The effectiveness of thoracic spine manipulation for the management of musculoskeletal conditions: a systematic review and meta-analysis of randomized clinical trials

Abstract

Thoracic spine manipulation (TSM) is an intervention practiced by different professions, and recently an incursion of research using TSM has been published. The purpose of this review was to examine the effectiveness of TSM for the management of musculoskeletal conditions and the quality of trials that included TSM techniques. A comprehensive search of online databases was performed, and first authors of studies identified were contacted. Thirteen randomized clinical trials were included in the final review. The methodological quality of all studies was assessed using the 10-point PEDro scale. Seven of the 13 studies were of high quality. Three studies looked at TSM for treatment of shoulder conditions; however, there is limited evidence to support the use of TSM for shoulder conditions. Nine studies used TSM for the management of neck conditions. The meta-analysis identified a subset of homogeneous studies evaluating neck pain. The value of the pooled estimator (1.33) was statistically significant for the treatment effect of TSM in the studies with researcher effect removed (95 % confidence interval: 1.15, 1.52). This analysis suggests there is sufficient evidence to support the use of TSM for specific subgroups of patients with neck conditions. This review also identifies the need for further studies to examine the effectiveness of TSM to treat shoulder conditions and the effectiveness of TSM on neck conditions with long-term follow-up studies.

Keywords: Meta-Analysis; Shoulder; Spinal Manipulation; Systematic Review; Thoracic Spine.

FIGURE 1

Flow chart of study selection.

FIGURE 2

Forest plot of the effect-size confidence intervals of all studies evaluating neck pain with researcher effect. Results are heterogeneous.

FIGURE 3

Forest plot of the effect-size confidence intervals of all studies evaluating neck pain without researcher effect. Results are homogenous and the pooled estimate is statistically significant. Abbreviations for Figures 2 and 3: C10 = Cleland¹⁰; C13 = Cleland¹³; CMCC = CMCC Neck Disability Index; GI17 = Gonzalez-Iglesias et al; GI18 = Gonzalez-Iglesias et al; K = Krauss et al; LBLM = left cervical bilateral motion; LROM = left cervical range of motion; McGill = McGill Short-form Pain Questionnaire; NPQ = Northwick Neck Pain Questionnaire; NPRS = Numeric Pain Rating Scale; NDI = Neck Disability Index; PS = Parkin-Smith and Penter; RBLM = right cervical bilateral motion; RROM = right cervical range of motion; VAS = visual analog scale for pain