Can systematic review findings on treatment effectiveness be trusted? : the case of Pilates exercise and chronic low back pain

In our systematic review of systematic reviews, we concluded that the effectiveness of Pilates exercise in people with CLBP cannot be supported by current research evidence [8]. This is due to the small number, variable methodological quality and heterogeneity of primary studies [8]. We, therefore, recommend that clinicians carefully consider the potential for bias in all research studies, including systematic reviews, before using findings to direct clinical practice. Systematic reviews traditionally may represent the highest level of evidence, but their ability to provide credible results can, in some circumstances, be compromised by the inclusion of non-randomised controlled trials, primary studies of poor methodological quality and the inappropriate use of meta-analyses.