The Effectiveness of Physical Therapy Interventions for Spondylolisthesis in Adults: A Systematic Review of Randomized Controlled Trials

Objective(s): To investigate the high-level evidence for the effectiveness of various physical therapy (PT) interventions for spondylolisthesis in adults.

Data Sources: A systematic review was performed using PubMed, MEDLINE, CINAHL, and Web of Science on April 26th, 2023. Search terms were spondylolisthesis AND (exercise OR physical therapy).

Study Selection: Inclusion criteria was adult patients, diagnosis of spondylolisthesis, randomized controlled trails (RCTs) only, and utilization of PT interventions. Exclusion criteria were a patient history of spine surgery, non-RCTs, comparison to surgical interventions, and no diagnosis of spondylolisthesis. A total of 1,014 articles were initially identified.

Data Extraction: Multiple authors performed article screening and data extraction. RCTs were graded via the Physiotherapy Evidence Database (PEDRO) scale.

Data Synthesis: A total of 5 RCTs met final inclusion criteria. Included patients (n=456) had a frequency weighted mean age of 49.1 ± 8.6 years with a frequency weighted mean follow-up time of 2.6 ± 2.3 months. All reported grades of isthmic or degenerative spondylolisthesis for included patients were grade I or II. The frequency weighted mean decrease in pain for the conventional physical therapy (CPT) group (n=157) was 2.6 ± 1.0 points whereas the frequency weighted mean in pain for the lumbar stabilization exercise (LSE) subgroup (n=56) was 2.9 ± 0.5 points. The frequency weighted mean decrease in disability (Oswestry Disability Index) for the CPT group was 14.4 ± 6.6 points whereas the frequency weighted mean decrease in disability for the LSE subgroup (n=56) was 17.3 ± 0.1 points. For CPT plus manual therapy, one study (n=47) found that lumbar mobilization significantly decreased pain (p < 0.001) while another study (n=100) found that thoracic mobilization significantly decreased disability (p < 0.001) as compared to CPT alone.

Conclusions: Various PT interventions may provide short-term improvements in pain and disability in adult patients with spondylolisthesis demonstrated through our systematic review of RCTs of fair to high quality. Interventions such as manual therapy and LSE along with CPT for adult patients with spondylolisthesis have promise, but require further research to determine clinical impact.

Author(s) Disclosures: None.