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Evidence summaries

Spinal Manipulative Therapy for Acute Low-Back Pain

Spinal manipulative therapy (SMT) appears to be no more effective in the treatment of patients with acute (1 week to 1 month) low-back pain than inert interventions or when added to another treatment such as standard medical care. SMT also appears to be no more effective than other recommended therapies. Level of evidence: "B"

The level of evidence is downgraded by imprecise results (few patients and outcome events).

Summary

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
OutcomesMean pain status range across control groupsCorresponding risk SMTRelative effect(95% CI)No of Participants(studies)Comments
Pain at one week 0 (no pain) to 10 (worse pain)2 to 4.2 points0.1 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 points1.2 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 points0.3 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 points0.3 standard deviations lower(0.6 lower to 0.04 higher) 178(1 study)Small, not clinically-relevant effect.
Recovery at one month33 per 10031 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 studiesTotal 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
OutcomesMean pain status range across control groupsCorresponding risk SMTRelative effect(95% CI)No of Participants(studies)Comments
Pain at one week 0 (no pain) to 10 (worse pain)2.6 to 3.5 points0.1 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 points0.2 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 points0.1 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 points0.5 points lower(1.2 lower to 0.2 higher) 681(3 studies)Small, not clinically-relevant effect.
Recovery at one month87 per 10092 per 100RR 1.06(0.94 to 1.21)117(2 studies)Small, not clinically-relevant effect.
Serious adverse events 2 studiesTotal 578 participants. No serious adverse events were observed in the SMT group.

Clinical comments

The decision to refer patients for SMT should be based upon costs and preferences of the patients and providers.

Note

Date of latest search: 2012-03-04

    References

    • Rubinstein SM, Terwee CB, Assendelft WJ et al. Spinal manipulative therapy for acute low-back pain. Cochrane Database Syst Rev 2012;9():CD008880. [PubMed]

Primary/Secondary Keywords