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Spinal Manipulative Therapy for Low Back Pain: A Meta-Analysis of Effectiveness Relative to Other Therapies

Willem J.J. Assendelft, MD, PhD; Sally C. Morton, PhD; Emily I. Yu, MPH; Marika J. Suttorp, MS; and Paul G. Shekelle, MD, PhD
[+] Article and Author Information

From The Cochrane Back Review Group, Toronto, Ontario, Canada, and Amsterdam, the Netherlands; Dutch College of General Practitioners, Utrecht, the Netherlands; RAND, Santa Monica, California; and Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California.


Grant Support: No external funding was obtained for this study.

Acknowledgments: The authors thank the members of the Editorial Board of the Cochrane Back Review Group for constructive comments on the protocol and draft version of this article. They also thank Bart W. Koes, PhD, and Maurits W. van Tulder, PhD, for helping develop some of the methods of searching and quality assessment used in this review.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Paul G. Shekelle, MD, PhD, RAND, 1700 Main Street, PO Box 2138, Santa Monica, CA 90407; e-mail, shekelle@rand.org.

Current Author Addresses: Dr. Assendelft: Dutch College of General Practitioners, Lomanlaan 103, Utrecth, the Netherlands.

Drs. Morton, Suttorp, and Shekelle: RAND, 1700 Main Street, PO Box 2138, Santa Monica, CA 90407.

Dr. Yu: University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI 48109.

Author Contributions: Conception and design: W.J.J. Assendelft, P.G. Shekelle.

Analysis and interpretation of the data: W.J.J. Assendelft, S.C. Morton, E.I. Yu, M.J. Suttorp, P.G. Shekelle.

Drafting of the article: W.J.J. Assendelft, S.C. Morton, P.G. Shekelle.

Critical revision of the article for important intellectual content: W.J.J. Assendelft, S.C. Morton, M.J. Suttorp, P.G. Shekelle.

Final approval of the article: W.J.J. Assendelft, M.J. Suttorp, P.G. Shekelle.

Statistical expertise: S.C. Morton, M.J. Suttorp, P.G. Shekelle.

Administrative, technical, or logistic support: E.I. Yu, M.J. Suttorp, P.G. Shekelle.

Collection and assembly of data: W.J.J. Assendelft, S.C. Morton, E.I. Yu, M.J. Suttorp, P.G. Shekelle.


Ann Intern Med. 2003;138(11):871-881. doi:10.7326/0003-4819-138-11-200306030-00008
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Our search strategy identified 1153 potentially relevant abstracts. After review of the full text of articles, 53 articles were included (716, 39, 4182), representing 39 studies meeting our inclusion criteria. The Appendix Figure is a flow chart of the selection. We excluded one study because it did not report sample sizes by group (82). Table 2 is a condensed version of an evidence table describing the key clinical and methodologic characteristics of each included study. Appendix Table 1 is a complete version of this table. Appendix Table 2 describes the excluded studies. There were 29 comparisons of spinal manipulative therapy for patients with acute or subacute pain, 29 comparisons of spinal manipulative therapy for patients with subacute or chronic pain, and 14 comparisons of spinal manipulative therapy for patients with mixed or unsure durations of pain. Most studies excluded patients with sciatica; 12 comparisons were restricted to patients with sciatica. The studies included a total of 5486 patients; study sample sizes ranged from 19 to 666 (median, 92). Quality varied but tended to be higher in the more recent studies.

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Figures

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Figure 1.
Effect of spinal manipulative therapy (SMT) on short-term pain for acute low back pain.

GP = general practitioner; PT = physical therapy.

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Figure 2.
Effect of spinal manipulative therapy (SMT) on short-term pain for chronic low back pain.

GP = general practitioner; PT = physical therapy.

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Figure 3.
Spinal manipulative therapy (SMT) for acute and chronic low back pain.RDQVAS

The bars represent CIs, and the values are scores for either the Roland Disability Questionnaire ( ) or visual analogue scale ( ). Ineffective therapies are traction, corset, bed rest, home care, topical gel, no treatment, diathermy, or minimal massage. GP = general practitioner; NS = no studies; PT = physical therapy.

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Appendix Figure. From Moher et al. . Excluded studies ( = 18) could be excluded for more than one reason. CCTR = Cochrane Controlled Trials Register; RCT = randomized, controlled trial.
Flow chart of selected studies (based on the Quality of Reporting of Meta-Analysis [QUOROM] format).(83)n
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Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

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Summary for Patients

The Effectiveness of Spinal Manipulation Relative to Other Therapies for Low Back Pain

The summary below is from the full report titled “Spinal Manipulative Therapy for Low Back Pain. A Meta-Analysis of Effectiveness Relative to Other Therapies.” It is in the 3 June 2003 issue of Annals of Internal Medicine (volume 138, pages 871-881). The authors are W.J.J. Assendelft, S.C. Morton, E.I. Yu, M.J. Suttorp, and P.G. Shekelle.

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