The effect of spinal manipulative therapy on pain relief and function in patients with chronic low back pain: an individual participant data meta-analysis

Annemarie de Zoete, Sidney M. Rubinstein, Michiel R. de Boer, Raymond Ostelo, Martin Underwood, Jill A. Hayden, Laurien M. Buffart, Maurits W. van Tulder, G. Bronfort, N. E. Foster, C. G. Maher, J. Hartvigsen, P. Balthazard, F. Cecchi, M. L. Ferreira, M. R. Gudavalli, M. Haas, B. Hidalgo, M. A. Hondras, C. Y. HsiehK. Learman, P. W. McCarthy, T. Petersen, E. Rasmussen-Barr, E. Skillgate, Y. Verma, L. Vismara, B. F. Walker, T. Xia, N. Zaproudina

Research output: Contribution to journalReview articlepeer-review

Abstract

Background: A 2019 review concluded that spinal manipulative therapy (SMT) results in similar benefit compared to other interventions for chronic low back pain (LBP). Compared to traditional aggregate analyses individual participant data (IPD) meta-analyses allows for a more precise estimate of the treatment effect. Purpose: To assess the effect of SMT on pain and function for chronic LBP in a IPD meta-analysis. Data sources: Electronic databases from 2000 until April 2016, and reference lists of eligible trials and related reviews. Study selection: Randomized controlled trials (RCT) examining the effect of SMT in adults with chronic LBP compared to any comparator. Data extraction and data synthesis: We contacted authors from eligible trials. Two review authors independently conducted the study selection and risk of bias. We used GRADE to assess the quality of the evidence. A one-stage mixed model analysis was conducted. Negative point estimates of the mean difference (MD) or standardized mean difference (SMD) favors SMT. Results: Of the 42 RCTs fulfilling the inclusion criteria, we obtained IPD from 21 (n = 4223). Most trials (s = 12, n = 2249) compared SMT to recommended interventions. There is moderate quality evidence that SMT vs recommended interventions resulted in similar outcomes on pain (MD −3.0, 95%CI: −6.9 to 0.9, 10 trials, 1922 participants) and functional status at one month (SMD: −0.2, 95% CI −0.4 to 0.0, 10 trials, 1939 participants). Effects at other follow-up measurements were similar. Results for other comparisons (SMT vs non-recommended interventions; SMT as adjuvant therapy; mobilization vs manipulation) showed similar findings. SMT vs sham SMT analysis was not performed, because we only had data from one study. Sensitivity analyses confirmed these findings. Limitations: Only 50% of the eligible trials were included. Conclusions: Sufficient evidence suggest that SMT provides similar outcomes to recommended interventions, for pain relief and improvement of functional status. SMT would appear to be a good option for the treatment of chronic LBP. Systematic Review Registration Number PROSPERO CRD42015025714

Original languageEnglish (US)
Pages (from-to)121-134
Number of pages14
JournalPhysiotherapy
Volume112
DOIs
StatePublished - Sep 2021

Bibliographical note

Funding Information:
Ethical approval: The study protocol was approved by the Review Board of the coordinating institution (EMGO Institute VU University Amsterdam). The protocol has also been approved by the Ethical Committee (Ref. No. 2015.554) of the VU University. Funding: This systematic review was funded by a grant from European Chiropractic Union Research Fund Contract No A.14.03. Conflict of interest: ADZ works in clinical practice as a chiropractor and treats patients with chronic low-back pain.

Funding Information:
MU was Chair of the NICE accreditation advisory committee until March 2017 for which he received a fee. He is chief investigator or co-investigator on multiple previous and current research grants from the UK National Institute for Health Research, Arthritis Research UK and is a co-investigator on grants funded by the Australian NHMRC . He is a NIHR Senior Investigator. He has received travel expenses for speaking at conferences from the professional organisations hosting the conferences. He is a director and shareholder of Clinvivo Ltd. that provides electronic data collection for health services research. He is part of an academic partnership with Serco Ltd. related to return to work initiatives. He is a co-investigator on a study receiving support in kind from Orthospace Ltd. He is an editor of the NIHR journal series, and a member of the NIHR Journal editors group, for which he receives a fee. He has published multiple papers on LBP some of which are referenced in this paper. He was lead author on one study included in the IPD meta-analysis. The authors declare they have no competing interests.

Funding Information:
Ethical approval: The study protocol was approved by the Review Board of the coordinating institution (EMGO Institute VU University Amsterdam). The protocol has also been approved by the Ethical Committee (Ref. No. 2015.554) of the VU University. Funding: This systematic review was funded by a grant from European Chiropractic Union Research Fund Contract No A.14.03. Conflict of interest: ADZ works in clinical practice as a chiropractor and treats patients with chronic low-back pain.SMR reports grants from European Chiropractor's Union, grants from Netherlands Chiropractic Association, grants from European Centre for Chiropractic Research Excellence, grants from Belgian Chiropractic Association, during the conduct of the study; and SMR works in clinical practice as a chiropractor and treats patients with chronic low-back pain.MU was Chair of the NICE accreditation advisory committee until March 2017 for which he received a fee. He is chief investigator or co-investigator on multiple previous and current research grants from the UK National Institute for Health Research, Arthritis Research UK and is a co-investigator on grants funded by the Australian NHMRC. He is a NIHR Senior Investigator. He has received travel expenses for speaking at conferences from the professional organisations hosting the conferences. He is a director and shareholder of Clinvivo Ltd. that provides electronic data collection for health services research. He is part of an academic partnership with Serco Ltd. related to return to work initiatives. He is a co-investigator on a study receiving support in kind from Orthospace Ltd. He is an editor of the NIHR journal series, and a member of the NIHR Journal editors group, for which he receives a fee. He has published multiple papers on LBP some of which are referenced in this paper. He was lead author on one study included in the IPD meta-analysis. The authors declare they have no competing interests.

Publisher Copyright:
© 2021 The Author(s)

Keywords

  • Individual participant data
  • Low back pain
  • Spinal manipulative therapy

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