Unstable shoes for the treatment of lower back pain: a meta-analysis of randomized controlled trials

We aimed to perform a systematic review and meta-analysis to compare the treatment effects of unstable shoes and flat shoes on lower back pain patients.

Literature databases, including PubMed, Web of Science, and EMBASE (up to June 2019), were searched systematically.

Two authors independently screened the retrieved records and identified the randomized controlled trials where patients with lower back pain who wore unstable shoes as intervention and wore flat shoes as a control. Relevant data were extracted for meta-analysis using Review Manager 5.3 software. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the pooled outcome evidence levels.

Five randomized controlled trials and 251 patients were included in the analysis. The meta-analysis results showed that there was a tendency toward a reduction in the Roland-Morris disability questionnaire score (mean difference (MD) -2.16, 95% confidence interval (CI) -4.28 to -0.03, I² = 53%) and pain score (MD -0.84, 95% CI -1.66 to -0.02, I² = 84%) in patients wearing unstable shoes compared to those wearing flat shoes. There was no significant difference in the life quality scores between the unstable shoe and flat shoe groups (MD -0.59, 95% CI -6.18 to 5.01, I² = 0%). Functional disability and pain scores were determined to have very low-quality evidence, and life quality scores were determined to have low-quality evidence according to the Grading of Recommendations Assessment, Development and Evaluation analysis.

Unstable shoes may be effective in treating lower back pain in the clinic, but the conclusion was limited by the current low-quality studies.