Effectiveness of dynamic neuromuscular stabilization-based interventions for nonspecific low back pain: a systematic review and meta-analysis

Introduction Nonspecific low back pain (NLBP) is a leading cause of disability and imposes substantial public health and socioeconomic burdens. Dynamic Neuromuscular Stabilization (DNS) is increasingly used in NLBP rehabilitation, but quantitative evidence of its effects remains limited. We systematically reviewed and meta-analyzed controlled trials evaluating DNS-based interventions for NLBP. Methods PubMed, Web of Science, Scopus, the Cochrane Library, and CNKI were searched. Two reviewers independently screened studies and extracted data. Random-effects meta-analysis, subgroup analyses, and leave-one-out analyses were performed using Review Manager 5.4 and Stata 17.0. Potential small-study effects were examined using Begg's rank-correlation test. Results Eight studies involving 289 participants were included. The pooled analysis favored DNS-based interventions for pain-related outcomes (SMD = −1.17, 95% CI: −1.85 to −0.48), but heterogeneity was substantial (I 2 = 85%). Subgroup analyses by intervention strategy, duration, weekly frequency, and session duration did not clearly account for the heterogeneity and were considered exploratory. Begg's test yielded p = 0.063, but the assessment of publication bias and small-study effects was inconclusive given the limited evidence base. Leave-one-out analysis indicated that no individual study alone materially altered the pooled estimate, but it did not resolve the remaining clinical and methodological uncertainties. Discussion DNS-based interventions may reduce pain-related outcomes in individuals with NLBP; however, the magnitude, clinical importance, and generalizability of the effect remain uncertain. Adequately powered, high-quality RCTs using standardized DNS protocols, clearly defined comparators, and consistent pain-specific outcomes are needed. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/ , PROSPERO (No. CRD420251152728).