A Systematic Review and Meta-Analysis of Efficacy, Cost-Effectiveness, and Safety of Selected Complementary and Alternative Medicine for Neck and Low-Back Pain

doi:10.1155/2012/953139

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Evid Based Complement Alternat Med. 2012; 2012: 953139.

Published online 2011 Nov 24. doi: 10.1155/2012/953139

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Table 10

Summary of findings of spinal manipulation plus mobilization for low-back pain (only pain and functional outcomes).

Duration and cause of pain	Outcomes	GRADE*	Findings
Manipulation + mobilization versus placebo

Acute/subacute nonspecific	Pain intensity (NRS 0–10)	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	In one trial [153] there were nonsignificant differences in pain intensity. Immediate posttreatment: −2.0 (95% CI: −0.7, 0.3) versus −0.1 (95% CI: −0.6, 0.4); short-term posttreatment: −0.2 (95% CI: −0.7, 0.3) versus 0.0 (95% CI: −0.5, 0.4).
Acute/subacute nonspecific	Roland-Morris Disability score	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	In one trial [153] there were nonsignificant differences in disability. Immediate posttreatment: −1.0 (95% CI: −2.0, 0.1) versus −0.7 (95%CI: −1.8, 0.4); short-term: −0.5 (95% CI: −1.7, 0.7) versus −0.1 (95% CI: −1.3, 1.1).

Acute/subacute specific	NA	Insufficient No trial	NA

Chronic, mixed, unknown (specific, nonspecific)	NA	Insufficient No trial	NA

Manipulation + mobilization versus physiotherapy

Acute/subacute, chronic, unknown (specific, nonspecific)	NA	Insufficient No trial	NA

Mixed nonspecific	Pain intensity (NRS 0–10)	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	In one trial [154] the combination of manipulation and mobilization was associated with significantly greater improvements in intermediate- and long-term posttreatment pain intensity (numerical data not provided).

Mixed specific	NA	Insufficient No trial	NA

Manipulation + mobilization versus usual care

Acute/subacute, Chronic (specific, nonspecific)	NA	Insufficient No trial	NA

Mixed nonspecific	Pain intensity (VAS score)	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	In one trial [156], the combination of manipulation and mobilization (with or without physical modalities) was not significantly different from medical care alone or medical care combined with physical modalities immediately posttreatment or in the long-term posttreatment measures of pain.
Mixed nonspecific	Roland-Morris Disability score	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	In one trial [156], the combination of manipulation and mobilization (with or without physical modalities) was not significantly different from medical care alone or medical care combined with physical modalities immediately posttreatment and in the long-term posttreatment measures of disability.

Mixed specific	NA	Insufficient No trial	NA

Unknown nonspecific	Oswestry Disability Index	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	In one trial [212] subjects receiving manipulation plus mobilization had significantly improved long-term disability. The mean change was 1.03 in the manipulation group versus 0.67 in the hospital outpatient treatment group at short-term posttreatment followup, and 0.94 versus 0.73 at intermediate-term posttreatment followup, respectively.

Unknown specific	NA	Insufficient No trial	NA

Manipulation + mobilization versus exercise

Acute/subacute, (specific, nonspecific)	NA	Insufficient No trial	NA

Chronic nonspecific	Pain intensity (VAS score)	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	In one trial [158] the manual therapy group showed significantly greater improvements than the exercise therapy group on pain intensity. The immediate posttreatment means (SD) in the manual therapy and exercise group were: 22 (18.56) and 37 (25.12), respectively. The corresponding means (SD) at short-term posttreatment followup were 22 (19.88) versus 39 (22.53). The corresponding means (SD) at intermediate-term posttreatment followup were 21 (14.58) versus 35 (35.89).
Chronic nonspecific	Oswestry Disability Index	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	In one trial [158] the manual therapy group showed significantly greater improvements than the exercise therapy group on disability. The posttreatment mean (SD) in the manual therapy versus exercise group were: (a) immediate followup: 18 (13.26) versus 30 (10.77) (b) short-term followup: 18 (11.93) versus 30 (14.36) (c) intermediate-term followup: 17 (13.25) versus 26 (14.36).

Chronic specific	NA	Insufficient No trial	NA

Mixed, Unknown (specific, nonspecific)	NA	Insufficient No trial	NA

*Precision in formal grading was applied only to pooled results.

VAS: visual analog scale; RMDQ: Roland-Morris disability scale; MPQ: McGill pain questionnaire; PDI: pain disability index; NPQ: neck pain questionnaire; NA: not applicable; ROB: risk of bias; RCT: randomized controlled trial.