Guideline-o ien ed low
back ea men (n= 39)
Guideline-o ien ed low
back
ea men + ailo ed
hip ea men (manual
he apy and s eng h-
ening) (n= 37)
-Pain (NPRS)
-Disabili y (ODI)
Medium- e m
(6 mon hs)
Long- e m (12 mon hs)
CG, con ol g oup; CLBP, ch onic low back pain; CNSLBP, ch onic non-specific low back pain; EG, expe imen al g oup; LBP, low back pain; MLBP, mechanical low back pain; NPRS, nume ic pain
a ing sco e; NSLBP, non-specific low back pain; ODI, Oswes y Disabili y Index; RMQ, Roland Mo is Ques ionnai e; SD, s anda d de ia ion; VAS, isual analogue scale.
5
B azilian Jou nal o Physical The apy 27 (2023) 100502

in e en ion p o ide no be e imp o emen in pain in en-
si y compa ed o specific low back in e en ion
(MD = 0.15; 95% CI 0.59, 0.30; I
2
: 0%; 3 s udies, 230 pa -
icipan s) (Fig. 3A).
These s udies measu ed pain in ensi y in he medium-
e m and long- e m.
39,43
Ve y low ce ain y e idence
showed ha hip join mobiliza ion and hip s eng hening
plus specific low back in e en ion p o ide no be e
imp o emen in pain in ensi y compa ed o specific
low back in e en ion a medium- e m (MD: 0.32;
95% CI: 0.96, 0.31; I
2
: 0%; 2 s udies; 146 pa icipan s)
(Fig. 3B), o long- e m (MD: 0.10; 95% CI: 0.65, 0.45; I
2
:
0%; 2 s udies; 146 pa icipan s) (Fig. 3C).
Fig. 2 Risk o bias Coch ane ool.
6
L. Ceballos-Lai a, E. Es 
ebanez-de-Miguel, J.J. Jim
enez-Rejano e al.
Disabili y
Disabili y was measu ed in all he s udies a e he in e -
en ion,
3643
and in 2 s udies a 6 and 12 mon hs o ollow-
up.
39,43
Hip s eng hening + specific low back exe cise
e sus specific low back
Ve y low ce ain y e idence showed ha hip s eng hening
plus specific low back exe cise p o ide a la ge imp o emen
in disabili y compa ed o specific low back in e en ion
(SMD = 0.81; 95% CI 1.53, 0.10; I
2
: 80%; 4 s udies, 220
pa icipan s) (Fig. 3D).
Hip join s e ching + specific low back exe cise
e sus specific low back
Ve y low ce ain y e idence showed ha hip join s e ching
plus specific low back exe cise p o ide a la ge imp o emen
in disabili y compa ed o specific low back in e en ion
(SMD = 1.03; 95% CI 1.82, 0.25; 1 s udy, 32 pa icipan s)
(Fig. 3D).
Hip abduc o s eng hening e sus specific low back
in e en ion
Ve y low ce ain y e idence showed ha hip abduc o
s eng hening p o ide no imp o emen in disabili y
Fig. 3B Fo es plo o pain in ensi y o hip- a ge ed in e en ions combined wi h LBP in e en ions e sus specific low back ea -
men in he medium- e m.
Fig. 3A Fo es plo o pain in ensi y o hip- a ge ed in e en ions in isola ion o in combina ion wi h LBP in e en ions e sus spe-
cific low back ea men in he sho - e m.
Fig. 3C Fo es plo o pain in ensi y o hip- a ge ed in e en ions combined wi h LBP in e en ions e sus specific low back ea -
men in he long- e m.
7
B azilian Jou nal o Physical The apy 27 (2023) 100502
compa ed o specific low back in e en ion (SMD = 0.77;
95% CI 1.60, 0.07; 1 s udy, 24 pa icipan s) (Fig. 3D).
Hip join mobiliza ion and hip
s eng hening + specific low back in e en ion
e sus specific low back in e en ion
Ve y low ce ain y e idence showed ha hip join mobiliza-
ion and hip s eng hening plus specific low back in e en-
ion p o ide no imp o emen in disabili y compa ed o
specific low back in e en ion (SMD = 0.06; 95% CI 0.30,
0.42; I
2
: 46%; 3 s udies, 230 pa icipan s) (Fig. 3D).
These s udies measu ed disabili y in he medium- e m
and long- e m.
39,43
Ve y low ce ain y e idence showed
ha hip join mobiliza ion and hip s eng hening plus
specific low back in e en ion p o ide no imp o emen in
disabili y compa ed o specific low back in e en ion in
hemedium e m(SMD=0.01; 95% CI; 0.33, 0.31; I
2
:
0%; 2 s udies; 146 pa icipan s) (Fig. 3E), o long- e m
(SMD = 0.05; 95% CI; 0.27, 0.38; I
2
: 0%; 2 s udies; 146
pa icipan s) (Fig. 3F).
Acco ding o GRADE, he o e all ce ain y o e idence o
all compa isons we e a ed as e y low o pain in ensi y and
disabili y (Table 2).
Fig. 3D Fo es plo o disabili y o hip- a ge ed in e en ions in isola ion o in combina ion wi h LBP in e en ions e sus specific
low back ea men in he sho - e m.
Fig. 3E Fo es plo o disabili y o hip- a ge ed in e en ions combined wi h LBP in e en ions e sus specific low back ea men
in he medium- e m.
Fig. 3F Fo es plo o disabili y o hip- a ge ed in e en ions combined wi h LBP in e en ions e sus specific low back ea men
in he long- e m.
8
L. Ceballos-Lai a, E. Es 
ebanez-de-Miguel, J.J. Jim
enez-Rejano e al.
Table 2 Summa y o e idence o he esul s acco ding o hei ce ain y and hei impo ance using he GRADE ool.
Ce ain y assessmen No pa ien s E ec Ce ain y
No s udies S udy design Risk o bias Inconsis ency Indi ec ness Imp ecision O he s [hip- a ge ed g oup] [Con ol g oup] Absolu e (95% CI)
Pain in ensi y (sho - e m) Hip s eng hening + specific low back exe cise e sus specific low back
3 RCTs Ve y se ious
a
Se ious
c
No se ious Se ious
d
None 93 87 MD 0.66 less
(0.86 less o 0.46 less)
⨁^
x^
x^
x
Ve y Low
Pain in ensi y (pos -in e en ion) hip join s e ching + specific low back exe cise e sus specific low back in e en ion
1 RCTs Ve y se ious
a
Ve y se ious
d
None 24 10 MD 0.55 less
(1.02 less o 0.08 highe )
⨁^
x^
x^
x
Ve y Low
Pain in ensi y (pos -in e en ion) hip abduc o s eng hening e sus specific low back in e en ion
1 RCTs Ve y se ious
a
Ve y se ious
d
None 12 12 MD 0.93 less
(1.67 less o 0.19 highe )
⨁^
x^
x^
x
Ve y Low
Pain in ensi y (pos -in e en ion) hip join mobiliza ion & hip s eng hening + specific low back in e en ion e sus specific low back in e en ion
3 RCTs Ve y se ious
a
Se ious
b
No se ious No se ious
d
None 117 113 MD 0.15 less
(0.59 less o 0.3 highe )
⨁^
x^
x^
x
Ve y Low
Pain in ensi y (6 mon hs ollow-up) hip join mobiliza ion & hip s eng hening + specific low back in e en ion e sus specific low back in e en ion
2 RCTs Se ious
a
Se ious
b
No se ious Se ious
d
None 72 74 MD 0.32 less
(0.96 less o 0.31 highe )
⨁^
x^
x^
x
Ve y Low
Pain in ensi y (12 mon hs ollow-up) hip join mobiliza ion & hip s eng hening + specific low back in e en ion e sus specific low back in e en ion
2 RCTs Se ious
a
Se ious
b
No se ious Se ious
d
None 72 74 MD 0.10 less
(0.65 less o 0.45 highe )
⨁^
x^
x^
x
Ve y Low
Disabili y (pos -in e en ion) Hip s eng hening + specific low back exe cise e sus specific low back in e en ion
4 RCTs Ve y se ious
a
Se ious
c
No se ious No Se ious None 113 107 SMD 0.81 less
(1.53 less o 0.10 less)
⨁^
x^
x^
x
Ve y Low
Disabili y (pos -in e en ion) hip join s e ching + specific low back exe cise e sus specific low back in e en ion
1 RCTs Ve y se ious
a
Ve y se ious
d
None 24 10 SMD 1.03 less
(1.82 less o 0.25 less)
⨁^
x^
x^
x
Ve y Low
Disabili y (pos -in e en ion) hip abduc o s eng hening e sus specific low back in e en ion
1 RCTs Ve y se ious
a
Ve y se ious
d
None 12 12 SMD 0.77 less
(1.6 less o 0.07 less)
⨁^
x^
x^
x
Ve y Low
Disabili y (pos -in e en ion) hip join mobiliza ion & hip s eng hening + specific low back in e en ion e sus specific low back in e en ion
3 RCTs Ve y se ious
a
Se ious
b
No se ious No se ious
d
None 117 113 SMD 0.06 less
(0.30 less a 0.42 highe )
⨁^
x^
x^
x
Ve y Low
Disabili y (6 mon hs ollow-up) hip join mobiliza ion & hip s eng hening + specific low back in e en ion e sus specific low back in e en ion
2 RCTs Se ious
a
Se ious
b
No se ious Se ious
d
None 72 74 SMD 0.01 less
(0.33 less a 0.31 highe )
⨁^
x^
x^
x
Ve y Low
Disabili y (12 mon hs ollow-up) hip join mobiliza ion & hip s eng hening + specific low back in e en ion e sus specific low back in e en ion
2 RCTs Se ious
a
Se ious
b
No se ious Se ious
d
None 72 74 SMD 0.05 highe .
(0.38 highe o 0.27 less)
⨁^
x^
x^
x
Ve y Low
CI, confidence in e al; MD, mean di e ence; RCTs, andomized con olled ial; SMD, s anda dized mean di e ence.
Explana ions:.
a. Mo e han 25% o he pa icipan s we e om s udies wi h poo o ai me hodological quali y, conside ing hese aspec s: Lack o alloca ion concealmen , andom alloca ion and/o sample
size calcula ion, pa icipan and pe sonnel blinding, blinding o ou come assesso s.
b. Significan he e ogenei y ega ding ou come measu emen o in e en ion, o i he I
2
alue was 50%.
c. Significan he e ogenei y ega ding ou come measu emen o in e en ion, o i he I
2
alue was 75%.
d. Fewe han 100 pa icipan s we e included in he compa ison o single andomized con olled ials included.
High: We a e e y confiden ha he ue e ec is close o he es ima e o he e ec .
Mode a e: We a e mode a ely confidence in he e ec es ima e. The ue e ec is close o he es ima e o he e ec , bu he esul can be di e en .
Low: Confidence in he e ec es ima e is limi ed, he ue e ec can be subs an ially di e en om he es ima e o he e ec .
Ve y Low: The e is li le confidence in he e ec es ima e, he ue e ec is likely o be subs an ially di e en om he es ima e e ec .
9
B azilian Jou nal o Physical The apy 27 (2023) 100502