The fidelity of comparison intervention in manual therapy trial for patients with low back pain: a systematic review

Abstract

Background: Comparison interventions for low back pain are described in the literature utilizing different treatment interventions with various terminology. The effectiveness of these comparison groups is not well defined.

Objectives: The objective of this systematic review is to assess the fidelity of comparison interventions within randomized controlled trials assessing the effect of manual therapy on low back pain.

Methods: This systematic review utilized PubMed, CINAHL, Scopus, Cochrane, and Pedro databases. Articles were screened by two authors for eligibility criteria and then extracted, reviewed, and cross-checked for data that included sample size, patient demographics, manual therapy intervention, the control group protocol, and outcomes. The Cochrane Risk of Bias tool was used to determine disagreement among authors. A qualitative synthesis of the evidence was completed.

Results: A total of 20 articles were included in this systematic review. The comparison interventions were categorized into themes based on the terminology used by the various studies. The themes consisted of “standard care”, “sham treatment”, “control groups”, and unnamed comparison interventions. These themes were then compared to the CPG based on the interventions utilized in each study.

Conclusions: There appears to be significant variability in comparison interventions within randomized controlled trials assessing manual therapy effects on patients with low back pain. This variability may lead to inconsistent published effect sizes. It is imperative to correctly follow evidence-based practice from resources, such as the CPG, to determine the effectiveness of treatment interventions.

Keywords:

• Manual therapy
• low back pain
• fidelity

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Mackenzie Snow

Mackenzie Snow is a third-year physical therapy student at Walsh University. She obtained her Bachelor of Science degree from Arizona State University with a major in Kinesiology. Her primary area of interest in physical therapy is outpatient orthopedics with a focus on sports rehabilitation and manual therapy. [email protected]

Sean Trexler

Sean Trexler is a third-year physical therapy student at Walsh University. He obtained his Bachelor of Science degree from Walsh University with a major in Exercise Science. His area of interest is outpatient physical therapy with a special interest in vestibular rehabilitation and manual therapy.

Christine Gates

Christine Gates is a third-year physical therapy student at Walsh University. She obtained her Bachelor of Science degree from Ball State University with a major in Exercise Science. Her area of interest in physical therapy is unknown at this time but she is interested in travel physical therapy after graduation.

Kathryn Pudoka

Kathryn Pudoka is a third-year physical therapy student at Walsh University. She obtained her Bachelor of Science degree from the University of Dayton with a major in Pre-Physical Therapy. Her area of interest in physical therapy is acute care with a focus in the ICU and cardiac rehabilitation.

Mark Wilhelm

Mark Wilhelm is an assistant professor of physical therapy at Walsh University. He completed his PhD in rehabilitation sciences from Texas Tech University Health Sciences Center. He teaches within the anatomy, research, and musculoskeletal impairments courses.