Do Manual Therapies Help Low Back Pain? A Comparative Effectiveness Meta-analysis (original) (raw)
Study Design. Meta-analysis methodology was extended to derive comparative effectiveness information on spinal manipulation for low back pain. Objective. Determine relative effectiveness of spinal manipulation therapies (SMTs), medical management, physical therapies, and exercise for acute and chronic nonsurgical low back pain. Summary of Background Data. Results of spinal manipulation treatments of nonsurgical low back pain are equivocal. Nearly 40 years of SMT studies were not informative. Methods. Studies were chosen on the basis of inclusion in prior evidence syntheses. Effect sizes were converted to standardized mean effect sizes and probabilities of recovery. Nested model comparisons isolated nonspecifi c from treatment effects. Aggregate data were tested for evidential support as compared with shams. Results. Of 84% acute pain variance, 81% was from nonspecifi c factors and 3% from treatment. No treatment for acute pain exceeded sham's effectiveness. Most acute results were within 95% confi dence bands of that predicted by natural history alone. For chronic pain, 66% of 98% was nonspecifi c, but treatments infl uenced 32% of outcomes. Chronic pain treatments also fi t within 95% confi dence bands as predicted by natural history. Though the evidential support for treating chronic back pain as compared with sham groups was weak, chronic pain seemed to respond to SMT, whereas whole systems of clinical management did not. Conclusion. Meta-analyses can extract comparative effectiveness information from existing literature. The relatively small portion of outcomes attributable to treatment explains why past research results fail to converge on stable estimates. The probability of treatment superiority matched a binomial random process.
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