| Author, Year, Followup,a Pain Duration, Study Quality | Intervention | Population | Function and Pain Outcomes | Other Outcomes |
|---|---|---|---|---|
Bronfort, 2011190 9 months Duration of pain: 5 years Fair | A. Standard manipulation (n=100), 12-24 sessions over 12 weeks B. Exercise (supervised) (n=100) C. Exercise (home) (n=101) | A vs. B Age: 45.2 vs. 44.5 vs. 45.6 years Female sex: 67% vs. 57% vs. 58% Baseline Modified RDQ (0-23): 8.7 vs. 8.4 vs. 8.7 Baseline pain (0-10 NRS): 5.4 vs. 5.1 vs. 5.2 | A vs. B 4 months Modified RDQ (0-23): 4.9 vs. 4.0 vs. 4.2, adjusted difference 0.5 (95% CI −1.0 to 2.1) for A vs. B and 0.7 (95% CI −0.9 to 2.3) for A vs. C Pain (0-10 NRS): 3.3 vs. 2.9 vs. 3.1, adjusted difference 0.3 (95% CI −0.5 to 1.0) for A vs. B and 0.1 (95% CI −0.6 to 0.9) for A vs. C 9 months Modified RDQ (0-23): 5.1 vs. 3.8 vs. 4.1, adjusted difference 0.4 (95% CI −1.2 to 2.0) for A vs. B and −0.1 (95% CI −0.7 to 0.5) for A vs. C Pain (0-10 NRS): 3.3 vs. 2.8 vs. 2.8, adjusted difference 0.3 (95% CI −0.5 to 1.1) for A vs. B and 0.3 (95% CI −0.6 to 1.1) for A vs. C | A vs. B 4 months SF-36 PCS (norm-based mean=50): 48.6 vs. 50.6 vs. 49.1, adjusted difference −1.8 (95% CI −4.4 to 0.9) for A vs. B and −0.3 (95% CI −3.0 to 2.4) for A vs. C SF-36 MCS (norm-based mean=50): 55.9 vs. 54.8 vs. 55.1, adjusted difference 0.4 (95% CI −2.0 to 2.9) for A vs. B and −0.5 (95% CI −3.0 to 2.1) for A vs. C OTC pain medication use, past week (days): 1.6 vs. 1.4 vs. 1.5, adjusted difference 0.4 (95% CI −0.4 to 1.1) for A vs. B and 0.4 (95% CI −0.3 to 1.2) for A vs. C 9 months SF-36 PCS (norm-based mean=50): 48.4 vs. 50.4 vs. 49.6, adjusted difference −1.7 (95% CI −4.2 to 0.8) for A vs. B and −1.0 (95% CI −3.5 to 1.5) for A vs. C SF-36 MCS (norm-based mean=50): 55.2 vs. 53.9 (8.6) vs. 56.0, adjusted difference 2.4 (95% CI −0.2 to 5.0) for A vs. B and −2.2 (95% CI −4.9 to 0.5) for A vs. C OTC pain medication use, past week (days): 1.8 vs. 1.8 vs. 1.6, adjusted difference 0.1 (95% CI −0.8 to 0.9) for A vs. B and 0.4 (95% CI −0.4 to 1.3) for A vs. C |
Ferreira, 2007191 10 months Duration of pain: Not reported Fair | A. Standard manipulation and mobilization (n=80), 12 sessions over 8 weeks B. Exercise (motor control) (n=80) C: Exercise (general exercise) (n=80) | A vs. B vs. C Age: 54 vs. 52 vs. 55 years Female: 70 % vs. 66% vs. 70% Baseline RDQ (0-24): 12.4 vs. 14.0 vs. 14.1 Baseline pain (0-10 VAS): 6.2 vs. 6.3 vs. 6.5 | A vs. B vs. C 4 months RDQ (0-24): 7.7 vs. 8.4 vs. 10.1, difference 0.2 (95% CI −1.5 to 1.9) for A vs. B and −0.9 (95% CI −2.7 to 0.9) for A vs. C Pain (0-10 VAS): 4.3 vs. 4.3 vs. 4.8, difference 0.0 (95% CI −0.9 to 0.8) for A vs. B and −0.5 (95% CI −1.4 to 0.3) for A vs. C 10 months RDQ (0-24): 9.2 vs. 8.8 vs. 9.6, difference 1.8 (95% CI 0.0 to 3.6) for A vs. B and 1.2 (95% CI −0.6 to 3.0) for A vs. C Pain (0-10 VAS): 4.9 vs. 4.9 vs. 5.2, difference 0.1 (95% CI −0.8 to 1.0) for A vs. B and −0.2 (95% CI −1.1 to 0.6) for A vs. C | A vs. B vs. C 4 months Patient Specific Functional Scale (3-30): 17.3 vs. 16.4 vs. 15.0, difference 0.7 (95% CI −1.3 to 2.7) for A vs. B and 1.7 (95% CI −0.4 to 3.,8) for A vs. C 10 months Patient Specific Functional Scale (3-30): 15.2 vs. 15.7 (6.8) vs. 13.9, difference −0.8 (95% CI −2.9 to 1.2) for A vs. B and 0.3 (95% CI −1.7 to 2.3) for A vs. C |
Gibson, 1985143 2 months Duration of pain: 2 to 12 months Poor | A. Manipulation (technique unclear) and mobilization (n=41), 4 sessions over 4 weeks B. Placebo (detuned short-wave diathermy) (n=34) | A vs. B 34 vs. 40 years Female: 61% vs. 32% Baseline pain (0-100 VAS): 35 vs. 48 | A vs. B 1 month Pain (median [range], 0-100 VAS): 28 (0−96) vs. 27(0-80) 3 months Pain (median [range], 0-100 VAS): 25 (4-90) vs. 6 (10-96) p<0.01 | A vs. B 1 month Using analgesics: 25% vs. 50% 3 months Using analgesics: 18% vs. 22% |
Gudavalli, 2006192 11 months Duration of pain: >3 months Fair | A. Flexion–distraction manipulation (n=123), 8-16 sessions over 4 weeks B. Exercise (n=112) | A vs. B Age: 42 vs. 41 years Female: 34% vs. 41% Baseline RDQ (0-24): 6.64 vs. 6.84 Baseline pain VAS (0-100: 38.00 vs. 35.70 | A vs. B 2 months RDQ (0-24): 3.50 vs. 3.75 Pain (0-100 VAS): 16.52 vs.12.04 5 months RDQ (0-24): 3.89 vs. 3.42 Pain (0-100 VAS): 18.26 vs. 8.92 11 months RDQ (0-24): 3.90 vs. 3.77 Pain (0-100 VAS): 17.10 vs. 12.36 | NR |
Haas, 2014171 10.5 months Duration of pain: 11 to 12 years Fair | A. Standard spinal manipulation (n=100), 6 sessions over 6 weeks B. Standard manipulation (n=100), 12 sessions over 6 weeks C. Standard manipulation (n=100), 18 sessions over 6 weeks D: Attention control (minimal massage) (n=100) | A vs. B vs. C vs. D Age: 41 vs. 42 vs. 41 vs. 41 Female: 49% vs. 49% vs. 52% vs. 49% Baseline Modified Von Korff functional disability (0–100): 44.8 vs.46.1 vs.45.2 vs. 45.2 Baseline Pain (0–100 VAS): 51.0 vs. 51.6 vs. 51. vs. 52.2 Baseline Von Korff pain intensity (0–100): 51.0 vs. 51.6 vs. 51.5 vs. 52.2 | A vs. B 4 months Von Korff functional disability (0-100): 25.6 vs. 24.0 vs. 24.1 vs. 27.1, adjusted difference −1.4 (95% CI −7.2 to 4.5) for A vs. D, −3.4 (95% CI −9.3 to 2.4) for B vs. D, and −2.9 (95% CI −8.8 to 2.9) for C vs. D Von Korff functional disability improved ≥50%: 51.5% vs. 59.8% vs. 54.0% vs. 49.5%, adjusted difference 2.5% (95% CI −11.5 to 16.5%) for A vs. D, 10.4% (95% CI −3.4 to 24.3%) for B vs. D, and 4.8% (95% CI −9.1 to 18.6%) for C vs. D Von Korff pain intensity (0-100): 32.5 vs. 33.7 vs. 32.1 vs. 34.9, adjusted difference −1.7 (95% CI −6.9 to 3.4) for A vs. D, −0.8 (95% CI −6.0 to 4.4) for B vs. D, and −2.4 (95% CI −7.6 to 2.9) for C vs. D 10.5 months Von Korff functional disability (0-100): 22.6 vs. 22.4 vs. 19.1 vs. 28.0, adjusted difference −5.2 (95% CI −10.9 to 0.5) for A vs. D, −5.9 (95% CI −11.8 to −0.1) for B vs. D, and −8.8 (95% CI −14.4 to −3.3) for C vs. D Von Korff functional disability improved ≥50%: 57.6% vs. 57.7% vs. 62.0% vs. 58.9%, adjusted difference −1.1% (95% CI −14.8 to 12.6%) for A vs. D, −1.4% (95% CI −15.4 to 12.6%) for B vs. D, and 2.7% (95% CI −11.0 to 16.5%) for C vs. D Von Korff pain intensity (0-100): 30.7 vs. 31.9 (vs. 28.7 vs. 36.5, adjusted difference −5.4 (95% CI −11.1 to 0.4) for A vs. D, −4.6 (95% CI −10.3 to 1.2) for B vs. D, and −7.6 (95% CI −13.2 to −2.0) for C vs. D | A vs. B 4 months SF-12 PCS (norm-based mean=50): 50.5 vs. 51.4 vs. 50.9 vs. 50.0, adjusted difference 0.0 (95% CI −2.4 to 2.3) for A vs. D, −0.8 (95% CI −3.2 to 1.6) for B vs. C, and −1.3 (95% CI −3.6 to 1.1) for C vs. D SF-12 MCS (norm-based mean=50): 52.8 vs. 50.8 vs. 51.3 vs. 51.8, adjusted difference −2.1 (95% CI −4.2 to 0.0) for A vs. D, −0.7 (95% CI −2.8 to 1.3) for B vs. D, and −0.1 (95% CI −2.2 to 2.1) for C vs. D EuroQoL (0-100): 77.8 vs. 77.0 vs. 74.5 vs. 73.9, difference −2.9 (95% CI −6.9 to 1.0) for A vs. D, −1.4 (95% CI −5.5 to 2.6) for B vs. D, and −1.5 (95% CI −5.8 to 2.7) for C vs. D 10.5 months SF-12 PCS (norm-based mean=50): 50.8 vs. 52.6 vs. 52.5 vs. 50.7, adjusted difference −0.3 (95% CI −2.1 to 2.7) for A vs. D, −1.4 (95% CI −4.0 to 1.2) for B vs. D, and −2.2 (95% CI −4.5 to 0.2) for C vs. D SF-12 MCS (norm-based mean=50): 50.4 vs. 50.6 vs. 50.4 vs. 51.3, adjusted difference −0.2 (95% CI −2.7 to 2.3) for A vs. D, −1.1 (95% CI −3.7 to 1.6) for B vs. D, and 0.3 (95% CI −2.3 to 2.9) for C vs. D EuroQoL (0-100): 77.1 vs. 77.3 vs. 77.2 vs. 74.8, adjusted difference −1.3 (95% CI −5.4 to 2.7) for A vs. D, −0.9 (95% CI −4.9 to 3.1) for B vs. D, and −3.3 (95% CI −7.2 to 0.5) for C vs. D |
Hondras, 2009172 4.5 months Duration of pain: Mean 9 to 13 years Fair | A. Standard manipulation (n=96), 12 sessions over 6 weeks B. Flexion distraction manipulation (n=95), 12 sessions over 6 weeks C: Usual care (n=49) | A vs. B vs. C Age: 64 vs. 62 vs. 63 years Female: 45% vs. 44% vs. 41% Baseline RDQ (0-24), mean: 6.5 vs. 6.6 vs. 5.7 Baseline pain (0-100 VAS): 42.1 (23.6) vs. 42.5 (25.2) vs. 42.4 (24.5) | 1.5 months RDQ (0-24): adjusted difference −1.5 (95% CI −3.1 to 0.1) for A vs. C and −2.2 (95% CI −3.7 to −0.6) for B vs. C Global improvement from baseline (1-10): adjusted difference 1.3 (95% CI 0.2 to 2.3) for A vs. C and 1.6 (95% CI 0.5 to 2.7) for B vs. C 4.5 months RDQ (0-24): adjusted difference −1.3 (95% CI −2.9 to 0.6) for A vs. C and −1.9 (95% CI −3.6 to −0.2) for B vs. C Global improvement from baseline (1-10): adjusted difference 1.7 (95% CI 0.5 to 2.8) for A vs. C and 1.8 (95% CI 0.6 to 3.0) for B vs. C | NR |
Senna, 2011173 9 months Duration of pain: 18-19 months Poor | A. Standard manipulation (n=25), 12 sessions over 4 weeks B. Standard manipulation maintained (n=26), 12 sessions over 4 weeks, plus every 2 weeks for 9 months C. Sham manipulation (n=37) | A vs. B Age: 40 vs. 42 vs. 42 years Female: 27% vs. 24% vs. 24% Baseline function (0-100 ODI): 39 vs. 40 vs. 38 Baseline pain (0-100 VAS): 42 vs. 43 vs. 41 | A vs. B 3 months ODI (0-100): 29.8 vs. 23.1 vs. 33.5; p>0.05 Pain (0-100 VAS): 35.2 vs. 25.9 vs. 35.2; p>0.05 6 months ODI (0-100): 32.2 vs. 22.4 vs. 35.3; p>0.05 Pain (0-100 VAS): 35.5 vs. 25.4 vs. 36.8; p>0.05 9 months ODI (0-100): 34.9 vs. 20.6 vs. 37.4 Pain (0-100 VAS): 38.5 vs. 23.5 vs. 38.3 | A vs. B 3 months SF-36, total (0-100): 29.2 vs. 32.8 vs. 26.4; p>0.05 6 months SF-36, total (0-100): 27.8 vs. 33.1 vs. 26.1; p>0.05 9 months SF-36, total (0-100): 27.6 vs. 33.70 vs. 25.9; p>0.05 |
9 months Duration of pain: >3 months in 59% Fair | A: Standard manipulation (n=353), 8 sessions over 12 weeks B: Usual care (n=338) C: Exercise (n=310) | A vs. B vs. C Age: 42 vs. 42 vs. 44 Female: 63% vs. 53% vs. 55% Baseline RDQ (0-24): 8.9 and 8.9 vs. 9.0 vs. 9.2 Baseline Von Korff Pain (0-100): 61.4 and 61.6 vs. 60.5 vs. 60.8 | A vs. B 9 months RDQ (0-24): 5.15 vs. 6.16, adjusted difference −1.01 (95% CI −1.81 to −0.22) Von Korff Disability (0-100): 29.85 vs. 35.50, adjusted difference −5.65 (95% CI −9.72 to −1.57) Von Korff Pain (0-100): 41.68 vs. 47.56, adjusted difference −5.87 (95% CI −10.17 to −1.58) A vs. C 9 months RDQ (0-24): 5.15 (0.29) vs. 5.74 (0.31) Von Korff Disability (0-100): 29.85 (1.50) vs. 29.73 (1.68) Von Korff Pain (0-100): 41.68 (1.58) vs. 41.54 (1.84) | A vs. B 9 months SF-36 PCS (0-100): 44.18 vs. 42.50, adjusted difference 1.68 (95% CI 0.18 to 3.19) SF-36 MCS (0-100): 48.09 vs. 46.41, adjusted difference 1.68 (95% CI −0.21 to 3.57) A vs. C 9 months SF-36 PCS (0-100): 44.18 (0.55) vs. 44.39 (0.63) SF-36 MCS (0-100): 48.09 (0.69) vs. 46.77 (0.81) |
CI = confidence interval; MCS = Mental Component Summary; NR = not reported; NRS = Numeric Rating Scale; ODI = Oswestry Disability Index; OTC = over-the-counter; PCS = Physical Component Score; RDQ = Roland-Morris Disability Questionnaire; SF-12 = Short-Form 12 Questionnaire; SF-36 = Short-Form 36 Questionnaire; VAS = visual analog scale
Unless otherwise noted, followup time is calculated from the end of the treatment period
From: Results
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