Systematic review A systematic review of physiotherapy for spondylolysis and spondylolisthesis Margaret L. McNeely, G. Torrance, D. J. Magee Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Canada SUMMARY. The purpose of this systematic review was to assess the evidence concerning the effectiveness of physiotherapy intervention in the treatment of low back pain related to spondylolysis and spondylolisthesis. A literature search of published and unpublished articles resulted in the retrieval of 71 potential studies on the subject area. Fifty-two of the 71 articles were studies, and these studies were reviewed using preset relevance criteria. Given the inclusion and exclusion criteria chosen for this systematic review, there were very few acceptable studies and only two studies met the relevance criteria for the critical appraisal. Both studies provide evidence to suggest that specific exercise interventions, alone or in combination with other treatments, have a positive effect on low-back pain due to spondylolysis and spondylolisthesis; however, the type of exercise used was different in the two studies. In this review, very few prospective studies were found that examined the efficacy of physiotherapy on the topic area; therefore, few conclusions can be made, and further research is warranted. r 2003 Elsevier Science Ltd. All rights reserved. INTRODUCTION A systematic review is an evaluation of existing literature using a research format. As such it constitutes research; it poses a question, identifies a population and draws a sample (Magee 1998). Published and unpublished studies are assembled using explicit searching methods, and a predeter- mined protocol of evaluation is used with inclusion and exclusion criteria (Jefferson & Deeks 1999, p 225). Research papers are read selectively and critically, measurements are analysed, and conclu- sions are drawn based on the scientific merit of the research findings. It is hoped that the findings of a systematic review will help guide practitioners in prescribing effective interventions for their patients (de Vet et al. 1997) and provide insight into future research directions. When doing a systematic literature review, large randomized controlled trials (RCTs) are sought, as they provide the strongest evidence (Stein & Cutler 1996; Magee 1998). Internal validity of the study, with an RCT, is enhanced as extraneous factors are controlled, and as randomization of subjects reduces selection bias (Portney & Watkins 2000, p 167). Valid and reliable measures, as well as valid, reliable, and sensitive measurements and instruments insure that data are accurate and meaningful (Warren 1994). In addition, having outcomes measured by independent (blinded) observers, or by the patients themselves, further enhance the validity of the study. To control for confounders and to assess the external validity of the study, inclusion and exclusion criteria should be clearly stated and details provided on the study population. Among these details, such things as agreement to participate, attrition and the reasons for subjects being lost to follow-up must be included. In treatment studies, pretreatment clinical signs and symptoms have to be documented, and treatment interventions explained in enough detail to allow for replication of the study (Magee 1998). The purpose of the present systematic review was to examine research studies assessing the efficacy of physiotherapy interventions in the treatment of low-back pain related to spondylolysis and spondy- lolisthesis. Manual Therapy (2003) 8(2), 80–91 r 2003 Elsevier Science Ltd. All rights reserved. 1356-689X/03/$-see front matter doi:10.1016/S1356-689X(02)00066-8 Received: 30 October 2001 Revised: 17 June 2002 Accepted: 2 July 2002 Margaret L. McNeely, MSc, PT, Graduate Student, Grace Torrance BSc PT, Graduate Student, Dr David J. Magee PhD, BPT, Professor, Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Canada Correspondence to: MM, Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 250 Corbett Hall, Alberta, Canada T6G 2G4. Fax: +1 780 492 1626; E-mail: dmcneely@planet.eon.net 80