Spinal Manipulation vs Sham Manipulation for Nonspecific Low Back Pain: A Systematic Review and Meta-Analysis

Jay K Ruddock; Hannah M Sallis; Andy R Ness; Rachel E Perry

doi:10.1016/j.jcm.2016.04.014

Spinal Manipulation vs Sham Manipulation for Nonspecific Low Back Pain: A Systematic Review and Meta-Analysis

Jay K Ruddock, Hannah M Sallis, Andy R Ness, Rachel E Perry

Research output: Contribution to journal › Article (Academic Journal) › peer-review

29 Citations (Scopus)

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Abstract

Objective

The purpose of this systematic review was to identify and critically evaluate randomized controlled trials of spinal manipulation (SM) vs sham manipulation in the treatment of nonspecific low back pain.

Methods

Four electronic databases were searched from their inception to March 2015 to identify all relevant trials. Reference lists of retrieved articles were hand-searched. All data were extracted by 2 independent reviewers, and risk of bias was assessed using the Cochrane Back Review Group Risk of Bias tool.

Results

Nine randomized controlled trials were included in the systematic review, and 4 were found to be eligible for inclusion in a meta-analysis. Participants in the SM group had improved symptoms compared with participants receiving sham treatment (standardized mean difference = − 0.36; 95% confidence interval, − 0.59 to − 0.12). The majority of studies were of low risk of bias; however, several of the studies were small, the practitioner could not be blinded, and some studies did not conduct intention-to-treat analysis and had a high level of dropouts.

Conclusion

There is some evidence that SM has specific treatment effects and is more effective at reducing nonspecific low back pain when compared with an effective sham intervention. However, given the small number of studies included in this analysis, we should be cautious of making strong inferences based on these results.

Original language	English
Pages (from-to)	165–183
Number of pages	19
Journal	Journal of Chiropractic Medicine
Volume	15
Issue number	3
Early online date	25 May 2016
DOIs	https://doi.org/10.1016/j.jcm.2016.04.014
Publication status	Published - Sept 2016

Keywords

Low back pain
Manipulation
Spinal
Placebo
Review of the literature

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This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Elsevier at http://www.sciencedirect.com/science/article/pii/S1556370716300268. Please refer to any applicable terms of use of the publisher.
Accepted author manuscript, 861 KBLicence: CC BY-NC-ND

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@article{306e3a4f658e4bc0a8951c3412077db7,

title = "Spinal Manipulation vs Sham Manipulation for Nonspecific Low Back Pain: A Systematic Review and Meta-Analysis",

abstract = "ObjectiveThe purpose of this systematic review was to identify and critically evaluate randomized controlled trials of spinal manipulation (SM) vs sham manipulation in the treatment of nonspecific low back pain.MethodsFour electronic databases were searched from their inception to March 2015 to identify all relevant trials. Reference lists of retrieved articles were hand-searched. All data were extracted by 2 independent reviewers, and risk of bias was assessed using the Cochrane Back Review Group Risk of Bias tool.ResultsNine randomized controlled trials were included in the systematic review, and 4 were found to be eligible for inclusion in a meta-analysis. Participants in the SM group had improved symptoms compared with participants receiving sham treatment (standardized mean difference = − 0.36; 95% confidence interval, − 0.59 to − 0.12). The majority of studies were of low risk of bias; however, several of the studies were small, the practitioner could not be blinded, and some studies did not conduct intention-to-treat analysis and had a high level of dropouts.ConclusionThere is some evidence that SM has specific treatment effects and is more effective at reducing nonspecific low back pain when compared with an effective sham intervention. However, given the small number of studies included in this analysis, we should be cautious of making strong inferences based on these results.",

keywords = "Low back pain, Manipulation, Spinal, Placebo, Review of the literature",

author = "Ruddock, {Jay K} and Sallis, {Hannah M} and Ness, {Andy R} and Perry, {Rachel E}",

year = "2016",

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language = "English",

volume = "15",

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journal = "Journal of Chiropractic Medicine",

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T1 - Spinal Manipulation vs Sham Manipulation for Nonspecific Low Back Pain

T2 - A Systematic Review and Meta-Analysis

AU - Ruddock, Jay K

AU - Sallis, Hannah M

AU - Ness, Andy R

AU - Perry, Rachel E

PY - 2016/9

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N2 - ObjectiveThe purpose of this systematic review was to identify and critically evaluate randomized controlled trials of spinal manipulation (SM) vs sham manipulation in the treatment of nonspecific low back pain.MethodsFour electronic databases were searched from their inception to March 2015 to identify all relevant trials. Reference lists of retrieved articles were hand-searched. All data were extracted by 2 independent reviewers, and risk of bias was assessed using the Cochrane Back Review Group Risk of Bias tool.ResultsNine randomized controlled trials were included in the systematic review, and 4 were found to be eligible for inclusion in a meta-analysis. Participants in the SM group had improved symptoms compared with participants receiving sham treatment (standardized mean difference = − 0.36; 95% confidence interval, − 0.59 to − 0.12). The majority of studies were of low risk of bias; however, several of the studies were small, the practitioner could not be blinded, and some studies did not conduct intention-to-treat analysis and had a high level of dropouts.ConclusionThere is some evidence that SM has specific treatment effects and is more effective at reducing nonspecific low back pain when compared with an effective sham intervention. However, given the small number of studies included in this analysis, we should be cautious of making strong inferences based on these results.

AB - ObjectiveThe purpose of this systematic review was to identify and critically evaluate randomized controlled trials of spinal manipulation (SM) vs sham manipulation in the treatment of nonspecific low back pain.MethodsFour electronic databases were searched from their inception to March 2015 to identify all relevant trials. Reference lists of retrieved articles were hand-searched. All data were extracted by 2 independent reviewers, and risk of bias was assessed using the Cochrane Back Review Group Risk of Bias tool.ResultsNine randomized controlled trials were included in the systematic review, and 4 were found to be eligible for inclusion in a meta-analysis. Participants in the SM group had improved symptoms compared with participants receiving sham treatment (standardized mean difference = − 0.36; 95% confidence interval, − 0.59 to − 0.12). The majority of studies were of low risk of bias; however, several of the studies were small, the practitioner could not be blinded, and some studies did not conduct intention-to-treat analysis and had a high level of dropouts.ConclusionThere is some evidence that SM has specific treatment effects and is more effective at reducing nonspecific low back pain when compared with an effective sham intervention. However, given the small number of studies included in this analysis, we should be cautious of making strong inferences based on these results.

KW - Low back pain

KW - Manipulation

KW - Spinal

KW - Placebo

KW - Review of the literature

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JF - Journal of Chiropractic Medicine

IS - 3

ER -

Spinal Manipulation vs Sham Manipulation for Nonspecific Low Back Pain: A Systematic Review and Meta-Analysis

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