A Cochrane review [Abstract] 1 [withdrawn from publication] included 39 studies with a total of 5,486 subjects. While manipulative therapy may be very effective for a small subgroup of patients with back pain, the meta-regression models of the studies on patients with acute low-back pain showed spinal manipulative therapy to be superior only to sham therapy (10-mm difference [95% CI, 2 to 17 mm] on a 100-mm visual analogue scale) or therapies judged to be ineffective or even harmful. Manipulative therapy had no statistically or clinically significant advantage over general practitioner care, analgesics, physical therapy, exercises, or back school. Results for patients with chronic low-back pain were similar. Radiation of pain, study quality, profession of manipulator, and use of manipulation alone or in combination with other therapies did not affect these results.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes).
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