Takaisin Tulosta

Spinal manipulative therapy for chronic low-back pain

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

Level of evidence: A↑↑

Spinal manipulative therapy (SMT) equals to other interventions like exercise therapy, standard medical care or physiotherapy for reducing pain and improving function in patients with chronic low-back pain.

Strong recommendation for using an intervention:

The recommendation attaches a relatively high value on clinical recovery and does not consider the cost of treatment (which may be higher or lower for SMT compared to other treatments depending on the intervention)

Summary

A Cochrane review «»1 «Rubinstein SM, van Middelkoop M, Assendelft WJ et ...»1 included 26 studies with a total of 6070 subjects. In general, SMT has a small, statistically significant but not clinically relevant, short-term (1 and 3 months, but not 12 month) effect on pain relief (MD: -4.16, 95% CI -6.97 to -1.36) and functional status (SMD: -0.22, 95% CI -0.36 to -0.07) compared to other interventions like exercise therapy, standard medical care or physiotherapy (Table 1). SMT has a statistically significant short-term effect on pain relief and functional status when added to another intervention. Data is sparse for recovery, return-to-work, quality of life, and costs of care.

Spinal manipulative therapy compared to all other interventions for chronic low-back pain
Outcomes Mean pain or functional status range across control groups Corresponding risk SMT No of Participants (studies)
Pain 1 month (VAS 0-100) (worse pain) 21.3 to 44 points 2.76 lower (5.19 to 0.32 lower) 1405 (6 studies)
Pain 3 months (VAS 0-100) (worse pain) 27.5 to 44.7 points 4.55 lower (8.68 to 0.43 lower) 1074 (5 studies)
Pain 12 months (VAS 0-100) (worse pain) 28 to 50.6 points 0.76 lower (3.19 lower to 1.66 higher) 1285 (3 studies)
Functional status 1 month (Scale 0-24) (worse function) 4 to 20.8 0.9 lower (1.6 to 0.3 lower) 1402 (6 studies)
Functional status 3 months (Scale 0-24) (worse function) 6 to 20.9 0.74 lower (1.5 lower to 0.04 higher) 1323 (6 studies)
Functional status 12 months (Scale 0-24) (worse function) 5.7 to 9.2 0.32 lower (0.86 lower to 0.27 higher) 1418 (4 studies)
Recovery at 1 month 598 per 1000 718 per 1000 (622 to 819) 370 (3 studies)

Clinical comments

Determining cost-effectiveness of care has high priority when SMT is considered as treatment for chronic low back pain.

Date of latest search: 2009-12-05

References

  1. Rubinstein SM, van Middelkoop M, Assendelft WJ et al. Spinal manipulative therapy for chronic low-back pain. Cochrane Database Syst Rev 2011;(2):CD008112. «PMID: 21328304»PubMed