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

Appendix 8. Certainty of evidence for intervention --
Efficacy of SMT vs comparator for Lumbar Spinal Stenosis

Outcomes No. of participants randomized (Studies) Results favor (SMT, null, comparator) Risk of Bias (low, acceptable, high) Certainty of the evidence Comments (Reasons for downgrade/ upgrade)
Pain Intensity No trials were identified that reported on this outcome. ⊕⊕○○
Very Low		 No Relevant Studies
Back-Specific Functional Status
Scale: SSS		 259 (1 RCT) 1 favors SMT 1 low risk ⊕⊕⊕○
Moderate		 Imprecision
Quality of Life/ Activities of daily living
Scale: SPWT, daily physical activity		 259 (1 RCT) 1 favors null 1 low risk ⊕⊕⊕○
Moderate		 Imprecision

Abbreviations:

RCT = randomized controlled trial;
SMT = spinal manipulative therapy;
SSS = Swiss Spinal Stenosis Questionnaire;
SPWT = Self-paced walking test