Search

This symposium introduction reflects on themes of tradition and innovation in the work of Antonio ('Nino') Cassese. These themes were central to Cassese's own thinking, in ways drawn out by the three symposium articles on aspects of his life and work, and they play important roles in international law more broadly. In exploring these themes in a loosely biographical inquiry, the introduction also poses questions about the nature of biographical writing in international law and its relation to memorialization and historicization of law's recent past. [ABSTRACT FROM AUTHOR]

Rationale: A recent randomized controlled trial revealed that a multicomponent sepsis transition and recovery (STAR) program delivered through specialized nurse navigators was effective in reducing a composite of 30-day readmission and mortality. Better understanding of patterns of care provided by the STAR program is needed to promote implementation and dissemination of this effective program. Objectives: This study characterizes individual care activities and distinct "packages" of care delivered by the STAR program. Methods: We performed a secondary analysis of data from the intervention arm of the IMPACTS (Improving Morbidity during Post–Acute Care Transitions for Sepsis) randomized controlled trial, conducted at three urban hospitals in the southeastern United States from January 2019 to March 2020. We used a structured data collection process to identify STAR nurse navigator care activities from electronic health record documentation. We then used latent class analysis to identify groups of patients receiving distinct combinations of intervention components. We evaluated differences in patient characteristics and outcomes between groups receiving distinct intervention packages. Results: The 317 sepsis survivors enrolled into the intervention arm of the IMPACTS trial received one or more of nine unique care activities delivered by STAR nurse navigators (care coordination, health promotion counseling, emotional listening, symptom management, medication management, chronic disease management, addressing social determinants of health, care setting advice and guidance, and primary palliative care). Patients received a median of three individual care activities (interquartile range, 2–5). Latent class analysis revealed four distinct packages of care activities delivered to patients with different observable characteristics and different frequency of 30-day readmission and mortality. Conclusions: We identified nine care activities delivered by an effective STAR program and four distinct latent classes or packages of intervention delivery. These results can be leveraged to increase widespread implementation and provide targets to augment future program delivery. [ABSTRACT FROM AUTHOR]

Systematically evaluate the comparative effectiveness of dry needling (DN) or local acupuncture to various types of wet needling (WN) for musculoskeletal pain disorders (MPD). Seven databases (PubMed, PEDro, SPORTDiscus, CINAHL, Scopus, Embase, and Cochrane Central Register of Controlled Trials) were searched following PROSPERO registration. Randomized clinical trials were included if they compared DN or local acupuncture with WN for MPD. Primary outcomes were pain and/or disability. The Revised Cochrane Collaboration tool (RoB 2.0) assessed the risk of bias. Twenty-six studies were selected. Wet Needling types included cortisone (CSI) (N = 5), platelet-rich plasma (PRP) (N = 6), Botox (BoT) (N = 3), and local anesthetic injection (LAI) (N = 12). Evidence was rated as low to moderate quality. Results indicate DN produces similar effects to CSI in the short-medium term and superior outcomes in the long term. In addition, DN produces similar outcomes compared to PRP in the short and long term and similar outcomes as BoT in the short and medium term; however, LAI produces better pain outcomes in the short term. Evidence suggests the effectiveness of DN to WN injections is variable depending on the injection type, outcome time frame, and diagnosis. In addition, adverse event data were similar but inconsistently reported. PROSPERO Registration: 2019 CRD42019131826 Dry needling produces similar effects for pain and disability in the short and medium term compared to cortisone, Botox, and platelet-rich plasma injections. Local anesthetic injection may be more effective at reducing short-term pain. Long-term effects on pain and disability are similar between dry needling and platelet-rich plasma injections, but dry needling may produce better long-term outcomes than cortisone injections. The available adverse event data is similar between dry and wet needling. The conclusions from this study may be beneficial for patients and clinicians for considering risk and cost benefit analyses. [ABSTRACT FROM AUTHOR]

This essay takes up the question of what it is to teach international law 'in context', drawing on experiences of teaching undergraduate survey courses in the US and UK, and designing a new LLM module on Histories of International Law. The essay begins with an exploration of teaching as a particular context of its own – one with constraints which might also function as foils for creativity. It then sketches some aspects of what teaching international law 'in context(s)' might involve, including the ways in which contexts of different kinds put in question one's theory of law, and vice versa. It turns, finally, to an examination of the promise and limits of interdisciplinarity – particularly recourse to history as a discipline – in illuminating contexts. [ABSTRACT FROM AUTHOR]

The article literary criticism is presented of the book "International Law and the Politics of History" by Anne Orford on politics of making history and law. It mentions rather than looking to history in a doomed attempt to find a new ground for formalist interpretations of what past legal texts really mean or what international regimes are really for, Orford urges lawyers and historians to embrace the creative role they play in making rather than finding the meaning of international law.

Systematic review. Physical therapists often use cervicothoracic and thoracic manual techniques to treat musculoskeletal disorders of the upper quarter ,however, the overall effectiveness of this approach remains to be elucidated. This systematic review explored studies that examined the short- and long-term effectiveness of manual physical therapy directed at the cervicothoracic and thoracic region in the management of upper quarter musculoskeletal conditions. The electronic databases MEDLINE, AMED, CINAHL, and Embase were searched from their inception through 30 October 2020. Eligible clinical trials included those where human subjects treated with cervicothoracic and/or thoracic manual procedures were compared with a control group or other interventions. The methodological quality of individual studies was assessed using the PEDro scale. The initial search returned 950 individual articles. After the screening of titles and abstracts, full texts were reviewed by two authors, with 14 articles determined to be eligible for inclusion. PEDro scores ranged from 66 to 10 (out of a maximum score of 10). In the immediate to 52-week follow-up period, studies provided limited evidence that cervicothoracic and thoracic manual physical therapy may reduce pain and improve function when compared to control/sham or other treatments. Evidence provides some support for the short-termeffectiveness of cervicothoracic and thoracic manual physical therapy in reducing pain and improving function in people experiencing upper quarter musculoskeletal disorders. Evidence is lacking for long-term effectiveness as only two studies explored outcomes beyond 26 weeks and this was for patient-perceived improvement. CRD42020219456 [ABSTRACT FROM AUTHOR]

Study Design: Systematic Review with meta-analysis. Background: Rehabilitation providers have begun to incorporate pain education into their treatment protocols to influence the patient's experience and knowledge to improve their condition. The purpose of this systematic review is to determine if the addition of pain education strategies to physical therapy treatments is beneficial in reducing pain intensity and disability for those with chronic musculoskeletal pain. Methods: A systematic database search was conducted for randomized control trials that investigated the concurrent use of pain education and physical therapy. Standardized methods for article identification, inclusion, and quality appraisal was utilized. Where possible, studies were pooled for meta-analysis, with pain and disability as the primary outcomes. Results: Fourteen articles were included in this review, of which all fourteen were rated as high quality using the PEDro scale of quality assessment. Meta-analyses were conducted on pain and disability constructs at short term (< 12 weeks) and long-term (≥ 12 weeks) for the studies that allowed for quantitative pooling of effect sizes. Thirteen out of the fourteen included studies demonstrated a decrease in pain and disability with the use of combined interventions. There was a large effect on short-term pain (SMD 0.837), long-term pain (SMD 0.964), and long-term disability (SMD 1.374). A moderate effect on with short-term disability (SMD 0.791). Conclusion: The results of this systematic review support the conclusion that utilizing pain education strategies in conjunction with interventions provided by physical therapists demonstrates a moderate to large effect sizes on pain and disability constructs but lack pooled statistical significance. [ABSTRACT FROM AUTHOR]

Background The average annual national estimate of injuries sustained by collegiate athletes is 210,674, which encompasses both those of a musculoskeletal and a concussive nature. Although athletic injuries are sustained through physical means and produce physical symptoms, sports-related injuries may be a stressor among athletes that is related to mental health. Purpose The purpose of this systematic review is to summarize existing literature describing mental health responses in collegiate athletes with a concussion compared to those with a musculoskeletal injury. Study Design Systematic Review Methods Systematic searches of PubMed, CINAHL, Scopus, ProQuest, and SportDiscus were completed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized. Methodological quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Tool. Data extracted from the included articles included the study design, number of participants, type of injury, sex, age, sport participation, outcome measures, and time to return to play. Results A total of six articles were included. Peak depressive symptoms in athletes who sustain a concussion or musculoskeletal injury occur within one-week post-injury. No significant differences between the concussive and musculoskeletal groups anxiety scores were found at baseline or at each follow-up session. Athletes from both groups were found to be returning to their respective sports with anxiety scores representative of clinical anxiety. Conclusion Similar trends in depressive and anxiety symptoms at various time points post-injury were observed in athletes with both musculoskeletal and concussive injuries. This study identified that athletes were returning to play before their psychological symptoms had returned to their baseline. Level of Evidence 2a [ABSTRACT FROM AUTHOR]

* OBJECTIVE: To (1) evaluate whether exercise therapy is effective for managing neck pain, and (2) investigate the relationship between exercise therapy dosage and treatment effect. * DESIGN: Intervention systematic review with meta-analysis and meta-regression. s LITERATURE SEARCH: An electronic search of 6 databases was completed for trials assessing the effects of exercise therapy on neck pain. * STUDY SELECTION CRITERIA: We included randomized controlled trials that compared exercise therapy to a no-exercise therapy control for treating neck pain. Two reviewers screened and selected studies, extracted outcomes, assessed article risk of bias, and rated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. * DATA SYNTHESIS: Data were pooled using random-effects meta-analysis. We used meta- regression to analyze the effect of exercise dosage on neck pain and disability. * RESULTS: Fourteen trials were included in the review. Seven trials were at high risk of bias, 4 were at unclear risk of bias, and 3 were at low risk of bias. Exercise therapy was superior to control for reducing pain (visual analog scale mean difference, -15.32 mm) and improving disability (Neck Disability Index mean difference, -3.64 points). Exercise dosage parameters did not predict pain or disability outcomes. * CONCLUSION: Exercise was beneficial for reducing pain and disability, regardless of exercise therapy dosage. Therefore, optimal exercise dosage recommendations remain unknown. We encourage clinicians to use exercise when managing mechanical neck pain. [ABSTRACT FROM AUTHOR]

Pain neuroscience education (PNE) and motivational interviewing (MI) have been widely implemented and tested in the field of chronic pain management, and both strategies have been shown to be effective in the short term (small effect sizes) for the management of chronic pain. PNE uses contemporary pain science to educate patients about the biopsychosocial nature of the chronicity of their pain experience. The goal of PNE is to optimize patients' pain beliefs/perceptions to facilitate the acquisition of adaptive pain–coping strategies. MI, on the other hand, is a patient-centered communication style for eliciting and enhancing motivation for behavior change by shifting the patient away from a state of indecision or uncertainty. Conceptually, PNE and MI appear to be complementary interventions, with complementary rather than overlapping effects; MI primarily improves cognitive and behavioral awareness and, potentially, adherence to treatment principles, whereas PNE potentially increases pain knowledge/beliefs, awareness, and willingness to explore psychological factors that are potentially associated with pain. Therefore, combining PNE with MI might lead to improved outcomes with larger and longer-lasting effect sizes. The combined use of PNE and MI in patients having chronic pain is introduced here, along with a description of how clinicians might be able to integrate PNE and MI in the treatment of patients experiencing chronic pain. Clinical trials are needed to examine whether combining PNE with MI is superior to PNE or MI alone for improving pain and quality of life in patients having chronic pain. [ABSTRACT FROM AUTHOR]

Early change is commonly assessed for manual therapy interventions and has been used to determine treatment appropriateness. However, current studies have only explored the relationship of between or within-session changes and short-/medium-term outcomes. The goal of this study was to determine whether pain changes after two weeks of pragmatic manual therapy could predict those participants with chronic low back pain who demonstrate continued improvements at 6-month follow-up. This study was a retrospective observational design. Univariate logistic regression analyses were performed using a 33% and a 50% pain change to predict improvement. Those who experienced a ≥33% pain reduction by 2 weeks had 6.98 (95% CI = 1.29, 37.53) times higher odds of 50% improvement on the GRoC and 4.74 (95% CI = 1.31, 17.17) times higher odds of 50% improvement on the ODI (at 6 months). Subjects who reported a ≥50% pain reduction at 2 weeks had 5.98 (95% CI = 1.56, 22.88) times higher odds of a 50% improvement in the GRoC and 3.99 (95% CI = 1.23, 12.88) times higher odds of a 50% improvement in the ODI (at 6 months). Future studies may investigate whether a change in plan of care is beneficial for patients who are not showing early improvement predictive of a good long-term outcome. [ABSTRACT FROM PUBLISHER]

Objectives:To determine the subacute effects of cervicothoracic spinal thrust/non-thrust in addition to shoulder non-thrust plus exercise in patients with subacromial pathology. Methods:This was a randomized, single blinded controlled trial pilot study. This trial was registered at ClinicalTrials.gov (NCT01753271) and reported according to Consolidated Standards of Reporting Trials requirements. Patients were randomly assigned to either shoulder treatment plus cervicothoracic spinal thrust/non-thrust or shoulder treatment-only group. Primary outcomes were average pain intensity (Numeric Pain Rating Scale) and physical function (Shoulder Pain and Disability Index) at 2 weeks, 4 weeks, and patient discharge. Results:18 patients, mean age 43.1(15.8) years satisfied the eligibility criteria and were analyzed for follow-up data. Both groups showed statistically significant improvements in both pain and function at 2 weeks, 4 weeks, and discharge. The between-group differences for changes in pain or physical function were not significant at any time point. Discussion:The addition of cervicothoracic spinal thrust/non-thrust to the shoulder treatment-only group did not significantly alter improvement in pain or function in patients with subacromial pathology. Both approaches appeared to provide an equally notable benefit. Both groups improved on all outcomes and met the criteria for clinical relevance for both pain and function. Level of Evidence:2b. [ABSTRACT FROM PUBLISHER]

Objective: To investigate the effectiveness of exercise therapy on pain, function, and mobility outcomes in patients with temporomandibular joint dysfunction. Study design: Systematic review with meta-analysis. Methods: A systematic review and meta-analysis undertaken following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that met the inclusion criteria: (1) randomized controlled trials; (2) a population with the diagnosis of temporomandibular joint dysfunction; and (3) interventions that included exercise therapy were considered for review. When studies demonstrated homogeneity on outcome measures, the mean differences or standardized mean differences with 95% confidence interval were calculated and pooled in a meta-analysis for pooled synthesis. Results: Six articles with a total of 419 participants were included in the review and only four studies were included in the meta-analysis. Mobility and mixed exercise therapy approaches appear to be the most common exercise approaches utilized for management of temporomandibular joint dysfunction. Exercise therapy and the associated dosage provide moderate short-term and varying long-term benefits in reduction of pain and improvement of range of motion of the in patients with temporomandibular joint dysfunction. Conclusion: Included studies suggest a mobility or a mixed approach to exercise therapies have impact on reducing pain, significant impact for increasing range of motion, but lack a significant impact for functional improvement. Level of evidence: Therapy, level 1a-. [ABSTRACT FROM AUTHOR]

Six internal medicine physicians reviewed STAR navigator notes in study patients' medical records and recorded whether interventions related to medications occurred and used granular EHR review to characterize the medication errors that were addressed. Sepsis survivors may be particularly vulnerable to medication errors because new medications are frequently started (e.g., antibiotics), home medications are frequently held during the acute phase, and physiologic changes may influence dose and tolerance of medications. [Extracted from the article]

B Introduction: b In the IMPACTS trial, a multicomponent sepsis transition and recovery (STAR) program using nurse navigators to deliver best practice care to sepsis survivors reduced 30-day readmission or mortality. B Results: b Of 317 patients randomized to receive STAR, 228 (72%) received >=1 intervention component via STAR while 91 (29%) received >=4; 9 (3%) refused participation, 17 (5%) had no care needs that required specific intervention, and 63 (20%) were unable to be reached post discharge. [Extracted from the article]

Background: Military physical therapists have been shown to have the necessary knowledge in musculoskeletal medicine in order to practice as a direct access provider. However, research about musculoskeletal knowledge in the civilian physical therapist (non-military) population is lacking. Purpose: The purpose of the current study was to compare the knowledge in managing musculoskeletal conditions between civilian and military physical therapists using a validated and standardized musculoskeletal competency examination. Furthermore, this study aims to investigate the potential factors that may lead to increased musculoskeletal competency. Study Design: Cross-sectional, electronic survey Methods: This study involved a cross-sectional, electronic survey completed in August and September of 2014 in order to assess licensed physical therapists' knowledge in identifying and managing musculoskeletal conditions. Only physical therapists practicing in orthopedics were permitted to be involved in the study. Descriptive statistics of the participants, and logistic regressions analyzing variables correlated with passing the musculoskeletal exam were calculated using SPSS 22.0. Frequencies were produced for multiple variables. Binary logistic regressions were used to correlate the frequency variables with performing at competency level on the musculoskeletal exam. Results: A total of 22,750 surveys were sent to physical therapists in Arizona, Ohio, Texas, Maine and Wyoming. Two thousand sixty-five surveys were returned for a response rate of 10.6%. Of the 2,065 surveys completed, 408 responses were included for analysis. The average score for the respondents on the exam was 65.08% and only 28.2% of all respondents met the competency cutoff score (previously established to be 73.1%). Respondents who were orthopedic certified specialists (OCS) or sports certified specialists (SCS) were 3.091 times more likely to perform at the competency level on the examination with a p-value of <0.001 and a confidence interval >95%. Conclusion: The current study utilized the results from a previous study for a comparison between the civilian and military physical therapist populations. The results indicate that civilian physical therapists in the current study (65.08%) scored lower than their military counterparts in the previous study (75.9%) on the musculoskeletal exam. Potential reasons for this include less autonomous practice responsibilities and a disparity in educational experiences. Board certifications may enhance civilian physical therapists ability to practice with greater autonomy as primary care clinicians when managing musculoskeletal conditions. [ABSTRACT FROM AUTHOR]

Purpose: To investigate differences in pain and disability between patients treated with thrust manipulation (TM) and those treated with non-thrust manipulation (NTM) in a group of patients with mechanical low back pain (LBP) who had a within-session response to an initial assessment and met the clinical prediction rule (CPR). Methods: Data from 71 patients who met the CPR were extracted from a database of patients in a larger randomized controlled trial comparing TM and NTM. Treatment of the first two visits involved either TM or NTM (depending on allocation) and a standardized home exercise programme. Data analysis included descriptive statistics and a two-way ANOVA examining within- and between-groups effects for pain and disability, as well as total visits, total days in care, and rate of recovery. Results: No between-group differences in pain or disability were found for NTM versus TM groups (p=0.55), but within-subjects effects were noted for both groups (p<0.001). Conclusions: This secondary analysis suggests that patients who satisfy the CPR benefit as much from NTM as from TM. [ABSTRACT FROM AUTHOR]

Formal transparency policies are increasingly prevalent in global governance institutions, partially attenuating the influence in these institutions of practices of secrecy inherited from interstate diplomacy. This article assesses the incidence and specific characteristics of formal transparency policies across a select group of institutions and outlines some of the justifications given for these policies-including justifications based on the publicness of these institutions-and for the more controversial exceptions to transparency, such as the exception for deliberative materials. It examines three drivers affecting the adoption, form, and content of transparency policies and other transparency measures in these institutions: spillover from national transparency laws and policies, growth in the reach and significance of authority exercised in and through global institutions, and criticism of global institutions by influential states and nongovernmental organizations. Twelve hypotheses are proposed about the effects, for states, nonstate actors, and global governance institutions, of transparency measures-formal policies and other steps to increase transparency-in global governance institutions. Finally, the article considers some implications of transparency measures for structures of political power and authority beyond the state and for global administrative law. [ABSTRACT FROM AUTHOR]

Takingglobalprescriptions for national infrastructure regulation as a case study, this Article examines the nature and implications of the mingling of law, governance, and economics that is increasingly prevalent in global regulatory governance. It focuses on three sets offormally non-binding but influential instruments issued in the 2000s by the World Bank, the OECD, and UNCU RAL, each of which promotes far-reaching reforms to existing national public law and institutions. The Article excavates these instruments' unarticulated theories of the state and its roles, and their visions of the nature andpreferredfeatures of law. It explores the use by these instruments of law-like hierarchies of norms and their deployment of legal concepts within a hybrid vocabulary of law, economics, and policy disdplines. This may amount merely to ersat% normativity. But this Article posits that\ by bringing discourses of public law and regulatory governance into relation, instruments of this kind could open possibilities for renovation of traditionalpublic law within the state through the opening to an indpient global public law. The production and use of these instruments largely escapes the reach of orthodox public and private international law, and of national constitutional or administrative law. Conceivably, global public law could transform the ways in which such prescriptions are developed, and their invocation in particular cases, and might eventually contribute to the reimagination or reinvigoration of public law as a distinct mode of ordering. To assess whether these are possibilities, we take the infrastrudure provisions as a "hard case " against which to analyse two approaches to global public law: "international public authority" and "global administrative law. " The infrastructure case illustrates significant limits in the current doctrinal framings and institutional spedfidties of these approaches, and indicates the importance of future struggles among multiple different political and legalprojects concerning the roles of law in global regulatory governance. [ABSTRACT FROM AUTHOR]

Background: The purpose of the study is to measure the relationship of findings of the Goutallier classification, a qualitative measure of fat content within a designated muscle group, and a dichotomous measure of fatty infiltration (presence or not present) toward delayed or poor recovery after physiotherapy intervention. Methods: The retrospective predictive validity study involved 35 adolescent patients diagnosed with spondylolysis, who received magnetic resonance imaging (MRI) prior to physiotherapy care. Scoring of presence of fatty infiltration and Goutallier classifications from the MRI were compared to success or delayed or poor outcomes with physiotherapy, upon patient discharge from formal care. Results: Although agreement among the physicians who were responsible for scoring was poor, consensus findings of fatty infiltration on both measurement mechanisms were related to delayed or poor physiotherapy outcomes (correlation = 0.28, and the sensitivity of presence of fatty infiltration was 76.2% [95% CI = 61%, 87%], the specificity was 69% [95% CI 44%, 87%], the LR + was 2.5 [95% CI 1.1, 6.8], and the LR- was 0.3 [95% CI 0.1, 0.8] for delayed or poor outcome). Discussion: To our knowledge, this is the first study that has looked at whether fatty infiltration of the multifidus muscle in adolescents was associated with poor or delayed recovery in physiotherapy treatment. Conclusions: The results indirectly support the importance of the multifidus muscles in recovery of low back pain and suggest the significance of future, further research. [ABSTRACT FROM AUTHOR]

Purpose/Background: To develop a consensus on the critical constructs necessary to be included in a physical performance assessment checklist (PPAC) to assess an athlete's ability for return to sport following a lower extremity injury. Methods: The study used a 3-round Delphi method to finalize the PPAI originally developed by a panel of experts. Fourteen Delphi representative sample participants were randomly derived from the authors of peer-reviewed publications of lower extremity injuries. Nine participants completed all 3 rounds. Results: Throughout the 3 rounds, the 10 initial constructs were modified and revised to produce the finalized PPAC consisting of 12 constructs necessary to consider for an athlete's return to sport after a lower extremity injury. Conclusions: This instrument can be used as a checklist to advocate for prospective batteries of physical performance tests to incorporate the elements identified by this study. Level of Evidence: 5 [ABSTRACT FROM AUTHOR]

Background: Historically, spondylolisthesis has been treated by a wide variety of techniques such as flexion exercises, bracing, abdominal stabilizing programs, general strengthening, stretching, and in some cases, motor control exercises. Although surgical treatment of spondylolisthesis has been outlined in current literature, strengthening programs have not been well defined for this population. Objective: To describe the outcomes in randomized clinical or controlled trials (RCTs) in which either a global or local strengthening approach was assessed against another comparator in conservative treatment of patients with a low-grade spondylolisthesis. Methods: A systematic review of the literature. This review was formatted using the PRISMA guidelines, a 27-item checklist and four-phase flow diagram. An electronic search strategy targeting randomized controlled and clinical trials that compared conservative treatments for low-grade (I and II) spondylolisthesis that used a local stabilization approach, motor control, and/or a general strengthening program versus a surgical intervention or a control group was used. Physiotherapy Evidence Database (PEDro) was used to critically appraise each study for quality. Outcome measures included changes in pain measured by the visual analog scale (VAS) along with secondary measures of functional disability, working status, and lumbar range of motion. Results: Although 28 studies went through full text review, only three studies met inclusion criteria. Within the studies, global strengthening exercise programs significantly decreased subjects' pain as measured using the VAS but did not significantly improve the level of disability. In contrast, local stabilization or motor control exercises demonstrated improvements in both pain and disability. No studies directly compared a global strengthening approach versus a stabilization approach. Conclusion: Our findings indicate that both exercise training programs of local strengthening/stabilization interventions, as well as general strengthening programs may be beneficial as conservative strengthening management to patients with a low-grade spondylolisthesis. A direct comparison of these approaches is needed for the spondylolisthesis population. [ABSTRACT FROM AUTHOR]