The effect of spinal manipulative therapy on pain relief and function in patients with chronic low back pain: An individual participant data meta-analysis

Abstract Background Proven treatments for low back pain, at best, only provide modest overall benefits. Matching people to treatments that are likely to be most effective for them may improve clinical outcomes and makes better use of health care resources. Methods We conducted an individual participant data meta-analysis of randomised controlled trials of three types of therapist delivered interventions for low back pain (active physical, passive physical and psychological treatments). We applied two statistical methods (recursive partitioning and adaptive risk group refinement) to identify potential subgroups who might gain greater benefits from different treatments from our individual participant data meta-analysis. Results We pooled data from 19 randomised controlled trials, totalling 9328 participants. There were 5349 (57%) females with similar ratios of females in control and intervention arms. The average age was 49 years (standard deviation, SD, 14). Participants with greater psychological distress and physical disability gained most benefit in improving on the mental component scale (MCS) of SF-12/36 from passive physical treatment than non-active usual care (treatment effects, 4.3; 95% confidence interval, CI, 3.39 to 5.15). Recursive partitioning method found that participants with worse disability at baseline gained most benefit in improving the disability (Roland Morris Disability Questionnaire) outcome from psychological treatment than non-active usual care (treatment effects, 1.7; 95% CI, 1.1 to 2.31). Adaptive risk group refinement did not find any subgroup that would gain much treatment effect between psychological and non-active usual care. Neither statistical method identified any subgroups who would gain an additional benefit from active physical treatment compared to non-active usual care. Conclusions Our methodological approaches worked well and may have applicability in other clinical areas. Passive physical treatments were most likely to help people who were younger with higher levels of disability and low levels of psychological distress. Psychological treatments were more likely to help those with severe disability. Despite this, the clinical importance of identifying these subgroups is limited. The sizes of sub-groups more likely to benefit and the additional effect sizes observed are small. Our analyses provide no evidence to support the use of sub-grouping for people with low back pain.

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Manipulation erzeugt bei chronischem LBP ähnliche Verbesserungen wie andere empfohlene Therapien

manuelletherapie ◽

10.1055/a-1180-1642 ◽

2020 ◽

Vol 24 (03) ◽

pp. 106-106

Author(s):

Arne Vielitz

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Spinal Manipulative Therapy ◽

Controlled Trials ◽

Low Back ◽

Manipulative Therapy ◽

Randomised Controlled

Rubinstein SM, de Zoete A, van Middelkoop M et al. Benefits and Harms of Spinal Manipulative Therapy for the Treatment of Chronic Low Back Pain: Systematic Review and Meta-analysis of Randomised Controlled Trials. BMJ 2019; 364: l689. doi: 10.1136/bmj.l689

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Does the inclusion of spinal manipulative therapy in multimodal treatment regimens result in better outcomes in chronic low back pain? A systematic review

Proceedings of Singapore Healthcare ◽

10.1177/2010105817698491 ◽

2017 ◽

Vol 26 (2) ◽

pp. 114-120 ◽

Cited By ~ 2

Author(s):

Oyinade Akindele-Agbeja ◽

Chidozie Emmanuel Mbada ◽

Michael Ogbonnia Egwu

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Multimodal Treatment ◽

Spinal Manipulative Therapy ◽

Controlled Trials ◽

Low Back ◽

Treatment Regimens ◽

Manipulative Therapy ◽

And Function

Low back pain (LBP) is the most common musculoskeletal disorder. It is costly, both health wise and socioeconomically. Spinal manipulative therapy (SMT) is a popular and well researched conservative management of chronic LBP. However, little is known about its role cum effectiveness as part of multimodal treatment regimens. The aim of this systematic review is to examine the evidence of the effectiveness of SMT as part of a multimodal regimen in the management of chronic LBP. Eligible studies were identified by searching Medline, Embase, PEDro, CINAHL, AMED, and the Cochrane Central Register of controlled trials. Randomized controlled trials (RCTs) on patients with chronic mechanical LBP were considered. Data from four RCTs (430 participants) were included in this review. All four had a low risk of bias. Three studies found a statistically significant improvement in pain and function at both short term and long term in the group that received SMT as part of a multimodal treatment regimen. Heterogeneity in the nature of the interventions that made up the treatment regimen, comparison interventions, duration of treatment and follow-up periods were identified. There is moderate quality evidence that the addition of SMT to multimodal treatment regimens for chronic LBP results in better outcomes in terms of pain and function as compared to other conservative interventions.

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Individual Participant Data Meta-Analysis of Mechanical Workplace Risk Factors and Low Back Pain

American Journal of Public Health ◽

10.2105/ajph.2011.300343 ◽

2012 ◽

Vol 102 (2) ◽

pp. 309-318 ◽

Cited By ~ 70

Author(s):

Lauren E. Griffith ◽

Harry S. Shannon ◽

Richard P. Wells ◽

Stephen D. Walter ◽

Donald C. Cole ◽

...

Keyword(s):

Risk Factors ◽

Low Back Pain ◽

Back Pain ◽

Meta Analysis ◽

Individual Participant Data ◽

Low Back ◽

Individual Participant

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Faculty Opinions recommendation of Spinal manipulative therapy for acute low-back pain.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717958423.793462983 ◽

2012 ◽

Author(s):

Roberta Hines ◽

Natalie Holt

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Spinal Manipulative Therapy ◽

Low Back ◽

Manipulative Therapy ◽

Acute Low Back Pain

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Changes in pain sensitivity and spinal stiffness in relation to responder status following spinal manipulative therapy in chronic low Back pain: a secondary explorative analysis of a randomized trial

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03873-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Casper Glissmann Nim ◽

Gregory Neil Kawchuk ◽

Berit Schiøttz-Christensen ◽

Søren O’Neill

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Randomized Trial ◽

Clinical Improvement ◽

Spinal Manipulation ◽

Pain Sensitivity ◽

Spinal Manipulative Therapy ◽

Low Back ◽

Manipulative Therapy ◽

Pressure Pain Thresholds

Abstract Background In a prior randomized trial, we demonstrated that participants receiving spinal manipulative therapy at a pain-sensitive segment instead of a stiff segment experienced increased mechanical pressure pain thresholds. We hypothesized that the targeted segment mediated this increase through a segment-dependent neurophysiological reflective pathway. Presently, it is not known if this decrease in pain sensitivity is associated with clinical improvement. Therefore, we performed an explorative analysis to examine if changes in experimental pain sensitivity (mechanical and thermal) and lumbar stiffness were further dependent on clinical improvement in disability and patient-reported low back pain. Methods This study is a secondary explorative analysis of data from the randomized trial that compared 132 participants with chronic low back pain who received lumbar spinal manipulative therapy applied at either i) the stiffest segment or ii) the segment having the lowest pain threshold (i.e., the most pain-sensitive segment). We collected data at baseline, after the fourth session of spinal manipulation, and at 14-days follow-up. Participants were dichotomized into responders/non-responders using different clinical variables (disability and patient-reported low back pain) with varying threshold values (0, 30, and 50% improvement). Mixed models were used to assess changes in experimental outcomes (stiffness and pain sensitivity). The fixed interaction terms were time, segment allocation, and responder status. Results We observed a significant increase in mechanical pressure pain thresholds for the group, which received spinal manipulative therapy at the most pain-sensitive segment independent of whether they improved clinically or not. Those who received spinal manipulation at the stiffest segment also demonstrated increased mechanical pain sensitivity, but only in the subgroup with clinical improvement. We did not observe any changes in lumbar stiffness. Conclusion Our results suggest the existence of two different mechanistic pathways associated with the spinal manipulation target. i) A decrease of mechanical pain sensitivity independent of clinical outcome (neurophysiological) and ii) a decrease as a reflection of the clinical outcome. Together, these observations may provide a novel framework that improves our understanding of why some respond to spinal manipulative therapy while others do not. Trial registration ClinicalTrials.gov identifier: NCT04086667 registered retrospectively September 11th 2019.

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