Table 2

Main treatment effects and GRADE summary of findings for all comparisons for the primary outcomes. Regression coefficients (β) and 95% confidence intervals (CI) of the intervention effects of random-effect models adjusted for baseline using REML (one stage analysis) are presented.

Comparison 1: SMT vs recommended therapies
Time measurement Difference in effect (β) (95% CI) # studies N Quality of the evidence (and reason for downgrading) Comments
Outcome: paina
 1 month MD −3.0, 95% CI −6.9 to 0.9 10 1922 Moderate (inconsistency)
 3 months MD −6.6, 95% CI −13.0 to −0.2 9 1647 Moderate (inconsistency)
 6 months MD −5.6, 95% CI −9.6 to −1.5 8 1321 Moderate (inconsistency)
 12 months MD −2.5, 95% CI −7.1 to 2.1 10 1791 Moderate (inconsistency)
Outcome: functional status SMD converted to a MD on the 24 point RMDQ scale
 1 month SMD −0.2, 95% CI −0.4 to 0.0 10 1939 Moderate (inconsistency) -0.8
 3 months SMD -0.1, 95% CI -0.4 to 0.1 11 1892 Moderate (inconsistency) -0.6
 6 months SMD -0.2, 95% CI -0.3 to 0.0 9 1490 Moderate (inconsistency) -0.8
 12 months SMD -0.1, 95% CI -0.3 to 0.1 10 1826 Moderate (inconsistency) -0.5
Comparison 2: SMT vs non-recommended therapies
Outcome: paina
 1 month MD −6.6 95% CI −10. 8 to −2.3 5 755 Moderate (inconsistency)
 3 months Not enough data
 6 months MD −8.3, 95% CI −20.5 to 3.8 3 419 Moderate (imprecision)
 12 months Not enough data
Outcome: functional status SMD converted to a MD on the 24 point RMDQ scale
 1 month SMD -0.3, 95% CI -0.6 to 0.0 5 835 Moderate (inconsistency) -0.6
 3 months SMD -0.0, 95% CI -0.8 to 0.7 2 375 Moderate (inconsistency) -0.9c
 6 months SMD -0.3, 95% CI -0.6 to -0.0 3 414 Moderate (imprecision) -0.9
 12 months Not enough data
Comparison 3: SMT vs sham SMT
 No results only data of one study
Comparison 4: SMT + intervention vs intervention alone
Outcome: paina
 1 month MD −7.44, 95% CI −12.7 to −2.1 5 762 Moderate (inconsistency)
 3 months MD −5.2, 95% CI −11.0 to 0.7 2 619 Moderate (inconsistency)
 6 months MD −1.4, 95% CI -6.7 to 3.8 2 222 Low (inconsistency, imprecision)
 12 months MD -−2.2, 95% CI −5.9 to 1.4 2 603 Moderate (inconsistency)
Outcome: functional statusb
 1 month MD −0.6, 95% CI −2.3 to 1.1 a 4 746 Moderate (inconsistency)
 3 months MD −1.3, 95% CI −2.6 to −0.1a 3 681 Moderate (inconsistency)
 6 months MD −1.0, 95% CI −2.1 to 0.1a 2 218 Low (imprecision, inconsistency)
 12 months MD −0.9, 95% CI −1.6 to −0.2a 2 626 Moderate (inconsistency)
Comparison 5: Manipulation vs mobilization
Outcome: pain
 1 month MD −1.5, 95% CI −6.8 to 3.9 3 321 Moderate (limitations)
 Not enough data for other time points
Outcome: Functional status SMD converted to a MD on the 24 point RMDQ scale
 1 month SMD 0.0, 95% CI -0.0 to 0.1 3 356 Moderate (limitations) -0.6
 Not enough data for other time points

Negative difference in effect indicates higher estimated decrease in pain or improvements in function for SMT group compared to the control
MD = mean difference of combined pain score on a 0–100 scale.
SMD = standardized mean difference of combined functional status score.
a Pain measured on a 0-100 point scale.
b All studies in the SMT + intervention vs intervention alone measured Roland Morris Disability questionnaire, therefore we use a mean difference
c Based on one small study.