The recommendation attaches a relatively high value on clinical recovery and does not consider the cost of treatment (which may be higher or lower for SMT compared to other treatments depending on the intervention)
A Cochrane review [Abstract] 1 included 26 studies with a total of 6070 subjects. In general, SMT has a small, statistically significant but not clinically relevant, short-term (1 and 3 months, but not 12 month) effect on pain relief (MD: -4.16, 95% CI -6.97 to -1.36) and functional status (SMD: -0.22, 95% CI -0.36 to -0.07) compared to other interventions like exercise therapy, standard medical care or physiotherapy (Table 1). SMT has a statistically significant short-term effect on pain relief and functional status when added to another intervention. Data is sparse for recovery, return-to-work, quality of life, and costs of care.
| Spinal manipulative therapy compared to all other interventions for chronic low-back pain | |||
| Outcomes | Mean pain or functional status range across control groups | Corresponding risk SMT | No of Participants (studies) |
| Pain 1 month (VAS 0-100) (worse pain) | 21.3 to 44 points | 2.76 lower (5.19 to 0.32 lower) | 1405 (6 studies) |
| Pain 3 months (VAS 0-100) (worse pain) | 27.5 to 44.7 points | 4.55 lower (8.68 to 0.43 lower) | 1074 (5 studies) |
| Pain 12 months (VAS 0-100) (worse pain) | 28 to 50.6 points | 0.76 lower (3.19 lower to 1.66 higher) | 1285 (3 studies) |
| Functional status 1 month (Scale 0-24) (worse function) | 4 to 20.8 | 0.9 lower (1.6 to 0.3 lower) | 1402 (6 studies) |
| Functional status 3 months (Scale 0-24) (worse function) | 6 to 20.9 | 0.74 lower (1.5 lower to 0.04 higher) | 1323 (6 studies) |
| Functional status 12 months (Scale 0-24) (worse function) | 5.7 to 9.2 | 0.32 lower (0.86 lower to 0.27 higher) | 1418 (4 studies) |
| Recovery at 1 month | 598 per 1000 | 718 per 1000 (622 to 819) | 370 (3 studies) |
Determining cost-effectiveness of care has high priority when SMT is considered as treatment for chronic low back pain.
Date of latest search: 2009-12-05
Primary/Secondary Keywords