Journal of Orthopaedic & Sports Physical Therapy
Published Online: July 28, 2023
Abstract
OBJECTIVE: To examine whether targeting spinal manipulative therapy (SMT), by applying the intervention to a specific vertebral level, produces superior clinical outcomes than a non-targeted approach in patients with non-specific low back pain.
DESIGN: Systematic review with meta-analysis.
LITERATURE SEARCH: MEDLINE, EMBASE, CENTRAL, CINAHL, Scopus, PEDro, and Index to Chiropractic Literature were searched up to May 31, 2023.
STUDY SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing targeted SMT (mobilization or manipulation) to a non-targeted approach in patients with non-specific low back pain, and measuring the effects on pain intensity and patient-reported disability.
DATA SYNTHESIS: Data extraction, risk of bias, and evaluation of the overall certainty of evidence using the GRADE approach were performed by two authors independently. Meta-analyses were performed using the Restricted Maximum Likelihood Method.
RESULTS: Ten RCTs (n = 931 patients) were included. There was moderate certainty evidence of no difference between targeted SMT and a non-targeted approach for pain intensity at post-intervention: weighted mean difference (WMD) = -0.20 (95% CI: -0.51; 0.10) and at follow-up: WMD = 0.05 (95% CI: -0.26; 0.36). For patient-reported disability, there was moderate certainty evidence of no difference at post-intervention: standardized mean difference (SMD) = -0.04 (95% CI: -0.36; 0.29) and at follow-up: SMD = -0.05 (95% CI: -0.24; 0.13). Adverse events were reported in four trials, and were minor and evenly distributed between groups.
CONCLUSION: Targeting a specific vertebral level when administering SMT for patients with non-specific low back pain did not result in improved outcomes on pain intensity and patient-reported disability compared to a non-targeted approach.