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Meta-Analysis
. 2010 Apr 14;2010(4):CD005427.
doi: 10.1002/14651858.CD005427.pub2.

Combined chiropractic interventions for low-back pain

Bruce F Walker  1 , Simon D French, William Grant, Sally Green
Affiliations
Meta-Analysis

Combined chiropractic interventions for low-back pain

Bruce F Walker et al. Cochrane Database Syst Rev. .

Abstract

Background: Chiropractors commonly use a combination of interventions to treat people with low-back pain (LBP).

Objectives: To determine the effects of combined chiropractic interventions (that is, a combination of therapies, other than spinal manipulation alone) on pain, disability, back-related function, overall improvement, and patient satisfaction in adults with LBP, aged 18 and older.

Search strategy: We searched: The Cochrane Back Review Group Trials Register (May 2009), CENTRAL (The Cochrane Library 2009, Issue 2), and MEDLINE (from January 1966), EMBASE (from January 1980), CINAHL (from January 1982), MANTIS (from Inception) and the Index to Chiropractic Literature (from Inception) to May 2009. We also screened references of identified articles and contacted chiropractic researchers.

Selection criteria: All randomised trials comparing the use of combined chiropractic interventions (rather than spinal manipulation alone) with no treatment or other therapies.

Data collection and analysis: At least two review authors selected studies, assessed the risk of bias, and extracted the data using standardised forms. Both descriptive synthesis and meta-analyses were performed.

Main results: We included 12 studies involving 2887 participants with LBP. Three studies had low risk of bias. Included studies evaluated a range of chiropractic procedures in a variety of sub-populations of people with LBP.No trials were located of combined chiropractic interventions compared to no treatment. For acute and subacute LBP, chiropractic interventions improved short- and medium-term pain (SMD -0.25 (95% CI -0.46 to -0.04) and MD -0.89 (95%CI -1.60 to -0.18)) compared to other treatments, but there was no significant difference in long-term pain (MD -0.46 (95% CI -1.18 to 0.26)). Short-term improvement in disability was greater in the chiropractic group compared to other therapies (SMD -0.36 (95% CI -0.70 to -0.02)). However, the effect was small and all studies contributing to these results had high risk of bias. There was no difference in medium- and long-term disability. No difference was demonstrated for combined chiropractic interventions for chronic LBP and for studies that had a mixed population of LBP.

Authors' conclusions: Combined chiropractic interventions slightly improved pain and disability in the short-term and pain in the medium-term for acute and subacute LBP. However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions. Future research is very likely to change the estimate of effect and our confidence in the results.

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Conflict of interest statement

BW is an academic chiropractor and has previously practised as a chiropractor from which he derived an income. SF has previously practised as a chiropractor from which he derived an income. WDG and SG ‐ no known conflicts

Figures

1
1
Flow chart of study inclusion
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Forest plot of comparison: 1 Chiropractic vs Other (acute and subacute LBP), outcome: 1.1 Pain.
4
4
Forest plot of comparison: 1 Chiropractic vs Other (acute and subacute LBP), outcome: 1.2 Pain medium‐term and Long Term.
5
5
Forest plot of comparison: 1 Chiropractic vs Other (acute and subacute LBP), outcome: 1.2 Disability.
6
6
Forest plot of comparison: 2 Chiropractic vs Other (Chronic LBP), outcome: 2.1 Pain.
7
7
Forest plot of comparison: 2 Chiropractic vs Other (Chronic LBP), outcome: 2.2 Disability.
8
8
Forest plot of comparison: 2 Chiropractic vs Other (Chronic LBP), outcome: 2.5 General health status.
9
9
Forest plot of comparison: 3 Chiropractic vs Other (Mixed), outcome: 3.4 Disability.
1.1
1.1. Analysis
Comparison 1 Chiropractic vs Other (acute and sub‐acute LBP), Outcome 1 Pain Short term.
1.2
1.2. Analysis
Comparison 1 Chiropractic vs Other (acute and sub‐acute LBP), Outcome 2 Pain Medium term and Long Term.
1.3
1.3. Analysis
Comparison 1 Chiropractic vs Other (acute and sub‐acute LBP), Outcome 3 Disability Short term.
1.4
1.4. Analysis
Comparison 1 Chiropractic vs Other (acute and sub‐acute LBP), Outcome 4 Disability Medium term and Long term.
2.1
2.1. Analysis
Comparison 2 Chiropractic vs Other (Chronic LBP), Outcome 1 Pain.
2.2
2.2. Analysis
Comparison 2 Chiropractic vs Other (Chronic LBP), Outcome 2 Disability.
2.3
2.3. Analysis
Comparison 2 Chiropractic vs Other (Chronic LBP), Outcome 3 General health status.
3.1
3.1. Analysis
Comparison 3 Chiropractic vs Other (Mixed), Outcome 1 Pain.
3.2
3.2. Analysis
Comparison 3 Chiropractic vs Other (Mixed), Outcome 2 Pain (average).
3.3
3.3. Analysis
Comparison 3 Chiropractic vs Other (Mixed), Outcome 3 Disability.
3.4
3.4. Analysis
Comparison 3 Chiropractic vs Other (Mixed), Outcome 4 Number of back pain related visits needed.
3.5
3.5. Analysis
Comparison 3 Chiropractic vs Other (Mixed), Outcome 5 Satisfaction.
3.6
3.6. Analysis
Comparison 3 Chiropractic vs Other (Mixed), Outcome 6 Pain partially or completely relieved.
3.7
3.7. Analysis
Comparison 3 Chiropractic vs Other (Mixed), Outcome 7 Pain free for several months.
3.8
3.8. Analysis
Comparison 3 Chiropractic vs Other (Mixed), Outcome 8 Further equally severe episode.
3.9
3.9. Analysis
Comparison 3 Chiropractic vs Other (Mixed), Outcome 9 Experiencing pain daily.
3.10
3.10. Analysis
Comparison 3 Chiropractic vs Other (Mixed), Outcome 10 Oswestry as high or higher than before treatment.
3.11
3.11. Analysis
Comparison 3 Chiropractic vs Other (Mixed), Outcome 11 Rate of improvement.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD005427

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