J Can Chiropr Assoc 2026 (Apr); 70 (1): 27-54

Appendix 7. Certainty of evidence for intervention --
Efficacy of SMT parameters for Low back pain

Outcomes No. of participants randomized (Studies) Parameter Results favor (SMT, null, parameter) Risk of Bias (low, acceptable, high) Certainty of the evidence Comments (Reasons for downgrade/ upgrade)
Pain Intensity
Scale: NPRS, 11-Point box pain scale		 49 (1 RCT) Thrust SMT vs Non-thrust SMT 1 favors null 1 acceptable risk ⊕○○○
Very Low		 Imprecision Risk of bias
182 (1 RCTs) 12 weeks SMT vs 36 weeks SMT 1 favors null 1 low risk ⊕⊕○○
Low		 Imprecision
Back-Specific Disability Status
Scale: ODI		 49 (1 RCT) Thrust SMT vs Non-thrust SMT 1 favors null 1 acceptable risk ⊕○○○
Very Low		 Imprecision Risk of bias
182 (1 RCTs) 12 weeks SMT vs 36 weeks SMT 1 favors null 1 low risk ⊕⊕○○○
Low		 Imprecision
Functional Status
Scale: SPPB		 182 (1 RCTs) 12 weeks SMT vs 36 weeks SMT 1 favors 36 weeks 1 low risk ⊕⊕○○
Low		 Imprecision
Quality of Life/ Activities of daily living
Scale: EQ		 182 (1 RCTs) 12 weeks SMT vs 36 weeks SMT 1 favors null 1 low risk ⊕⊕○○
Low		 Imprecision

Abbreviations:

NPRS = numerical pain rating scale;
ODI = Oswestry Disability Index;
RCT = randomized controlled trial;
SMT = spinal manipulative therapy;
SPPB = Short Physical Performance Battery;
EQ = EuroQol EQ-5D