‘Disappointing’ findings for spinal manipulative therapy

By Lucy Piper, Senior medwireNews Reporter

Spinal manipulative therapy (SMT) for acute low-back pain appears to be no better than other existing therapies for reducing pain and improving functional status, show the findings of a Cochrane review.

The authors of the report therefore believe that "the decision to refer for SMT should be based upon costs, preferences of the patients and providers, and relative safety of the various treatment options."

They point out, however, that strong conclusions or recommendations were difficult to make because no high-quality evidence was provided for any comparison, outcome, or time interval.

"It would appear from the continuing 'disappointing' results from the trials included in this review (at least from the perspective of the clinician) that either further research on such heterogenous populations with acute low-back pain is a waste of funding or that something more fundamental is lacking in our approach," they comment.

The review, published in the Cochrane Database of Systematic Reviews, involved a total of 20 randomized controlled trials representing 2674 participants with acute low-back pain lasting no more than 6 weeks. Participants whose pain was predominantly in the lower back but also radiating into the buttocks and legs were included.

SMT was delivered by a variety of practitioners, including chiropractors, manual therapists, and osteopaths. Approximately a third of the trials were considered to be of high methodologic quality.

Overall, there was no difference in the effect of SMT on pain or functional status compared to inert interventions, sham SMT, or when added to another intervention, based on low to very-low-quality evidence. And there was no significant effect of SMT compared with other interventions, based on low-to-moderate-quality evidence.

The authors report two exceptions, however. The first, was a statistically significant short term, but not clinically relevant, effect of SMT on pain relief compared with inert interventions and, the second, a moderate short-term effect of SMT on functional status when added to another intervention.

There was also isolated evidence in two studies of a positive, in some cases clinically relevant, effect of SMT as an adjuvant therapy for functional status and recovery, but these studies had a high risk for bias, the authors note.

Given the findings, authors Sidney Rubinstein (VU University Medical Center, Amsterdam, the Netherlands) and colleagues suggest that future research into the effects of SMT should explore different avenues, such as the identification of subgroups likely to respond to SMT, the prevention of chronic low-back pain onset, and an economic evaluation.

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