Takaisin Tulosta

Spinal manipulative therapy for acute low-back pain

Evidence summaries
Jukkapekka Jousimaa
Last reviewed as up-to-date 16.10.2013Latest change 16.10.2013

Level of evidence: B

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.

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

Summary

A Cochrane review «»1, «Rubinstein SM, Terwee CB, Assendelft WJ et al. Spi...»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.

Clinical comments

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

References

  1. Rubinstein SM, Terwee CB, Assendelft WJ et al. Spinal manipulative therapy for acute low-back pain. Cochrane Database Syst Rev 2012;9():CD008880. «PMID: 22972127»PubMed