Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials

Sidney M Rubinstein, Annemarie de Zoete, Marienke van Middelkoop, Willem J J Assendelft, Michiel R de Boer, Maurits W van Tulder, Sidney M Rubinstein, Annemarie de Zoete, Marienke van Middelkoop, Willem J J Assendelft, Michiel R de Boer, Maurits W van Tulder

Abstract

Objective: To assess the benefits and harms of spinal manipulative therapy (SMT) for the treatment of chronic low back pain.

Design: Systematic review and meta-analysis of randomised controlled trials.

Data sources: Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, Physiotherapy Evidence Database (PEDro), Index to Chiropractic Literature, and trial registries up to 4 May 2018, including reference lists of eligible trials and related reviews.

Eligibility criteria for selecting studies: Randomised controlled trials examining the effect of spinal manipulation or mobilisation in adults (≥18 years) with chronic low back pain with or without referred pain. Studies that exclusively examined sciatica were excluded, as was grey literature. No restrictions were applied to language or setting.

Review methods: Two reviewers independently selected studies, extracted data, and assessed risk of bias and quality of the evidence. The effect of SMT was compared with recommended therapies, non-recommended therapies, sham (placebo) SMT, and SMT as an adjuvant therapy. Main outcomes were pain and back specific functional status, examined as mean differences and standardised mean differences (SMD), respectively. Outcomes were examined at 1, 6, and 12 months. Quality of evidence was assessed using GRADE. A random effects model was used and statistical heterogeneity explored.

Results: 47 randomised controlled trials including a total of 9211 participants were identified, who were on average middle aged (35-60 years). Most trials compared SMT with recommended therapies. Moderate quality evidence suggested that SMT has similar effects to other recommended therapies for short term pain relief (mean difference -3.17, 95% confidence interval -7.85 to 1.51) and a small, clinically better improvement in function (SMD -0.25, 95% confidence interval -0.41 to -0.09). High quality evidence suggested that compared with non-recommended therapies SMT results in small, not clinically better effects for short term pain relief (mean difference -7.48, -11.50 to -3.47) and small to moderate clinically better improvement in function (SMD -0.41, -0.67 to -0.15). In general, these results were similar for the intermediate and long term outcomes as were the effects of SMT as an adjuvant therapy. Evidence for sham SMT was low to very low quality; therefore these effects should be considered uncertain. Statistical heterogeneity could not be explained. About half of the studies examined adverse and serious adverse events, but in most of these it was unclear how and whether these events were registered systematically. Most of the observed adverse events were musculoskeletal related, transient in nature, and of mild to moderate severity. One study with a low risk of selection bias and powered to examine risk (n=183) found no increased risk of an adverse event (relative risk 1.24, 95% confidence interval 0.85 to 1.81) or duration of the event (1.13, 0.59 to 2.18) compared with sham SMT. In one study, the Data Safety Monitoring Board judged one serious adverse event to be possibly related to SMT.

Conclusion: SMT produces similar effects to recommended therapies for chronic low back pain, whereas SMT seems to be better than non-recommended interventions for improvement in function in the short term. Clinicians should inform their patients of the potential risks of adverse events associated with SMT.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: SMR received personal grants from the European Chiropractors’ Union (ECU), the European Centre for Chiropractic Research Excellence (ECCRE), the Belgian Chiropractic Association (BVC) and the Netherlands Chiropractic Association (NCA) for his position at the Vrije Universiteit Amsterdam. He also received funding for a research project on chiropractic care for the elderly from the European Centre for Chiropractic Research and Excellence (ECCRE). AdeZ received a grant from the European Chiropractors’ Union (ECU) (grant No A14.03), for an independent study on the effects of SMT. SMR and AdeZ declare that they work in their own private clinics as chiropractors. The remaining authors received no support from any organisation for the submitted work; have no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and have no other relationships or activities that could appear to have influenced the submitted work.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Fig 1
Fig 1
Selection of studies through review
Fig 2
Fig 2
Mean difference in reduction of pain at 1, 3, 6, and 12 months (0-100; 0=no pain, 100 maximum pain) for spinal manipulative therapy (SMT) versus recommended therapies in review of the effects of SMT for chronic low back pain. Pooled mean differences calculated by DerSimonian-Laird random effects model. See supplementary file for more detailed graphic
Fig 3
Fig 3
Standardised mean difference for improvement in function at 1, 3, 6, and 12 months for spinal manipulative therapy (SMT) versus recommended therapies in review of the effects of SMT for chronic low back pain. Pooled standardised mean differences calculated by DerSimonian-Laird random effects model. See supplementary file for more detailed graphic
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/6396088/bin/rubs048232.va.jpg

References

    1. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390:1211-59. 10.1016/S0140-6736(17)32154-2
    1. Airaksinen O, Brox JI, Cedraschi C, et al. COST B13 Working Group on Guidelines for Chronic Low Back Pain Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006;15(Suppl 2):S192-300. 10.1007/s00586-006-1072-1
    1. Qaseem A, Wilt TJ, McLean RM, Forciea MA, Clinical Guidelines Committee of the American College of Physicians Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med 2017;166:514-30. 10.7326/M16-2367
    1. Bons SCS, Borg MAJP, Van den Donk M, et al. NHG guideline for aspecific low-back pain, 2017. www.nhgorg/standaarden/samenvatting/aspecifieke-lagerugpijn#idp23613872.
    1. NICE guideline. Low back pain and sciatica in over 16s: assessment and management. , 2016.
    1. Koes BW, van Tulder M, Lin CW, Macedo LG, McAuley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 2010;19:2075-94. 10.1007/s00586-010-1502-y
    1. Foster NE, Anema JR, Cherkin D, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. (1474-547X)
    1. Sandoz R. The significance of the manipulative crack and of other articular noises. Ann Swiss Chiro Assoc 1969;4:47-68.
    1. Bialosky JE, Bishop MD, Robinson ME, Zeppieri G, Jr, George SZ. Spinal manipulative therapy has an immediate effect on thermal pain sensitivity in people with low back pain: a randomized controlled trial. Phys Ther 2009;89:1292-303. 10.2522/ptj.20090058
    1. Fryer G. Integrating osteopathic approaches based on biopsychosocial therapeutic mechanisms. Part 1: The mechanisms. Int J Osteopath Med 2017;25:30-41 10.1016/j.ijosm.2017.05.002.
    1. Wong AYL, Parent EC, Dhillon SS, Prasad N, Kawchuk GN. Do participants with low back pain who respond to spinal manipulative therapy differ biomechanically from nonresponders, untreated controls or asymptomatic controls? Spine (Phila Pa 1976) 2015;40:1329-37. 10.1097/BRS.0000000000000981
    1. Xia T, Long CR, Vining RD, et al. Association of lumbar spine stiffness and flexion-relaxation phenomenon with patient-reported outcomes in adults with chronic low back pain - a single-arm clinical trial investigating the effects of thrust spinal manipulation. BMC Complement Altern Med 2017;17:303. 10.1186/s12906-017-1821-1
    1. Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Man Ther 2009;14:531-8. 10.1016/j.math.2008.09.001
    1. Bialosky JE, George SZ, Horn ME, Price DD, Staud R, Robinson ME. Spinal manipulative therapy-specific changes in pain sensitivity in individuals with low back pain (NCT01168999). J Pain 2014;15:136-48. 10.1016/j.jpain.2013.10.005
    1. Coronado RA, Gay CW, Bialosky JE, Carnaby GD, Bishop MD, George SZ. Changes in pain sensitivity following spinal manipulation: a systematic review and meta-analysis. J Electromyogr Kinesiol 2012;22:752-67. 10.1016/j.jelekin.2011.12.013
    1. Currie SJ, Myers CA, Durso C, Enebo BA, Davidson BS. The neuromuscular response to spinal manipulation in the presence of pain. J Manipulative Physiol Ther 2016;39:288-93. 10.1016/j.jmpt.2016.02.011
    1. Dorron SL, Losco BE, Drummond PD, Walker BF. Effect of lumbar spinal manipulation on local and remote pressure pain threshold and pinprick sensitivity in asymptomatic individuals: a randomised trial. Chiropr Man Therap 2016;24:47-56. 10.1186/s12998-016-0128-5
    1. Randoll C, Gagnon-Normandin V, Tessier J, et al. The mechanism of back pain relief by spinal manipulation relies on decreased temporal summation of pain. Neuroscience 2017;349:220-8. 10.1016/j.neuroscience.2017.03.006
    1. Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database Syst Rev 2011;(2):CD008112.
    1. Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database Syst Rev 2011;(2):CD008112.
    1. Higgins JPT. Green S. Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration , 2011;Version 5.1.0 [updated March 2011].
    1. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177-88. 10.1016/0197-2456(86)90046-2
    1. IntHout J, Ioannidis JPA, Rovers MM, et al. Plea for routinely presenting prediction intervals in meta-analysis. BMJ Open 2016;6:e010247 10.1136/bmjopen-e47.
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences. Academic Press, 1988: 1-474.
    1. Furlan AD, Pennick V, Bombardier C, van Tulder M, Editorial Board, Cochrane Back Review Group 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine (Phila Pa 1976) 2009;34:1929-41. 10.1097/BRS.0b013e3181b1c99f
    1. Savovic J, Turner RM, Mawdsley D, et al. Association Between Risk-of-Bias Assessments and Results of Randomized Trials in Cochrane Reviews: the ROBES Meta-Epidemiologic Study. Am J Epidemiol 2018;187;1113-22. 10.1093/aje/kwx344.
    1. Balthazard P, de Goumoens P, Rivier G, Demeulenaere P, Ballabeni P, Dériaz O. Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial. BMC Musculoskelet Disord 2012;13:162. 10.1186/1471-2474-13-162
    1. Brønfort G, Goldsmith CH, Nelson CF, Boline PD, Anderson AV. Trunk exercise combined with spinal manipulative or NSAID therapy for chronic low back pain: a randomized, observer-blinded clinical trial. J Manipulative Physiol Ther 1996;19:570-82.
    1. Bronfort G, Maiers MJ, Evans RL, et al. Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: a randomized clinical trial. Spine J 2011;11:585-98. 10.1016/j.spinee.2011.01.036
    1. Castro-Sánchez AM, Lara-Palomo IC, Matarán-Peñarrocha GA, et al. Short-term effectiveness of spinal manipulative therapy versus functional technique in patients with chronic nonspecific low back pain: a pragmatic randomized controlled trial. Spine J 2016;16:302-12. 10.1016/j.spinee.2015.08.057
    1. Cecchi F, Molino-Lova R, Chiti M, et al. Spinal manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic low back pain: a randomized trial with one-year follow-up. Clin Rehabil 2010;24:26-36. 10.1177/0269215509342328
    1. Chown M, Whittamore L, Rush M, et al. A prospective study of patients with chronic back pain randomised to group exercise, physiotherapy or osteopathy. Physiotherapy 2008;94:21-8 10.1016/j.physio.2007.04.014.
    1. Cook C, Learman K, Showalter C, Kabbaz V, O’Halloran B. Early use of thrust manipulation versus non-thrust manipulation: a randomized clinical trial. Man Ther 2013;18:191-8. 10.1016/j.math.2012.08.005
    1. Dougherty PE, Karuza J, Savino D, Katz P. Evaluation of a modified clinical prediction rule for use with spinal manipulative therapy in patients with chronic low back pain: a randomized clinical trial. Chiropr Man Therap 2014;22:41. 10.1186/s12998-014-0041-8
    1. Evans DP, Burke MS, Lloyd KN, Roberts EE, Roberts GM. Lumbar spinal manipulation on trial. Part I--clinical assessment. Rheumatol Rehabil 1978;17:46-53. 10.1093/rheumatology/17.1.46
    1. Ferreira ML, Ferreira PH, Latimer J, et al. Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: A randomized trial. Pain 2007;131:31-7. 10.1016/j.pain.2006.12.008
    1. Ghroubi S, Elleuch H, Baklouti S, Elleuch MH. [Chronic low back pain and vertebral manipulation] [French]. Ann Readapt Med Phys 2007;50:570-6. 10.1016/j.annrmp.2007.02.012
    1. Gibson T, Grahame R, Harkness J, Woo P, Blagrave P, Hills R. Controlled comparison of short-wave diathermy treatment with osteopathic treatment in non-specific low back pain. Lancet 1985;1:1258-61. 10.1016/S0140-6736(85)92323-2
    1. Goldby LJ, Moore AP, Doust J, Trew ME. A randomized controlled trial investigating the efficiency of musculoskeletal physiotherapy on chronic low back disorder. Spine (Phila Pa 1976) 2006;31:1083-93. 10.1097/01.brs.0000216464.37504.64
    1. Gudavalli MR, Cambron JA, McGregor M, et al. A randomized clinical trial and subgroup analysis to compare flexion-distraction with active exercise for chronic low back pain. Eur Spine J 2006;15:1070-82. 10.1007/s00586-005-0021-8
    1. Haas M, Vavrek D, Peterson D, Polissar N, Neradilek MB. Dose-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial. Spine J 2014;14:1106-16. 10.1016/j.spinee.2013.07.468
    1. Hemmilä HM, Keinänen-Kiukaanniemi SM, Levoska S, Puska P. Long-term effectiveness of bone-setting, light exercise therapy, and physiotherapy for prolonged back pain: a randomized controlled trial. J Manipulative Physiol Ther 2002;25:99-104. 10.1067/mmt.2002.122329
    1. Hidalgo B, Pitance L, Hall T, Detrembleur C, Nielens H. Short-term effects of Mulligan mobilization with movement on pain, disability, and kinematic spinal movements in patients with nonspecific low back pain: a randomized placebo-controlled trial. J Manipulative Physiol Ther 2015;38:365-74.
    1. Hondras MA, Long CR, Cao Y, Rowell RM, Meeker WC. A randomized controlled trial comparing 2 types of spinal manipulation and minimal conservative medical care for adults 55 years and older with subacute or chronic low back pain. J Manipulative Physiol Ther 2009;32:330-43. 10.1016/j.jmpt.2009.04.012
    1. Hsieh CY, Adams AH, Tobis J, et al. Effectiveness of four conservative treatments for subacute low back pain: a randomized clinical trial. Spine (Phila Pa 1976) 2002;27:1142-8. 10.1097/00007632-200206010-00003
    1. Hurwitz EL, Morgenstern H, Harber P, et al. University of California-Los Angeles A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA low back pain study. Spine (Phila Pa 1976) 2002;27:2193-204. 10.1097/00007632-200210150-00002
    1. Koes BW, Bouter LM, van Mameren H, et al. The effectiveness of manual therapy, physiotherapy, and treatment by the general practitioner for nonspecific back and neck complaints. A randomized clinical trial. Spine (Phila Pa 1976) 1992;17:28-35. 10.1097/00007632-199201000-00005
    1. Krekoukias G, Gelalis ID, Xenakis T, Gioftsos G, Dimitriadis Z, Sakellari V. Spinal mobilization vs conventional physiotherapy in the management of chronic low back pain due to spinal disk degeneration: a randomized controlled trial. J Man Manip Ther 2017;25:66-73. 10.1080/10669817.2016.1184435
    1. Licciardone JC, Stoll ST, Fulda KG, et al. Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. Spine (Phila Pa 1976) 2003;28:1355-62. 10.1097/01.BRS.0000067110.61471.7D
    1. Mohseni-Bandpei MA, Critchley J, Staunton T, et al. A prospective randomised controlled trial of spinal manipulation and ultrasound in the treatment of chronic low back pain. Physiotherapy 2006;92:34-42 10.1016/j.physio.2005.05.005.
    1. Muller R, Giles LG. Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes. J Manipulative Physiol Ther 2005;28:3-11. 10.1016/j.jmpt.2004.12.004
    1. Paatelma M, Kilpikoski S, Simonen R, Heinonen A, Alen M, Videman T. Orthopaedic manual therapy, McKenzie method or advice only for low back pain in working adults: a randomized controlled trial with one year follow-up. J Rehabil Med 2008;40:858-63. 10.2340/16501977-0262
    1. Petersen T, Larsen K, Nordsteen J, Olsen S, Fournier G, Jacobsen S. The McKenzie method compared with manipulation when used adjunctive to information and advice in low back pain patients presenting with centralization or peripheralization: a randomized controlled trial. Spine (Phila Pa 1976) 2011;36:1999-2010. 10.1097/BRS.0b013e318201ee8e
    1. Pope MH, Phillips RB, Haugh LD, Hsieh CY, 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 (Phila Pa 1976) 1994;19:2571-7. 10.1097/00007632-199411001-00013
    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.
    1. Rasmussen J, Laetgaard J, Lindecrona AL, Qvistgaard E, Bliddal H. Manipulation does not add to the effect of extension exercises in chronic low-back pain (LBP). A randomized, controlled, double blind study. Joint Bone Spine 2008;75:708-13. 10.1016/j.jbspin.2007.12.011
    1. Rasmussen-Barr E, Nilsson-Wikmar L, Arvidsson I. Stabilizing training compared with manual treatment in sub-acute and chronic low-back pain. Man Ther 2003;8:233-41. 10.1016/S1356-689X(03)00053-5
    1. Samir SM, Zak YLA, Soliman MO. Mulligan versus Maitland mobilizations in patients with chronic low back dysfunction. Int J Pharm Tech Res 2016;9:92-9.
    1. Sarker KK, Mohanty U, Sethi J. Effect of spinal manipulation on postural instability in patients with non specific low back pain. Int J Pharm Bio Sci 2017;7:992-9.
    1. Senna MK, Machaly SA. Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome? Spine (Phila Pa 1976) 2011;36:1427-37. 10.1097/BRS.0b013e3181f5dfe0
    1. Skillgate E, Vingård E, Alfredsson L. Naprapathic manual therapy or evidence-based care for back and neck pain: a randomized, controlled trial. Clin J Pain 2007;23:431-9. 10.1097/AJP.0b013e31805593d8
    1. UK BEAM Trial Team United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ 2004;329:1377-81. 10.1136/
    1. Ulger O, Demirel A, Oz M, Tamer S. The effect of manual therapy and exercise in patients with chronic low back pain: Double blind randomized controlled trial. J Back Musculoskelet Rehabil 2017;30:1303-9. 10.3233/BMR-169673
    1. Verma Y, Goyal M. Narkeesh. Pain, range of motion and back strength in chronic mechanical low back pain before & after lumbar mobilisation. Int J Physiother Res 2013;3:48-57.
    1. Vismara L, Cimolin V, Menegoni F, et al. Osteopathic manipulative treatment in obese patients with chronic low back pain: a pilot study. Man Ther 2012;17:451-5. 10.1016/j.math.2012.05.002
    1. Waagen GN, Haldeman S, Cook G, et al. Short term trial of chiropractic adjustments for the relief of chronic low back pain. Man Med 1986;2:63-7.
    1. Walker BF, Hebert JJ, Stomski NJ, Losco B, French SD. Short-term usual chiropractic care for spinal pain: a randomized controlled trial. Spine (Phila Pa 1976) 2013;38:2071-8. 10.1097/01.brs.0000435032.73187.c7
    1. Waqqar S, Shakil-Ur-Rehman S, Ahmad S. McKenzie treatment versus mulligan sustained natural apophyseal glides for chronic mechanical low back pain. Pak J Med Sci 2016;32:476-9.
    1. Wilkey A, Gregory M, Byfield D, McCarthy PW. A comparison between chiropractic management and pain clinic management for chronic low-back pain in a national health service outpatient clinic. J Altern Complement Med 2008;14:465-73. 10.1089/acm.2007.0796
    1. Xia T, Long CR, Gudavalli MR, et al. Similar Effects of Thrust and Nonthrust Spinal Manipulation Found in Adults With Subacute and Chronic Low Back Pain: A Controlled Trial With Adaptive Allocation. Spine (Phila Pa 1976) 2016;41:E702-9. 10.1097/BRS.0000000000001373
    1. Zaproudina N, Hietikko T, Hänninen OOP, Airaksinen O. Effectiveness of traditional bone setting in treating chronic low back pain: a randomised pilot trial. Complement Ther Med 2009;17:23-8. 10.1016/j.ctim.2008.08.005
    1. Licciardone JC, Minotti DE, Gatchel RJ, Kearns CM, Singh KP. Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial. Ann Fam Med 2013;11:122-9. 10.1370/afm.1468
    1. UK BEAM Trial Team United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care. BMJ 2004;329:1381-5. 10.1136/
    1. Gilbert JR, Taylor DW, Hildebrand A, Evans C. Clinical trial of common treatments for low back pain in family practice. BMJ 1985;291:791-4. 10.1136/bmj.291.6498.791
    1. Hurwitz EL, Morgenstern H, Kominski GF, Yu F, Chiang LM. A randomized trial of chiropractic and medical care for patients with low back pain: eighteen-month follow-up outcomes from the UCLA low back pain study. Spine (Phila Pa 1976) 2006;31:611-21, discussion 622. 10.1097/01.brs.0000202559.41193.b2
    1. Walker BF, Hebert JJ, Stomski NJ, et al. Outcomes of usual chiropractic. The OUCH randomized controlled trial of adverse events. Spine (Phila Pa 1976) 2013;38:1723-9. 10.1097/BRS.0b013e31829fefe4
    1. Rubinstein SM, van Eekelen R, Oosterhuis T, de Boer MR, Ostelo RW, van Tulder MW. The risk of bias and sample size of trials of spinal manipulative therapy for low back and neck pain: analysis and recommendations. J Manipulative Physiol Ther 2014;37:523-41. 10.1016/j.jmpt.2014.07.007
    1. Dima A, Lewith GT, Little P, Moss-Morris R, Foster NE, Bishop FL. Identifying patients’ beliefs about treatments for chronic low back pain in primary care: a focus group study. Br J Gen Pract 2013;63:e490-8. 10.3399/bjgp13X669211.
    1. Chou R, Deyo R, Friedly J, et al. Noninvasive Treatments for Low Back Pain. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Feb Report No: 16-EHC004-EF AHRQ Comparative Effectiveness Reviews 2016; Report No: 16-ReporEHC004-EF.
    1. Franke H, Franke JD, Fryer G. Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis. BMC Musculoskelet Disord 2014;15:286. 10.1186/1471-2474-15-286
    1. Ruddock JK, Sallis H, Ness A, Perry RE. Spinal Manipulation Vs Sham Manipulation for Nonspecific Low Back Pain: A Systematic Review and Meta-analysis. J Chiropr Med 2016;15:165-83. 10.1016/j.jcm.2016.04.014
    1. Stochkendahl MJ, Kjaer P, Hartvigsen J, et al. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J 2018;27:60-75. 10.1007/s00586-017-5099-2
    1. Hebert JJ, Stomski NJ, French SD, Rubinstein SM. Serious Adverse Events and Spinal Manipulative Therapy of the Low Back Region: A Systematic Review of Cases. J Manipulative Physiol Ther 2015;38:677-91. 10.1016/j.jmpt.2013.05.009
    1. Swait G, Finch R. What are the risks of manual treatment of the spine? A scoping review for clinicians. Chiropr Man Therap 2017;25:37. 10.1186/s12998-017-0168-5.
    1. Andronis L, Kinghorn P, Qiao S, Whitehurst DG, Durrell S, McLeod H. Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain: a Systematic Literature Review. Appl Health Econ Health Policy 2017;15:173-201. 10.1007/s40258-016-0268-8.
    1. Niemistö L, Rissanen P, Sarna S, Lahtinen-Suopanki T, Lindgren KA, Hurri H. Cost-effectiveness of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain: a prospective randomized trial with 2-year follow-up. Spine (Phila Pa 1976) 2005;30:1109-15. 10.1097/01.brs.0000162569.00685.7b
    1. Michaleff ZA, Lin CW, Maher CG, van Tulder MW. Spinal manipulation epidemiology: systematic review of cost effectiveness studies. J Electromyogr Kinesiol 2012;22:655-62. 10.1016/j.jelekin.2012.02.011.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe