{
  "abstract": "Introduction Non-specific low back pain (NSLBP) is one of the leading causes of disability worldwide. Emerging evidence suggests that altered diaphragmatic function may be associated with lumbar pain, impaired trunk stabilisation and functional disability. Manual diaphragmatic techniques have been proposed as an intervention to modulate diaphragmatic tension, mobility and neuromyofascial relationships; however, their effectiveness has not yet been synthesised using rigorous systematic review methods.Methods and analysis This protocol follows Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidance and has been prospectively registered in PROSPERO. Randomised controlled trials evaluating manual techniques specifically applied to the diaphragm in adults with NSLBP will be eligible. The primary outcomes will include pain intensity and functional disability; secondary outcomes will include lumbar mobility, respiratory function, quality of life and adverse events. Searches will be performed in PubMed/MEDLINE, Cochrane CENTRAL, PEDro, CINAHL, Scopus, Embase and clinical trial registries without language or date restrictions. Two reviewers will independently perform study selection, data extraction and risk-of-bias (RoB) assessment using the Cochrane RoB 2 tool. Where appropriate, a random-effects meta-analysis will be conducted; the certainty of evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation approach. Substantial clinical and methodological heterogeneity is anticipated across trials, which may limit the feasibility of quantitative data pooling.Ethics and dissemination As this study uses data from previously published trials, ethical approval is not required. Findings will be disseminated through peer-reviewed publication, conference presentations and a plain-language summary for clinical stakeholders.PROSPERO registration CRD420251172616.",
  "authors": [
    {
      "affiliations": [
        "Physiotherapy Department, Faculty of Physiotherapy and Podiatry, University of Seville, Seville, Spain"
      ],
      "name": "Francisco José Vera‑Serrano"
    },
    {
      "affiliations": [
        "Department of Nursing and Physiotherapy, University of Cadiz, Cadiz, Spain"
      ],
      "name": "Maria Jesus Vinolo-Gil"
    },
    {
      "affiliations": [
        "MOVE‑IT Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz, Spain"
      ],
      "name": "Rubén Aragón‑Martín"
    },
    {
      "affiliations": [
        "Grupo PAIDI CTS1152 Fisioterapia, University of Cadiz, Cádiz, Spain"
      ],
      "name": "Carlos Pérez-Pérez"
    },
    {
      "affiliations": [
        "Physiotherapy Department, Faculty of Physiotherapy and Podiatry, University of Seville, Seville, Spain",
        "Rehabilitation Clinical Management Unit, Interlevels-Intercenters Hospital Puerta del Mar, Cádiz, Spain"
      ],
      "name": "Pedro Alfonso Domínguez-Vera"
    },
    {
      "affiliations": [
        "Physiotherapy Department, Faculty of Physiotherapy and Podiatry, University of Seville, Seville, Spain"
      ],
      "name": "Juan Antonio Díaz-Mancha"
    }
  ],
  "title": "Effectiveness of manual diaphragmatic techniques in adults with non-specific low back pain: a systematic review and meta-analysis protocol",
  "uid": "4ccbc48d-d9ab-5718-a08d-c33d776e7015"
}