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Meta-Analysis
. 2012 Sep 12;2012(9):CD008880.
doi: 10.1002/14651858.CD008880.pub2.

Spinal manipulative therapy for acute low-back pain

Sidney M Rubinstein  1 , Caroline B Terwee, Willem J J Assendelft, Michiel R de Boer, Maurits W van Tulder
Affiliations
Meta-Analysis

Spinal manipulative therapy for acute low-back pain

Sidney M Rubinstein et al. Cochrane Database Syst Rev. .

Abstract

Background: Many therapies exist for the treatment of low-back pain including spinal manipulative therapy (SMT), which is a worldwide, extensively practised intervention. This report is an update of the earlier Cochrane review, first published in January 2004 with the last search for studies up to January 2000.

Objectives: To examine the effects of SMT for acute low-back pain, which is defined as pain of less than six weeks duration.

Search methods: A comprehensive search was conducted on 31 March 2011 in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, PEDro, and the Index to Chiropractic Literature. Other search strategies were employed for completeness. No limitations were placed on language or publication status.

Selection criteria: Randomized controlled trials (RCTs) which examined the effectiveness of spinal manipulation or mobilization in adults with acute low-back pain were included. In addition, studies were included if the pain was predominantly in the lower back but the study allowed mixed populations, including participants with radiation of pain into the buttocks and legs. Studies which exclusively evaluated sciatica were excluded. No other restrictions were placed on the setting nor the type of pain. The primary outcomes were back pain, back-pain specific functional status, and perceived recovery. Secondary outcomes were return-to-work and quality of life. SMT was defined as any hands-on therapy directed towards the spine, which includes both manipulation and mobilization, and includes studies from chiropractors, manual therapists, and osteopaths.

Data collection and analysis: Two review authors independently conducted the study selection and risk of bias (RoB) assessment. Data extraction was checked by the second review author. The effects were examined in the following comparisons: SMT versus 1) inert interventions, 2) sham SMT, 3) other interventions, and 4) SMT as an additional therapy. In addition, we examined the effects of different SMT techniques compared to one another. GRADE was used to assess the quality of the evidence. Authors were contacted, where possible, for missing or unclear data. Outcomes were evaluated at the following time intervals: short-term (one week and one month), intermediate (three to six months), and long-term (12 months or longer). Clinical relevance was defined as: 1) small, mean difference (MD) < 10% of the scale or standardized mean difference (SMD) < 0.4; 2) medium, MD = 10% to 20% of the scale or SMD = 0.41 to 0.7; and 3) large, MD > 20% of the scale or SMD > 0.7.

Main results: We identified 20 RCTs (total number of participants = 2674), 12 (60%) of which were not included in the previous review. Sample sizes ranged from 36 to 323 (median (IQR) = 108 (61 to 189)). In total, six trials (30% of all included studies) had a low RoB. At most, three RCTs could be identified per comparison, outcome, and time interval; therefore, the amount of data should not be considered robust. In general, for the primary outcomes, there is low to very low quality evidence suggesting no difference in effect for SMT when compared to inert interventions, sham SMT, or when added to another intervention. There was varying quality of evidence (from very low to moderate) suggesting no difference in effect for SMT when compared with other interventions, with the exception of low quality evidence from one trial demonstrating a significant and moderately clinically relevant short-term effect of SMT on pain relief when compared to inert interventions, as well as low quality evidence demonstrating a significant short-term and moderately clinically relevant effect of SMT on functional status when added to another intervention. In general, side-lying and supine thrust SMT techniques demonstrate a short-term significant difference when compared to non-thrust SMT techniques for the outcomes of pain, functional status, and recovery.

Authors' conclusions: SMT is no more effective in participants with acute low-back pain than inert interventions, sham SMT, or when added to another intervention. SMT also appears to be no better than other recommended therapies. Our evaluation is limited by the small number of studies per comparison, outcome, and time interval. Therefore, future research is likely to have an important impact on these estimates. The decision to refer patients for SMT should be based upon costs, preferences of the patients and providers, and relative safety of SMT compared to other treatment options. Future RCTs should examine specific subgroups and include an economic evaluation.

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Conflict of interest statement

Maurits van Tulder is Coordinating Editor of the Cochrane Back Review Group. Editors are required to conduct at least one Cochrane review, to ensure that editors are aware of the processes and commitment needed to conduct reviews. This involvement does not seem to be a source of conflict of interest in the Cochrane Back Review Group. Any editor who is a review author is excluded from editorial decisions on the review in which they are contributors.

Sidney Rubinstein is a chiropractor who uses SMT in his clinical practice.

Figures

1
1
Study flow diagram. Summary of selection process. (Updated July 25, 2012)
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Funnel plot of comparison: 5 SMT versus all comparisons ‐ for the outcome 'Pain'. Note: negative values favour SMT.
4
4
Funnel plot of comparison: 5 SMT versus all comparisons ‐ for the outcome 'Functional status'. Note: negative values favour SMT.
5
5
Forest plot of comparison: 3 Spinal manipulative therapy versus all other therapies, outcome 3.1 'Pain'.
6
6
Forest plot of comparison: 3 Spinal manipulative therapy versus all other therapies, outcome 3.2 'Functional status'.
1.1
1.1. Analysis
Comparison 1 Spinal manipulative therapy versus inert interventions, Outcome 1 Pain.
1.2
1.2. Analysis
Comparison 1 Spinal manipulative therapy versus inert interventions, Outcome 2 Functional status.
1.3
1.3. Analysis
Comparison 1 Spinal manipulative therapy versus inert interventions, Outcome 3 Recovery.
2.1
2.1. Analysis
Comparison 2 Spinal manipulative therapy versus sham SMT, Outcome 1 Pain.
2.2
2.2. Analysis
Comparison 2 Spinal manipulative therapy versus sham SMT, Outcome 2 Functional status.
3.1
3.1. Analysis
Comparison 3 Spinal manipulative therapy versus all other therapies, Outcome 1 Pain.
3.2
3.2. Analysis
Comparison 3 Spinal manipulative therapy versus all other therapies, Outcome 2 Functional status.
3.3
3.3. Analysis
Comparison 3 Spinal manipulative therapy versus all other therapies, Outcome 3 Recovery.
3.4
3.4. Analysis
Comparison 3 Spinal manipulative therapy versus all other therapies, Outcome 4 Return‐to‐work.
4.1
4.1. Analysis
Comparison 4 Spinal manipulative therapy plus any intervention versus that same intervention alone, Outcome 1 Pain.
4.2
4.2. Analysis
Comparison 4 Spinal manipulative therapy plus any intervention versus that same intervention alone, Outcome 2 Functional status.
4.3
4.3. Analysis
Comparison 4 Spinal manipulative therapy plus any intervention versus that same intervention alone, Outcome 3 Recovery.
4.4
4.4. Analysis
Comparison 4 Spinal manipulative therapy plus any intervention versus that same intervention alone, Outcome 4 Return‐to‐work.
5.1
5.1. Analysis
Comparison 5 Spinal manipulative therapy (SMT) versus another SMT technique, Outcome 1 Pain.
5.2
5.2. Analysis
Comparison 5 Spinal manipulative therapy (SMT) versus another SMT technique, Outcome 2 Functional status.
5.3
5.3. Analysis
Comparison 5 Spinal manipulative therapy (SMT) versus another SMT technique, Outcome 3 Recovery.
6.1
6.1. Analysis
Comparison 6 SMT versus all comparisons ‐ for construction of funnel plot, Outcome 1 Pain ‐ For funnel plot.
6.2
6.2. Analysis
Comparison 6 SMT versus all comparisons ‐ for construction of funnel plot, Outcome 2 Functional status ‐ For funnel plot.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD008880

References

References to studies included in this review

Bergquist‐Ullman 1977 {published data only}
    1. Bergquist‐Ullman M, Larsson U. Acute low back pain in industry: a controlled prospective study with special reference to therapy and confounding factors. Acta Orthopaedica Scandinavica 1977;170 Suppl:1‐117. - PubMed
Brennan 2006 {published data only}
    1. Brennan GP, Fritz JM, Hunter SJ, Thackeray A, Delitto A, Erhard RE. Identifying subgroups of patients with acute/subacute "nonspecific" low back pain. Spine 2006;31(6):623‐31. - PubMed
Cherkin 1998 {published data only}
    1. Cherkin DC, Deyo RA, Battie M, Street J, Barlow W. A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. New England Journal of Medicine 1998;339:1021‐9. - PubMed
Childs 2004 {published data only}
    1. Childs JD, Flynn TW, Fritz JM. A perspective for considering the risks and benefits of spinal manipulation in patients with low back pain. Manual Therapy 2006;11:316‐20. - PubMed
    1. Childs JD, Fritz JM, Flynn TW, Irrgang JJ, Johnson KK, Majkowski GR, Delitto A. A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: A validation study. Annals of Internal Medicine 2004;141:920‐8. - PubMed
Cleland 2009 {published data only}
    1. Cleland JA, Fritz JM, Kulig K, Davenport TE, Eberhart S, Magel J, Childs JD. Comparison of the effectiveness of three manual physical therapy techniques in a subgroup of patients with low back pain who satisfy a clinical prediction rule. Spine 2009;34(25):2720‐9. - PubMed
Cramer 1993 {published data only}
    1. Cramer GD, Humphreys CR, Hondras MA, McGregor M, Triano JJ. The Hmax/Mmax ratio as an outcome measure for acute low back pain. Journal of Manipulative and Physiological Therapeutics 1993;16:7‐13. - PubMed
Farrell 1982 {published data only}
    1. Farrell JP, Twomey LT. Acute low back pain: comparison of two conservative treatment approaches. The Medical Journal of Australia 1982;1:160‐4. - PubMed
Glover 1974 {published data only}
    1. Glover JR. A clinical trial of rotational manipulation of the spine in back pain cases occurring in a factory. Proceedings of the Royal Society of Medicine 1966;59:847. - PMC - PubMed
    1. Glover JR. Occupational health research and the problem of back pain. The Transactions of the Society of Occupational Medicine 1970;21:2‐12. - PubMed
    1. Glover JR, Morris JG, Khosla T. Back pain: A randomized clinical trial of rotational manipulation of the trunk. British Journal of Industrial Medicine 1974;31:59‐64. - PMC - PubMed
Hadler 1987 {published data only}
    1. Hadler NM, Curtis P, Gillings DB, Stinnett S. A benefit of spinal manipulation as adjunctive therapy for acute low‐back pain: a stratified controlled trial. Spine 1987;12:703‐5. - PubMed
    1. Hadler NM, Curtis P, Gillings DB, Stinnett S. The use of manipulation in acute low back pain: A group‐controlled study [Der nutzen von manipulationen als zusazliche therapie bei akuten lumbalgie: eine gruppenkontrolierte studie]. Manuelle Medizin 1990;28:2‐6.
Hallegraeff 2009 {published data only}
    1. Hallegraeff H, Greef M, Winters JC, Lucas C. Manipulative therapy and clinical prediction criteria in treatment of acute nonspecific low back pain. Perceptual and Motor Skills 2009;108(1):196‐208. - PubMed
Hancock 2007 {published data only}
    1. Hancock MJ, Maher CG, Latimer J, McLachlan AJ, Cooper CW, Day RO, et al. Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first‐line treatment for acute low back pain: a randomised controlled trial. Lancet 2007;370:1638‐43. - PubMed
    1. Hancock MJ, Maher CG, Latimer J, McLachlan AJ, Cooper CW, O Day R, et al. Manipulative therapy and/or NSAIDs for acute low back pain: design of a randomized controlled trial [ACTRN012605000036617] (study protocol). BMC Musculoskeletal Disorders 2005;6:57. - PMC - PubMed
Hoehler 1981 {published data only}
    1. Buerger AA. A controlled trial of rotational manipulation in low back pain. Manuelle Medizin 1980;2:17‐26.
    1. Hoehler GK, Tobis JS, Buerger AA. Spinal manipulation for low back pain. JAMA 1981;245:1835‐8. - PubMed
    1. Tobis JS, Hoehler FK. Musculoskeletal manipulation in the treatment of low back pain. Bulletin of the New York Academy of Medicine 1983;7:660‐8. - PMC - PubMed
Hoiriis 2004 {published data only}
    1. Hoiriis KT, Pfleger B, McDuffie FC, Cotsonis G, Elsangak O, Hinson R, Verzosa GT. A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. Journal of Manipulative and Physiological Therapeutics 2004;27:388‐98. - PubMed
Juni 2009 {published data only}
    1. Juni P, Battaglia M, Nuesch E, Hammerle G, Eser P, Beers R, et al. A randomised controlled trial of spinal manipulative therapy in acute low back pain. Annals of the Rheumatic Diseases 2009;68:1420‐7. - PubMed
MacDonald 1990 {published data only}
    1. MacDonald RS, Bell CMJ. An open controlled assessment of osteopathic manipulation in nonspecific low‐back pain. Spine 1990;15:364‐70. - PubMed
Postacchini 1988 {published data only}
    1. Postacchini F, Facchini M, Palieri P. Efficacy of various forms of conservative treatment in low back pain: a comparative study. Neuro‐Orthopedics 1988;6:28‐35.
Rasmussen 1979 {published data only}
    1. Rasmussen GG. Manipulation in treatment of low back pain: a randomized clinical trial. Manuelle Medizin 1979;1:8‐10.
Seferlis 1998 {published data only}
    1. Seferlis T, Lindholm L, Nemeth G. Cost‐minimisation analysis of three conservative treatment programmes in 180 patients sick‐listed for acute low‐back pain. Scandinavian Journal of Primary Health Care 2000;18:53‐7. - PubMed
    1. Seferlis T, Nemeth G, Carlsson AM, Gillstrom P. Conservative treatment in patients sick‐listed for acute low‐back pain: a prospective randomised study with 12 months' follow‐up. European Spine Journal 1998;7:461‐70. - PMC - PubMed
Skargren 1997 {published data only}
    1. Skargren EI, Carlsson PG, Oberg BE. One year follow‐up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain. Subgroup analysis, recurrence, and additional health care utilization. Spine 1998;23(17):1875‐83. - PubMed
    1. Skargren EI, Oberg BE. Predictive factors for 1‐year outcome of low‐back and neck pain in patients treated in primary care: comparison between the treatment strategies chiropractic and physiotherapy. Pain 1998;77(2):201‐7. - PubMed
    1. Skargren EI, Oberg BE, Carlsson PG, Gade M. Cost and effectiveness analysis of chiropractic and physiotherapy treatment for low‐back and neck pain. Six month follow‐up. Spine 1997;22(18):2167‐77. - PubMed
Sutlive 2009 {published data only}
    1. Sutlive TG, Mabry LM, Easterling EJ, Durbin JD, Hanson SL, Wainner RS, Childs JD. Comparison of short‐term response to two spinal manipulation techniques for patients with low back pain in a military beneficiary population. Military Medicine 2009;174(7):750‐6. - PubMed

References to studies excluded from this review

Andersson 1999 {published data only}
    1. Andersson GB, Lucente T, Davis AM, Kapler RE, Lipton JA, Leurgans S. A comparison of osteopathic spinal manipulation with spinalcare for patients with low back pain. New England Journal of Medicine 1999;341:1426‐31. - PubMed
Beyerman 2006 {published data only}
    1. Beyerman KL, Palmerino MB, Zohn LE, Kane GM, Foster KA. Efficacy of treating low back pain and dysfunction secondary to osteoarthritis: chiropractic care compared with moist heat alone. Journal of Manipulative and Physiological Therapeutics 2006;29:107‐14. - PubMed
Bishop 2010 {published data only}
    1. Bishop PB, Quon JA, Fisher CG, Dvorak MFS. The Chiropractic Hospital‐based Interventions Research Outcomes (CHIRO) study: A randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic managment of patients with acute mechanical low back pain. The Spine Journal 2010;10:1055‐64. - PubMed
Blomberg 1994 {published data only}
    1. Blomberg S, Hallin G, Grann K, Berg E, Sennerby U. Manual therapy with steroid injections: A new approach to treatment of low back pain. A controlled multicenter trial with an evaluation by orthopedic surgeons. Spine 1994;19:569‐77. - PubMed
    1. Blomberg S, Svardsudd K, Mildenberger F. A controlled, multicentre trial of manual therapy in low‐back pain. Initial status, sick‐leave and pain score during follow‐up. Scandinavian Journal of Primary Health Care 1992;10:170‐8. - PubMed
    1. Blomberg S, Svardsudd K, Tibblin G. A randomized study of manual therapy with steroid injections in low‐back pain: Telephone interview follow‐up of pain, disability, recovery and drug consumption. European Spine Journal 1994;3:246‐54. - PubMed
    1. Blomberg S, Svardsudd K, Tibblin G. Manual therapy with steroid injections in low‐back pain. Improvement of quality of life in a controlled trial with four months' follow‐up. Scandinavian Journal of Primary Health Care 1993;11:83‐90. - PubMed
    1. Blomberg S, Tibblin G. A controlled, multicentre trial of manual therapy with steroid injections in low‐back pain: Functional variables, side‐effects and complications during four months follow‐up. Clinical Rehabilitation 1993;7:49‐62.
Bronfort 1989 {published data only}
    1. Bronfort G. Chiropractic versus general medical treatment of low back pain: A small scale controlled clinical trial. American Journal of Chiropractic Medicine 1989;2:145‐50.
Coyer 1955 {published data only}
    1. Coyer AB, Curwin IH. Low back pain treated by manipulation: A controlled series. British Medical Journal 1955;1(4915):705‐7. - PMC - PubMed
Delitto 1993 {published data only}
    1. Delitto A, Cibulka MT, Erhard RE, Bowling RW, Tenhuis JA. Evidence for use of an extension‐mobilization category in acute low back syndrome: A prescriptive validation pilot study. Physical Therapy 1993;73(4):216‐22. - PubMed
Doran 1975 {published data only}
    1. Doran DML, Newell DJ. Manipulation in treatment of low back pain: a multicentre study. British Medical Journal 1975;2:161‐4. - PMC - PubMed
Erhard 1994 {published data only}
    1. Erhard RE, Delitto A, Cibulka MT. Relative effectiveness of an extension program and a combined program of manipulation and flexion and extension exercises in patients with acute low back syndrome. Physical Therapy 1994;74:1093‐100. - PubMed
Gemmell 1995 {published data only}
    1. Gemmell HA, Jacobson BH. The immediate effect of activator vs. meric adjustment on acute low‐back pain ‐ a randomized controlled trial. Journal of Manipulative and Physiological Therapeutics 1995;18:453‐6. - PubMed
Godfrey 1984 {published data only}
    1. Godfrey CM, Morgan PP, Schatzker J. A randomized trial of manipulation for low‐back pain in a medical setting. Spine 1984;9:301‐4. - PubMed
Grunnesjo 2004 {published data only}
    1. Bogefeldt J, Grunnesjo M, Svardsudd K, Blomberg S. Diagnostic differences between general practitioners and orthopaedic surgeons in a randomised controlled trial in low back pain: The Gotland low back pain study. Upsala Journal of Medical Sciences 2007;112:199‐212. - PubMed
    1. Bogefeldt J, Grunnesjo MI, Svardsudd K, Blomberg S. Sick leave reductions from a comprehensive manual therapy programme for low back pain: The Gotland low back pain study. Clinical Rehabilitation 2008;22:529‐41. - PubMed
    1. Grunnesjo MI, Bogefeldt JP, Svardsudd KF, Blomberg SIE. A randomized controlled clinical trial of stay‐active care versus manual therapy in addition to stay‐active care: Functional variables and pain. Journal of Manipulative and Physiological Therapeutics 2004;27:431‐41. - PubMed
Helliwell 1987 {published data only}
    1. Helliwell PS, Cunliffe G. Manipulation in low‐back pain. The Physician 1987;April:187‐8.
Hsieh 2002 {published data only}
    1. Hsieh C‐Y, Adams A, Tobis J, Hong C‐Z, Danielson C, Platt K, et al. Effectiveness of four conservative treatments for subacute low back pain. A randomized clinical trial. Spine 2002;27:1142‐8. - PubMed
Hurley 2004 {published data only}
    1. Hurley DA, McDonough SM, Dempster M, Moore AM, Baxter GD. A randomized clinical trial of manipulative therapy and interferential therapy for acute low back pain. Spine 2004;29(20):2207‐16. - PubMed
Kinalski 1989 {published data only}
    1. Kinalski R, Kuwik W, Pierzak D. The comparison of the results of manual therapy versus physiotherapy methods used in treatment of patients with low back pain syndromes. Manual Medicine 1989;4:44‐6.
Mathews 1987 {published data only}
    1. Mathews JA, Mills SB, Jenkins VM, Grimes SM, Morkel MJ, Mathews W, et al. Back pain and sciatica: controlled trials of manipulation, traction, sclerosant and epidural injections. British Journal of Rheumatology 1987;26:416‐23. - PubMed
    1. Mathews W, Morkel M, Mathews J. Manipulation and traction for lumbago and sciatica: physiotherapeutic techniques used in two controlled trials. Physiotherapy Practice 1988;4:201‐6.
Meade 1990 {published data only}
    1. Meade TW, Dyer S, Browne W, Frank AO. Randomised comparison of chiropractic and hospital outpatient management for low‐back pain: results from extended follow‐up. BMJ 1995;311:349‐51. - PMC - PubMed
    1. Meade TW, Dyer S, Browne W, Townsend J, Frank AO. Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. BMJ 1990;300:1431‐7. - PMC - PubMed
Nwuga 1982 {published data only}
    1. Nwuga VCB. Relative therapeutic efficacy of vertebral manipulation and conventional treatment in back pain management. American Journal of Physical Medicine 1982;61:273‐8. - PubMed
Pope 1994 {published data only}
    1. Pope M, Phillips R, Haugh L, Hsieh C‐Y, MacDonald L, Haldeman S. A prospective randomized three‐week trial of spinal manipulation, transcutaneous muscle stimulation, massage and corset in the treatment of subacute low back pain. Spine 1994;19:2571‐7. - PubMed
Rupert 1985 {published data only}
    1. Rupert RL, Wagnon R, Thompson P, Ezzeldin MT. Chiropractic adjustments: Results of a controlled clinical trial in Egypt. ICA International Review of Chiropractic 1985;Winter:58‐60.
Sanders 1990 {published data only}
    1. Sanders GE, Reinert O, Tepe R, Maloney P. Chiropractic adjustive manipulation on subjects with acute low‐back pain: Visual analog pain scores and plasma beta‐endorphin levels. Journal of Manipulative and Physiological Therapeutics 1990;13:390‐5. - PubMed
Santilli 2006 {published data only}
    1. Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double‐blind clinical trial of active and simulated spinal manipulations. The Spine Journal 2006;6:131‐7. - PubMed
Sims‐Williams 1978 {published data only}
    1. Sims‐Williams H, Jayson MIV, Young SMS, Baddeley H, Collins E. Controlled trial of mobilisation and manipulation for patients with low back pain in general practice. British Medical Journal 1978;2:1338‐40. - PMC - PubMed
Sims‐Williams 1979 {published data only}
    1. Sims‐Williams H, Jayson MIV, Young SMS, Baddeley H, Collins E. Controlled trial of mobilisation and manipulation for low back pain: hospital patients. British Medical Journal 1979;2:1318‐20. - PMC - PubMed
Terrett 1984 {published data only}
    1. Terrett ACJ, Vernon H. Manipulation and pain tolerance. A controlled study of the effect of spinal manipulation on paraspinal cutaneous pain tolerance levels. American Journal of Physical Medicine 1984;63(5):217‐25. - PubMed
Waterworth 1985 {published data only}
    1. Waterworth RF, Hunter IA. An open study of diflunisal, conservative and manipulative therapy in the management of acute mechanical low back pain. The New Zealand Medical Journal 1985;98(779):372‐5. - PubMed
Williams 2003 {published data only}
    1. Williams NH, Wilkinson C, Russell I, Edwards RT, Hibbs R, Linck P, Muntz R. Randomized osteopathic manipulation study (ROMANS): pragmatic trial for spinal pain in primary care. Family Practice 2003;20:662‐9. - PubMed
Wreje 1992 {published data only}
    1. Wreje U, Nordgren B, Aberg H. Treatment of pelvic joint dysfunction in primary care: a controlled study. Scandinavian Journal of Primary Health Care 1992;10:310‐5. - PubMed
Zylbergold 1981 {published data only}
    1. Zylbergold RS, Piper MC. Lumbar disc disease: comparative analysis of physical therapy treatments. Archives of Physical Medicine and Rehabilitation 1981;62:176‐9. - PubMed

References to studies awaiting assessment

Cruser 2012 {published data only}
    1. Cruser A, Maurer D, Hensel K, Brown SK, White K, Stoll ST. A randomized, controlled trial of osteopathic manipulative treatment for acute low back pain in active duty military personnel. Journal of Manual and Manipulative Therapy 2012;20:5‐15. - PMC - PubMed
Kamali 2012 {published data only}
    1. Kamali F, Shokri E. The effect of two manipulative therapy techniques and their outcome in patients with sacroiliac joint syndrome. Journal of Bodywork and Movement Therapies 2012;16(1):29‐35. - PubMed
Schenk 2012 {published data only}
    1. Schenk R, Dionne C, Simon C, Johnson R. Effectiveness of mechanical diagnosis and therapy in patients with back pain who meet a clinical prediction rule for spinal manipulation. Journal of Manual and Manipulative Therapy 2012;20(1):43‐9. - PMC - PubMed

References to ongoing studies

NCT00497861 {published data only}
    1. http://ClinicalTrials.gov/show/NCT00497861Title: Comparison of Mechanical Force, Manually Assisted Activator Manipulation Versus Manual Side Posture Manipulation in Patients With Low Back Pain: a Randomized Pilot StudyPurpose: This study compared the treatment effect of Activator Methods Chiropractic Technique (AMCT) and manual Diversified type spinal manipulative therapy in a sample of patients with acute and sub‐acute low back pain.. Ongoing study Study completion date: April 2007.
NCT00632060 {published data only}
    1. http://clinicaltrials.gov/show/NCT00632060Title: The Efficacy of Manual and Manipulative Therapy for Low Back Pain in Military Active Duty Personnel: A Feasibility StudyThe specific aims of this research project are to determine feasibility of, and the comparative treatment effect size for, conducting a larger clinical trial of Manual/Manipulative Therapy (M/MT) in restoring peak performance in military personnel in operational environments and to evaluate the ability of the addition of M/MT to standard care to decrease pain and increase function for patients with low back pain.The following two hypotheses will guide the data collection:The primary hypothesis is that the addition of a course of M/MT to standard care for low back pain will decrease pain at 4 weeks when compared to standard care alone;In addition, the secondary hypothesis will be that the addition of a course of M/MT to standard care for low back pain will decrease pain and increase function over 2 and 4 weeks when compared to standard care alone.. Ongoing study February 2008.
NCT01211613 {published data only}
    1. http://clinicaltrials.gov/show/NCT01211613A Comparison of Chiropractic Manipulation Methods and Standard Medical Care for Low Back Pain.Purpose: The investigators will be comparing the effectiveness of two types of chiropractic manipulation and standard medical care for patients with a recent onset of low back pain. The two types of chiropractic treatments being compared will be hands‐on (manual) manipulation and mechanical‐assisted (Activator) manipulation. The standard medical care will consist of a medical examination and prescription for over‐the‐counter anti‐inflammatory medication.. Ongoing study Nov. 2010; Estimated study completion date Nov. 2013.

Additional references

Airaksinen 2006
    1. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber‐Moffett J, Kovacs F, et al. European guidelines for the management of chronic non‐specific low back pain 2004. European Spine Journal 2006;15 Suppl 2:192‐298. - PMC - PubMed
Assendelft 1996
    1. Assendelft WJ, Bouter LM, Knipschild PG. Complications of spinal manipulation: A comprehensive review of the literature. Journal of Family Practice 1996;42(5):475‐80. - PubMed
Axen 2005
    1. Axen I, Jones JJ, Rosenbaum A, Lovgren PW, Halasz L, Larsen K, et al. The Nordic Back Pain Subpopulation Program: Validation and improvement of a predictive model for treatment outcome in patients with low back pain receiving chiropractic treatment. Journal of Manipulative and Physiological Therapeutics 2005;28(6):381‐5. - PubMed
Bekelman 2003
    1. Bekelman JE, Li Y, Gross CP. Scope and impact of financial conflicts of interest in biomedical research: A systematic review. JAMA 2003;289(4):454‐65. - PubMed
Bouter 1998
    1. Bouter LM, Tulder MW, Koes BW. Methodological issues in low back pain research in primary care. Spine 1998;23:2014‐20. - PubMed
Boutron 2005
    1. Boutron I, Moher D, Tugwell P, Giraudeau B, Poiraudeau S, Nizard R, et al. A checklist to evaluate a report of a non pharmacological trial (CLEAR NPT) was developed using consensus. Journal of Clinical Epidemiology 2005;58:1233‐40. - PubMed
Bronfort 2004
    1. Bronfort G, Evans RL, Maiers M, Anderson AV. Spinal manipulation, epidural injections, and self‐care for sciatica: A pilot study for a randomized clinical trial. Journal of Manipulative and Physiological Therapeutics 2004;27:503‐8. - PubMed
Bronfort 2004a
    1. Bronfort G, Haas M, Evans RL, Bouter LM. Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. The Spine Journal 2004;4:335‐56. - PubMed
Bronfort 2008
    1. Bronfort G, Haas M, Evans R, Kawchuk G, Dagenais S. Evidence‐informed management of chronic low back pain with spinal manipulation and mobilization. The Spine Journal 2008;8(1):213‐25. - PubMed
Brown 2007
    1. Brown A, Angus D, Chen S, Tang Z, Milne S, Pfaff J, et al. Costs and outcomes of chiropractic treatment for low back pain [technology report no. 56]. Ottawa: Canadian Coordinating Office for Health Technology Assessment 2007.
Cherkin 2003
    1. Cherkin DC, Sherman KJ, Deyo RA, Shekelle PG. A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Annals of Internal Medicine 2003;138:898‐906. - PubMed
Chou 2007
    1. Chou R, Huffman LH. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Annals of Internal Medicine 2007;147(7):492‐504. - PubMed
Cohen 1988
    1. Cohen J. Statistical power analysis for the behavioural sciences. Statistical power analysis for the behavioural sciences. New Jersey, USA: Lawrence Earlbaum Associates, Inc., 1988:474pp.
Dagenais 2008
    1. Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. The Spine Journal 2008;8(1):8‐20. - PubMed
Dagenais 2010
    1. Dagenais S, Gay RE, Tricco AC, Freeman MD, Mayer JM. NASS Contemporary concepts in spine care: Spinal manipulation therapy for acute low back pain. The Spine Journal 2010;10:918‐40. - PubMed
Dunn 2004
    1. Dunn KM, Croft PR. Epidemiology and natural history of low back pain. Europo Medicophysica 2004;40:9‐13. - PubMed
Evans 2002
    1. Evans DW. Mechanisms and effects of spinal high‐velocity, low‐amplitude thrust manipulation: previous theories. Journal of Manipulative and Physiological Therapeutics 2002;25:251‐62. - PubMed
Foster 2010
    1. Foster NE, Hill JC, Hay EM. Subgrouping low‐back pain patients in primary care: Are we getting any better at it?. Manual Therapy 2011;16(1):3‐8. - PubMed
Furlan 2009
    1. Furlan AD, Pennick V, Bombardier C, Tulder M, Editorial Board Cochrane Back Review Group. 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine 2009;34(18):1929‐41. - PubMed
Guyatt 2008
    1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck‐Ytter Y, Alonso‐Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924‐6. - PMC - PubMed
Haldeman 2011
    1. Haldeman S. Is it time to discard the term "diagnosis" when examining a person with uncomplicated axial neck pain?. The Spine Journal 2011;11:171‐6. - PubMed
Hancock 2008
    1. Hancock MJ, Maher CG, Latimer J, Herbert RD, McAuley JH. Independent evaluation of a clinical prediction rule for spinal manipulative therapy: A randomised controlled trial. European Spine Journal 2008;17:936‐43. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hopewell 2004
    1. Hopewell S, McDonald S, Clarke M, Egger M. Grey literature in meta‐analyses of randomized trials of health care interventions. The Cochrane Library 2004;1:Chichester, UK: John Wiley & Sons, Ltd.. - PMC - PubMed
Khalsa 2006
    1. Khalsa PS, Eberhart A, Cotler A, Nahin R. The 2005 conference on the biology of manual therapies. Journal of Manipulative and Physiological Therapeutics 2006;29:341‐6. - PubMed
Koes 2001
    1. Koes BW, Tulder MW, Ostelo R, Burton K, Waddell G. Clinical guidelines for the management of low back pain in primary care: an international comparison. Spine 2001;26:2504‐13. - PubMed
Lamb 2010
    1. Lamb SE, Hansen Z, Lall R, Castelnuovo E, Withers EJ, Nichols V, Potter R, Underwood MR, Back Skills Training Trial investigators. Group cognitive behavioural treatment for low‐back pain in primary care: A randomised controlled trial and cost‐effectiveness analysis. Lancet 2010;375:916‐23. - PubMed
Leboeuf‐Yde 1997
    1. Leboeuf‐Yde C, Hennius B, Rudberg E, Leufvenmark P, Thunman M. Side‐effects of chiropractic treatment: A prospective study. Journal of Manipulative and Physiological Therapeutics 1997;20:511‐5. - PubMed
Malmqvist 2008
    1. Malmqvist S, Leboeuf‐Yde C, Ahola T, Andersson O, Ekstrom K, Pekkaarinen H, et al. The Nordic back pain subpopulation program: Predicting outcome among chiropractic patients in Finland. Chiropractic & Osteopathy 2008;16:13. - PMC - PubMed
McAuley 2000
    1. McAuley L, Pham B, Tugwell P, Moher D. Does the inclusion of grey literature influence the estimates of intervention effectiveness reported in meta‐analyses. Lancet 2000;356:1228‐31. - PubMed
Mueller 2007
    1. Mueller PS, Montori VM, Bassler D, Koenig BA, Guyatt GH. Ethical issues in stopping randomized trials early because of apparent benefit. Annals of Internal Medicine 2007;146(12):878‐81. - PubMed
Okike 2008
    1. Okike K, Kocher MS, Mehlman CT, Bhandari M. Industry‐sponsored research. Injury 2008;39(6):666‐80. - PubMed
Ostelo 2008
    1. Ostelo RWJG, Deyo RA, Stratford P, Waddell G, Croft P, Korff M, Bouter LM, Vet HC. Interpreting change scores for pain and functional status in low back pain: Towards international consensus regarding minimal important change. Spine 2008;33(1):90‐4. - PubMed
Pickar 2002
    1. Pickar JG. Neurophysiological effects of spinal manipulation. The Spine Journal 2002;2:357‐71. - PubMed
Rubinstein 2008
    1. Rubinstein SM, Tulder M. A best‐evidence review of diagnostic procedures for neck and low‐back pain. Best Practice and Research Clinical Rheumatology 2008;22(3):471‐82. - PubMed
Rubinstein 2010
    1. Rubinstein SM, Terwee C, Assendelft WJJ, Boer MR, Tulder MW. Spinal manipulation for acute low‐back pain. Cochrane Database of Systematic Reviews 2010, Issue 12. [DOI: 10.1002/14651858.CD008880] - DOI
Rubinstein 2011
    1. Rubinstein SM, Middelkoop M, Assendelft WJJ, Boer MR, Tulder MW. Spinal manipulative therapy for chronic low‐back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. [DOI: 10.1002/14651858.CD008112.pub2] - DOI - PMC - PubMed
Rubinstein 2012
    1. Rubinstein SM, Terwee CB, Boer MR, Tulder MW. Is the methodological quality of trials on spinal manipulative therapy for low‐back pain improving?. International Journal of Osteopathic Medicine 2012;15:37‐52.
Sandoz 1969
    1. Sandoz R. The significance of the manipulative crack and of other articular noises. Annals of the Swiss Chiropractors' Association 1969;4:47‐68.
Senstad 1997
    1. Senstad O, Leboeuf‐Yde C, Borchgrevink C. Frequency and characteristics of side‐effects of spinal manipulative therapy. Spine 1997;22:435‐40. - PubMed
Triano 2001
    1. Triano JJ. Biomechanics of spinal manipulative therapy. The Spine Journal 2001;1:121‐30. - PubMed
Unsworth 1971
    1. Unsworth A, Dowson D, Wright V. 'Cracking joints'. A bioengineering study of cavitation in the metacarpophalangeal joint. Annals of the Rheumatic Diseases 1971;30:348‐58. - PMC - PubMed
van de Veen 2005
    1. Veen EA, Vet HC, Pool JJ, Schuller W, Zoete A, Bouter LM. Variance in manual treatment of nonspecific low back pain between orthomanual physicians, manual therapists, and chiropractors. Journal of Manipulative and Physiological Therapeutics 2005;28:108‐16. - PubMed
van Tulder 2003
    1. Tulder M, Furlan A, Bombardier C, Bouter L, Editorial Board Cochrane Back Review Group. Updated method guidelines for systemic reviews in the Cochrane Collaboration Back Review Group. Spine 2003;28(12):1290‐9. - PubMed
van Tulder 2004
    1. Tulder MW, Tuut M, Pennick V, Bombardier C, Assendelft WJ. Quality of primary care guidelines for acute low back pain. Spine 2004;29:E357‐62. - PubMed
van Tulder 2006
    1. Tulder MV, Becker A, Bekkering T, Breen A, Real MTG, Hutchinson A, et al. European Guidelines for the management of acute non‐specific low back pain in primary care 2004. European Spine Journal 2006;15 Suppl 2:169‐91. - PMC - PubMed
van Tulder 2009
    1. Tulder MW, Suttorp M, Morton S, Bouter LM, Shekelle P. Empirical evidence of an association between internal validity and effect size in randomized controlled trials of low‐back pain. Spine 2009;34(16):1685‐92. - PubMed

References to other published versions of this review

Assendelft 2003
    1. Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low back pain. A meta‐analysis of effectiveness relative to other therapies. Annals of Internal Medicine 2003;138:898‐906. - PubMed
Assendelft 2004
    1. Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low‐back pain. Cochrane Database of Systematic Reviews 2004, Issue 1. [DOI: 10.1002/14651858.CD000447.pub2] - DOI - PubMed

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