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

PMC full text:

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

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

Copyright/License ►Request permission to reuse: Copyright © 2012 Andrea D. Furlan et al.
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Table 6

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

Duration and cause of pain	Outcomes	GRADE*	Findings
Mobilization versus no treatment

Acute/subacute, nonspecific	Pain intensity (MPQ)	Low Design: RCT ROB: High Consistency: NA (one trial) Directness: yes	In one trial [122] mobilization group had significantly lower pain intensity immediately posttreatment (P = 0.048). No further numerical data was provided.

Acute/subacute specific	NA	Insufficient No trial	NA

Chronic nonspecific	Pain intensity score (VAS)	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	In one trial [34] mobilization (Kaltenborn's wedge assisted posteroanterior) was significantly superior to “no treatment.” Immediate posttreatment mean pain score values were 33.40 for mobilization versus 49.77 for “no treatment” (P < 0.001).
Chronic nonspecific	Roland-Morris Disability score	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	In one trial [34] mobilization (Kaltenborn's wedge assisted posteroanterior) was significantly superior to “no treatment.” Immediate posttreatment mean pain score values were 7.69 for mobilization versus 10.64 for “no treatment” (P < 0.003).

Chronic specific	Oswestry Disability Index	Low Design: RCT ROB: High Consistency: NA (one trial) Directness: yes	One trial [123] showed no difference between-groups immediately posttreatment in disability index: 5.57 (2.38) with mobilization and 2.19 (1.54) with “no treatment”.

Mixed nonspecific	Pain intensity score (VAS)	Low Design: RCT ROB: High Consistency: NA (one trial) Directness: yes	In one trial [124] mobilization did not significantly differ from “no treatment” immediately after treatment. The mean difference in pain (overall %) was −24.7 with mobilization and −11.1 with no treatment (F = 2.63, P > 0.05).

Mixed specific	NA	Insufficient No trial	NA

Unknown (specific, nonspecific)	NA	Insufficient No trial	NA

Mobilization versus placebo

Acute/subacute nonspecific	NA	Insufficient No trial	NA

Acute/subacute specific	Pain intensity score (VAS)	Low Design: RCT ROB: High Consistency: NA (one trial) Directness: yes	In one trial, [125, 126] of subjects with sacroiliac joint dysfunction (96% women), there was no statistically significant difference immediately posttreatment between mobilization and placebo (no numerical data was reported).

Chronic (specific, nonspecific)	NA	Insufficient No trial	NA

Mixed nonspecific	Pain intensity score (VAS)	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	In one trial, [127] mobilization did not significantly differ from placebo in reducing immediate or short-term posttreatment pain intensity. The mean (SD) pain intensity immediately posttreatment was 4.2 (2.5) with mobilization and 4.3 (2.2) with placebo (P = 0.8).

Mixed specific	NA	Insufficient No trial	NA

Unknown (specific, nonspecific)	NA	Insufficient No trial	NA

Mobilization versus physiotherapy

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

Chronic nonspecific	Pain intensity score (VAS)	Low Design: RCT ROB: Medium Consistency: no Directness: yes	The pooled estimate of 2 trials showed a significant benefit of mobilization immediately posttreatment (mean difference in VAS score: −0.50, 95% CI: −0.72, −0.28) [128–130].
Chronic nonspecific	Oswestry Disability Index	Moderate Design: RCT ROB: Medium Consistency: yes Directness: yes	The pooled estimate of 2 trials [128–130] showed a significant benefit of mobilization immediately posttreatment (mean difference in disability score: −4.93, 95% CI: −5.91, −3.96).

Chronic specific	Oswestry Disability Index	Low Design: RCT ROB: High Consistency: NA (one trial) Directness: yes	One trial [123] showed no difference between-groups immediately posttreatment in disability index: 5.57 (2.38) with mobilization and 2.55 (1.03) with physiotherapy (physical modalities including exercise).

Mixed nonspecific	Oswestry Disability Index	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	In one trial [131] there was no difference between mobilization and physiotherapy in disability. Mean change (95% CI) in mobilization group at immediate-, short-term, intermediate-term and long-term posttreatment were 7.0 (3.4, 10.2), 5.1 (1.7, 8.4), 9.4 (6.7, 12.1) and 8.4 (5.2, 11.6), respectively. Mean change (95% CI) in the physiotherapy group at immediate-, short-term, intermediate-term and long-term posttreatment were 2.0 (−1.1, 5.1), 4.0 (1.3, 6.7), 4.7 (1.5, 7.9), and 4.4 (1.2, 7.6), respectively. The between-group difference was statistically significant at intermediate and long-term posttreatment followups only.

Mixed specific	NA	Insufficient No trial	NA

Unknown (specific, nonspecific)	NA	Insufficient No trial	NA

Mobilization versus manipulation

Acute/subacute (nonspecific)	Roland-Morris Disability score	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	In one trial, [132] the manipulation group had a significantly better disability score compared to the mobilization group immediately posttreatment. The mean (SD) disability scores were 9.1 (5.3) with manipulation and 3.9 (4.3) with mobilization (P < 0.04).

Acute/subacute (specific)	NA	Insufficient No trial	NA

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

Mobilization versus massage

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

Chronic (nonspecific)	Pain intensity score (VAS)	Low Design: RCT ROB: High Consistency: NA (one trial) Directness: yes	In one trial [133], short-term posttreatment pain intensity was slightly but significantly greater in the mobilization group compared to the massage group (3.36 ± 0.25 versus 2.48 ± 0.25, P = 0.017).

Chronic (specific)	NA	Insufficient No trial	NA

Mixed (specific, nonspecific)	NA	Insufficient No trial	NA

Unknown (nonspecific)	NA	Insufficient No trial	NA

Unknown (specific)	Pain intensity score (VAS)	Low Design: RCT ROB: High Consistency: NA (one trial) Directness: yes	In one trial [25] of subjects with disc protrusion, there was no statistically significant difference in posttreatment pain intensity between the groups (5.59 ± 0.80 versus 4.71 ± 0.52, P > 0.05).

Mobilization versus exercise

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

Chronic (specific, nonspecific)	NA	Insufficient No trial	NA

Mixed nonspecific	Pain intensity score (VAS)	Low Design: RCT ROB: High Consistency: NA (one trial) Directness: yes	One trial [134] showed no significant difference between mobilization and exercise in reducing pain immediately after the end of a single treatment. The mean change (SD) was 1.7 (2.1) with mobilization and 1.2 (1.4) with exercise (no significant between-group difference).
Mixed nonspecific	Oswestry Disability Index	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	Mean change (95% CI) in mobilization group at immediate-, short-term, intermediate-term and long-term posttreatment were 7.0 (3.4, 10.2), 5.1 (1.7, 8.4), 9.4 (6.7, 12.1), and 8.4 (5.2, 11.6), respectively [131]. Mean change (95% CI) in the exercise group at immediate-, short-term, intermediate-term and long-term posttreatment were 3.2 (0.4, 6.1), 2.9 (−0.2, 5.9), 3.5 (0.2, 6.8), and 2.2 (−1.2, 5.7), respectively [131]. Difference between-groups was statistically significant for intermediate and long-term posttreatment followups [131].

Mixed specific	NA	Insufficient No trial	NA

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.