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Abstract
Introduction: Manipulation is frequently used to treat low back pain (LBP) but international guidelines regarding its use are conflicting.
Materials and Methods: A search for randomised controlled trials (RCTs) was conducted. Scores were allocated for methodological quality, the authors’ conclusion, and results based on the main outcome measures.
Results: 62 RCTs comparing manipulation to other treatment interventions and placebo were identified. 16 RCTs (25.8%) were of good quality and only 21 (33.9%) included long-term follow-up. 33 (53.2%) reported positive results and 5 (8.1%) were positive only in sub-groups of patients. 14 RCTs included patients with acute LBP (5 with positive results), 21 with chronic LBP (11 positive results), and 27 included mixed populations of patients (19 had positive results).
Discussion: Despite this study involving no blinded assessment and only 1 reviewer, the scores were comparable with previous reviews. Stronger evidence for chronic and mixed population LBP was found than in previous reviews due to the larger number of RCTs located and viewing some RCTs with negative outcomes in a positive light.
Conclusion: There is some evidence for the use of manipulation in treating acute LBP and strong evidence for its use in treating patients with chronic LBP. There is no evidence that it is ineffective and very little weak evidence to suggest that it is less effective than any other treatment intervention.
