Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis

A ChiroSecure Research Update

Abstract: The present study aims to determine the efficacy, effectiveness, and safety of various mobilization and manipulation therapies for treatment of chronic low back pain.

Discussion: Fifty-one trials were included in the systematic review. Nine trials (1,176 patients) provided sufficient data and were judged similar enough to be pooled for meta-analysis. The standardized mean difference for a reduction of pain was SMD=−0.28, 95% confidence interval (CI) −0.47 to −0.09, p=.004; I2=57% after treatment; within seven trials (923 patients), the reduction in disability was SMD=−0.33, 95% CI −0.63 to −0.03, p=.03; I2=78% for manipulation or mobilization compared with other active therapies. Subgroup analyses showed that manipulation significantly reduced pain and disability, compared with other active comparators including exercise and physical therapy (SMD=−0.43, 95% CI −0.86 to 0.00; p=.05, I2=79%; SMD=−0.86, 95% CI −1.27 to −0.45; p<.0001, I2=46%). Mobilization interventions, compared with other active comparators including exercise regimens, significantly reduced pain (SMD=−0.20, 95% CI −0.35 to −0.04; p=.01; I2=0%) but not disability (SMD=−0.10, 95% CI −0.28 to 0.07; p=.25; I2=21%). Studies comparing manipulation or mobilization with sham or no treatment were too few or too heterogeneous to allow for pooling as were studies examining relationships between dose and outcomes. Few studies assessed health-related quality of life. Twenty-six of 51 trials were multimodal studies and narratively described.

Conclusion: There is moderate-quality evidence that manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain; manipulation appears to produce a larger effect than mobilization. Both therapies appear safe. Multimodal programs may be a promising option.

Reference: Booth, M., MS, Coulter, I., PhD, Crawford, C., BA, Herman, P., ND, PhD, Hurwitz, E., DC, PhD, Khorsan, R., PhD. Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. The Spine Journal, VOL 18, Issue 5,P866-879, May 01, 2018.https://www.thespinejournalonline.com/article/S1529-9430(18)30016-0/fulltext#secst0010
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