The level of evidence is downgraded by imprecise results (few patients and outcome events).
A Cochrane review [Abstract], 1 included 20 studies with a total of 2674 subjects. Spinal manipulative therapy was compared to inert interventions (detuned diathermy and detuned ultrasound) (Table 1) or sham SMT and other interventions (e.g. physiotherapy, exercise, back school) (Table 2) for acute low-back pain in primary or tertiary care patients. Primary outcomes included pain and functional status at one week and one month, perceived recovery and serious adverse effects. In general, the effects of spinal manipulative therapy compared with sham treatments or other recommended treatments were small and clinically not relevant.
| Table 1. Spinal manipulative therapy compared to inert interventions for acute low-back pain | |||||
| Outcomes | Mean pain status range across control groups | Corresponding risk SMT | Relative effect(95% CI) | No of Participants(studies) | Comments |
| Pain at one week 0 (no pain) to 10 (worse pain) | 2 to 4.2 points | 0.1 points higher(0.7 lower to 1 higher) | 311(3 studies) | Small, not clinically-relevant effect. | |
| Pain at one month 0 (no pain) to 10 (worse pain) | 3.1 points | 1.2 points lower(2 to 0.4 lower) | 178(1 study) | Moderately clinically-relevant effect. | |
| Functional status at one week from: 0 (no dysfunction) to 24 (worse function) | 7.8 points | 0.3 points lower(1.5 lower to 0.8 higher) | 205(2 studies) | Small, not clinically-relevant effect. | |
| Functional status at one month from: 0 (no dysfunction) to 24 (worse function) | 4.9 points | 0.3 standard deviations lower(0.6 lower to 0.04 higher) | 178(1 study) | Small, not clinically-relevant effect. | |
| Recovery at one month | 33 per 100 | 31 per 100(16 to 60) | RR 0.96(0.5 to 1.85) | 263(2 studies) | Small, not clinically-relevant effect. |
| Serious adverse events | 2 studies | Total 427 participants. No serious adverse events were observed in the SMT group. | |||
| Table 2. Spinal manipulative therapy compared to other interventions for acute low-back pain | |||||
| Outcomes | Mean pain status range across control groups | Corresponding risk SMT | Relative effect(95% CI) | No of Participants(studies) | Comments |
| Pain at one week 0 (no pain) to 10 (worse pain) | 2.6 to 3.5 points | 0.1 higher(0.5 lower to 0.7 higher) | 383(3 studies) | Small, not clinically-relevant effect. | |
| Pain at one month 0 (no pain) to 10 (worse pain) | 0.5 to 2.3 points | 0.2 lower(0.5 lower to 0.2 higher) | 606(3 studies) | Small, not clinically-relevant effect. | |
| Functional status at one week from: 0 (no dysfunction) to 24 (worse function) | 7.2 points | 0.1 SD higher(0.2 lower to 0.3 higher) | 241(1 study) | Small, not clinically-relevant effect. | |
| Functional status at one month from: 0 (no dysfunction) to 24 (worse function) | 4.1 points | 0.5 points lower(1.2 lower to 0.2 higher) | 681(3 studies) | Small, not clinically-relevant effect. | |
| Recovery at one month | 87 per 100 | 92 per 100 | RR 1.06(0.94 to 1.21) | 117(2 studies) | Small, not clinically-relevant effect. |
| Serious adverse events | 2 studies | Total 578 participants. No serious adverse events were observed in the SMT group. | |||
The decision to refer patients for SMT should be based upon costs and preferences of the patients and providers.
Date of latest search: 2012-03-04
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