The efficacy of manual therapy and exercise for different stages of non-specific low back pain: an update of systematic reviews

Abstract

Objective:

to review and update the evidence for different forms of manual therapy (MT) for patients with different stages of non-specific low back pain (LBP).

Data sources:

MEDLINE, Cochrane-Register-of-Controlled-Trials, PEDro, EMBASE.

Method:

A systematic review of MT with a literature search covering the period of January 2000 to April 2013 was conducted by two independent reviewers according to Cochrane and PRISMA guidelines. A total of 360 studies were evaluated using qualitative criteria. Two stages of LBP were categorized; combined acute–subacute and chronic. Further sub-classification was made according to MT intervention: MT1 (manipulation); MT2 (mobilization and soft-tissue-techniques); and MT3 (MT1 combined with MT2). In each sub-category, MT could be combined or not with exercise or usual medical care (UMC). Consequently, quantitative evaluation criteria were applied to 56 eligible randomized controlled trials (RCTs), and hence 23 low-risk of bias RCTs were identified for review. Only studies providing new updated information (11/23 RCTs) are presented here.

Results:

Acute–subacute LBP: STRONG-evidence in favour of MT1 when compared to sham for pain, function and health improvements in the short-term (1–3 months). MODERATE-evidence to support MT1 and MT3 combined with UMC in comparison to UMC alone for pain, function and health improvements in the short-term.

Chronic LBP:

MODERATE to STRONG-evidence in favour of MT1 in comparison to sham for pain, function and overall-health in the short-term. MODERATE-evidence in favour of MT3 combined with exercise or UMC in comparison to exercise and back-school was established for pain, function and quality-of-life in the short and long-term. LIMITED-evidence in favour of MT2 combined with exercise and UMC in comparison to UMC alone for pain and function from short to long-term. LIMITED-evidence of no effect for MT1 with extension-exercise compared to extension-exercise alone for pain in the short to long-term.

Conclusion:

This systematic review updates the evidence for MT with exercise or UMC for different stages of LBP and provides recommendations for future studies.

Keywords:

• Non-specific low back pain
• Manual therapy
• Spinal manipulation
• Efficacy
• Randomized controlled trials

Acknowledgements

The authors thank for their contributions: Dr Léon Plaghki as scientific adviser and Anne Klöcker for writing corrections (University of Louvain, Belgium).