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Study flow diagram. Summary of selection process. (Updated July 25, 2012)
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Figure 1

Study flow diagram. Summary of selection process. (Updated July 25, 2012)

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Funnel plot of comparison: 5 SMT versus all comparisons ‐ for the outcome 'Pain'. Note: negative values favour SMT.
Figuras y tablas -
Figure 3

Funnel plot of comparison: 5 SMT versus all comparisons ‐ for the outcome 'Pain'. Note: negative values favour SMT.

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Funnel plot of comparison: 5 SMT versus all comparisons ‐ for the outcome 'Functional status'. Note: negative values favour SMT.
Figuras y tablas -
Figure 4

Funnel plot of comparison: 5 SMT versus all comparisons ‐ for the outcome 'Functional status'. Note: negative values favour SMT.

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Forest plot of comparison: 3 Spinal manipulative therapy versus all other therapies, outcome 3.1 'Pain'.
Figuras y tablas -
Figure 5

Forest plot of comparison: 3 Spinal manipulative therapy versus all other therapies, outcome 3.1 'Pain'.

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Forest plot of comparison: 3 Spinal manipulative therapy versus all other therapies, outcome 3.2 'Functional status'.
Figuras y tablas -
Figure 6

Forest plot of comparison: 3 Spinal manipulative therapy versus all other therapies, outcome 3.2 'Functional status'.

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Comparison 1 Spinal manipulative therapy versus inert interventions, Outcome 1 Pain.
Figuras y tablas -
Analysis 1.1

Comparison 1 Spinal manipulative therapy versus inert interventions, Outcome 1 Pain.

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Comparison 1 Spinal manipulative therapy versus inert interventions, Outcome 2 Functional status.
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Analysis 1.2

Comparison 1 Spinal manipulative therapy versus inert interventions, Outcome 2 Functional status.

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Comparison 1 Spinal manipulative therapy versus inert interventions, Outcome 3 Recovery.
Figuras y tablas -
Analysis 1.3

Comparison 1 Spinal manipulative therapy versus inert interventions, Outcome 3 Recovery.

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Comparison 2 Spinal manipulative therapy versus sham SMT, Outcome 1 Pain.
Figuras y tablas -
Analysis 2.1

Comparison 2 Spinal manipulative therapy versus sham SMT, Outcome 1 Pain.

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Comparison 2 Spinal manipulative therapy versus sham SMT, Outcome 2 Functional status.
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Analysis 2.2

Comparison 2 Spinal manipulative therapy versus sham SMT, Outcome 2 Functional status.

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Comparison 3 Spinal manipulative therapy versus all other therapies, Outcome 1 Pain.
Figuras y tablas -
Analysis 3.1

Comparison 3 Spinal manipulative therapy versus all other therapies, Outcome 1 Pain.

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Comparison 3 Spinal manipulative therapy versus all other therapies, Outcome 2 Functional status.
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Analysis 3.2

Comparison 3 Spinal manipulative therapy versus all other therapies, Outcome 2 Functional status.

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Comparison 3 Spinal manipulative therapy versus all other therapies, Outcome 3 Recovery.
Figuras y tablas -
Analysis 3.3

Comparison 3 Spinal manipulative therapy versus all other therapies, Outcome 3 Recovery.

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Comparison 3 Spinal manipulative therapy versus all other therapies, Outcome 4 Return‐to‐work.
Figuras y tablas -
Analysis 3.4

Comparison 3 Spinal manipulative therapy versus all other therapies, Outcome 4 Return‐to‐work.

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Comparison 4 Spinal manipulative therapy plus any intervention versus that same intervention alone, Outcome 1 Pain.
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Analysis 4.1

Comparison 4 Spinal manipulative therapy plus any intervention versus that same intervention alone, Outcome 1 Pain.

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Comparison 4 Spinal manipulative therapy plus any intervention versus that same intervention alone, Outcome 2 Functional status.
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Analysis 4.2

Comparison 4 Spinal manipulative therapy plus any intervention versus that same intervention alone, Outcome 2 Functional status.

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Comparison 4 Spinal manipulative therapy plus any intervention versus that same intervention alone, Outcome 3 Recovery.
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Analysis 4.3

Comparison 4 Spinal manipulative therapy plus any intervention versus that same intervention alone, Outcome 3 Recovery.

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Comparison 4 Spinal manipulative therapy plus any intervention versus that same intervention alone, Outcome 4 Return‐to‐work.
Figuras y tablas -
Analysis 4.4

Comparison 4 Spinal manipulative therapy plus any intervention versus that same intervention alone, Outcome 4 Return‐to‐work.

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Comparison 5 Spinal manipulative therapy (SMT) versus another SMT technique, Outcome 1 Pain.
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Analysis 5.1

Comparison 5 Spinal manipulative therapy (SMT) versus another SMT technique, Outcome 1 Pain.

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Comparison 5 Spinal manipulative therapy (SMT) versus another SMT technique, Outcome 2 Functional status.
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Analysis 5.2

Comparison 5 Spinal manipulative therapy (SMT) versus another SMT technique, Outcome 2 Functional status.

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Comparison 5 Spinal manipulative therapy (SMT) versus another SMT technique, Outcome 3 Recovery.
Figuras y tablas -
Analysis 5.3

Comparison 5 Spinal manipulative therapy (SMT) versus another SMT technique, Outcome 3 Recovery.

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Comparison 6 SMT versus all comparisons ‐ for construction of funnel plot, Outcome 1 Pain ‐ For funnel plot.
Figuras y tablas -
Analysis 6.1

Comparison 6 SMT versus all comparisons ‐ for construction of funnel plot, Outcome 1 Pain ‐ For funnel plot.

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Comparison 6 SMT versus all comparisons ‐ for construction of funnel plot, Outcome 2 Functional status ‐ For funnel plot.
Figuras y tablas -
Analysis 6.2

Comparison 6 SMT versus all comparisons ‐ for construction of funnel plot, Outcome 2 Functional status ‐ For funnel plot.

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Summary of findings for the main comparison. Spinal manipulative therapy compared to other interventions for acute low‐back pain

Spinal manipulative therapy compared to other interventions for acute low‐back pain

Patient or population: Patients with acute low‐back pain
Settings: Primary or tertiary care
Intervention: Spinal manipulative therapy
Comparison: Other interventions (e.g. physiotherapy, exercise, back school)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Other interventions

Spinal manipulative therapy

Pain at one week
0 (no pain) to 10 (worse pain)

The mean pain at one week ranged across control groups from
2.6 to 3.5 points

The mean pain at one week in the intervention groups was
0.1 higher
(0.5 lower to 0.7 higher)

383
(3 studies)

⊕⊕⊝⊝
low1,2

Small, not clinically‐relevant effect.

Pain at one month
0 (no pain) to 10 (worse pain)

The mean pain at one month ranged across control groups from
0.5 to 2.3 points

The mean pain at one month in the intervention groups was
0.2 lower
(0.5 lower to 0.2 higher)

606
(3 studies)

⊕⊕⊕⊝
moderate1

Small, not clinically‐relevant effect.

Functional status at one week
Roland Morris Disability Questionnaire. Scale from: 0 (no dysfunction) to 24 (worse function)

The mean functional status at one week in the control groups was
7.2 points

The mean functional status at one week in the intervention groups was
0.1 standard deviations higher
(0.2 lower to 0.3 higher)

241
(1 study)

⊕⊕⊝⊝
low2,3

Small, not clinically‐relevant effect.

Functional status at one month
Roland Morris Disability Questionnaire. Scale from: 0 (no dysfunction) to 24 (worse function)

The mean functional status at one month in the control groups was
4.1 points

The mean functional status at one month in the intervention groups was
0.5 points lower
(1.2 lower to 0.2 higher)

681
(3 studies)

⊕⊕⊕⊝
moderate1

Small, not clinically‐relevant effect. Based on pooled SMD: ‐0.11 (‐0.26 to 0.05).4

Recovery at one month

Study population

RR 1.06
(0.94 to 1.21)

117
(2 studies)

⊕⊕⊝⊝
low1,5

Small, not clinically‐relevant effect.

87 per 100

92 per 100
(81 to 100)

Serious adverse events

Study population

Not estimable

2 studies

Total 578 participants. No serious adverse events were observed in the SMT group.

CI: Confidence interval; RR: Risk ratio;⊕⊕⊝⊝ = these symbols indicate how many of the items were fulfilled (for each ⊕, one item was fulfilled and corresponds to the different levels of evidence).

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 High RoB
2 N<400 subjects.
3 Only one study reported the outcome; therefore, data are inconsistent and imprecise.
4 RMDQ based upon Cherkin 1998.
5 N<300 events.

Figuras y tablas -
Summary of findings for the main comparison. Spinal manipulative therapy compared to other interventions for acute low‐back pain
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Summary of findings 2. Spinal manipulative therapy plus another intervention compared to the intervention alone for acute low‐back pain

Spinal manipulative therapy plus another intervention compared to the intervention alone for acute low‐back pain

Patient or population: Patients with acute low‐back pain
Settings: Primary or tertiary care
Intervention: Spinal manipulative therapy plus another intervention
Comparison: The intervention alone (e.g. usual care, exercise)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

The intervention alone

Spinal manipulative therapy plus another intervention

Pain at one week
Scale from: 0 (no pain) to 10 (worse pain)

The mean pain at one week in the control groups was
1.9 points

The mean pain at one week in the intervention groups was
0.8 points higher
(0.04 lower to 1.7 higher)

102
(1 study)

⊕⊕⊝⊝
low1

Small, not clinically‐relevant effect.

Pain at 3 to 6 months
Scale from: 0 (no pain) to 10 (worse pain)

The mean pain at 3 to 6 months in the control groups was
1.5 points

The mean pain at 3 to 6 months in the intervention groups was
0.7 points higher
(0.3 lower to 1.6 higher)

104
(1 study)

⊕⊕⊝⊝
low1

Small, not clinically‐relevant effect.

Functional status at one week
Oswestry Disability Index. Scale from: 0 (no dysfunction) to 100 (worse function).

The mean functional status at one week in the control groups was
33 points

The mean functional status at one week in the intervention groups was
5.7 points lower
(10.1 to 1.4 lower)

225
(2 studies)

⊕⊕⊝⊝
low2,3

Moderately clinically‐relevant effect. Based on pooled SMD: ‐0.41 (‐0.73 to ‐0.10).4

Functional status at 3 to 6 months
Oswestry Disability Index. Scale from: 0 (no dysfunction) to 100 (worse function)

The mean functional status at 3 to 6 months in the control groups was
24.4 points

The mean functional status at 3 to 6 months in the intervention groups was
3.8 points lower
(10.6 lower to 2.8 higher)

225
(2 studies)

⊕⊕⊝⊝
low2,3

Small, not clinically‐relevant effect. Based on pooled SMD: ‐0.22 (‐0.61 to 0.16).4

Recovery at one week

Study population

RR 0.89
(0.32 to 2.47)

196
(2 studies)

⊕⊝⊝⊝
very low2,5,6

Small, not clinically‐relevant effect. Based on pooled RR: 0.88 (0.36 to 2.19).

16 per 100

14 per 100
(5 to 40)

Recovery at 3 to 6 months

Study population

RR 0.75
(0.51 to 1.1)

195
(2 studies)

⊕⊝⊝⊝
very low2,6

Small, not clinically‐relevant effect. Based on pooled RR: 0.96 (0.71 to 1.31). I2=57%.

64 per 100

48 per 100
(33 to 70)

Serious adverse events

Study population

Not estimable

2 studies

Total 199 participants. In one of the studies, two serious adverse events were observed in the SMT group; however, they "appeared not to be related to the treatment". An equal number of adverse events were seen in the control group (Juni 2009).

CI: Confidence interval; RR: Risk ratio;⊕⊕⊝⊝ = these symbols indicate how many of the items were fulfilled (for each ⊕, one item was fulfilled and corresponds to the different levels of evidence).

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Only one study reported the outcome; therefore, the data are inconsistent and imprecise.
2 High RoB.
3 N<400 subjects.
4 ODI based upon Childs 2004.
5 Widely varying estimates of effect.
6N<300 events.

Figuras y tablas -
Summary of findings 2. Spinal manipulative therapy plus another intervention compared to the intervention alone for acute low‐back pain
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Summary of findings 3. Spinal manipulative therapy compared to inert interventions for acute low‐back pain

Spinal manipulative therapy compared to inert interventions for acute low‐back pain

Patient or population: Patients with acute low‐back pain
Settings: Primary or tertiary care
Intervention: Spinal manipulative therapy
Comparison: Inert interventions (e.g. educational booklet, detuned diathermy)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Inert interventions

Spinal manipulative therapy

Pain at one week
Scale from: 0 (no pain) to 10 (worse pain).

The mean pain at one week ranged across control groups from
2 to 4.2 points

The mean pain at one week in the intervention groups was
0.1 points higher
(0.7 lower to 1 higher)

311
(3 studies)

⊕⊕⊝⊝
low1,2

Small, not clinically‐relevant effect.

Pain at one month
Scale from: 0 (no pain) to 10 (worse pain).

The mean pain at one month in the control groups was
3.1 points

The mean pain at one month in the intervention groups was
1.2 points lower
(2 to 0.4 lower)

178
(1 study)

⊕⊕⊝⊝
low3

Moderately clinically‐relevant effect.

Functional status at one week
Roland Morris Disability Questionnaire. Scale from: 0 (no dysfunction) to 24 (worse function)

The mean functional status at one week in the control groups was
7.8 points

The mean functional status at one week in the intervention groups was
0.3 points lower
(1.5 lower to 0.8 higher)

205
(2 studies)

⊕⊕⊕⊝
moderate2

Small, not clinically‐relevant effect. Based on pooled SMD: ‐0.08 (‐0.37 to 0.21).4

Functional status at one month
Roland Morris Disability Questionnaire. Scale from: 0 (no dysfunction) to 24 (worse function)

The mean functional status at one month in the control groups was
4.9 points

The mean functional status at one month in the intervention groups was
0.3 standard deviations lower
(0.6 lower to 0.04 higher)

178
(1 study)

⊕⊕⊝⊝
low3

Small, not clinically‐relevant effect.

Recovery at one week

Study population

RR 0.96
(0.5 to 1.85)

263
(2 studies)

⊕⊕⊝⊝
low5,6

Small, not clinically‐relevant effect.

33 per 100

31 per 100
(16 to 60)

Serious adverse events

Study population

Not estimable

2 studies

Total 427 participants. No serious adverse events were observed in the SMT group.

CI: Confidence interval; RR: Risk ratio;⊕⊕⊝⊝ = these symbols indicate how many of the items were fulfilled (for each ⊕, one item was fulfilled and corresponds to the different levels of evidence).

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 High RoB
2 N<400 subjects
3 Only one study reported the outcome; therefore, the data are inconsistent and imprecise.
4 RMDQ based upon Cherkin 1998.
5 I2=58%
6 N<300 events

Figuras y tablas -
Summary of findings 3. Spinal manipulative therapy compared to inert interventions for acute low‐back pain
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Summary of findings 4. Spinal manipulative therapy (SMT) compared to sham SMT for acute low‐back pain

Spinal manipulative therapy (SMT) compared to sham SMT for acute low‐back pain

Patient or population: Patients with acute low‐back pain
Settings: Primary or tertiary care
Intervention: Spinal manipulative therapy (SMT)
Comparison: Sham SMT

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Sham SMT

Spinal manipulative therapy (SMT)

Pain at one month
0 (no pain) to 10 (worse pain)

The mean pain at one month in the control groups was
2.2 points

The mean pain at one month in the intervention groups was
0.5 lower
(1.4 lower to 0.4 higher)

74
(1 study)

⊕⊝⊝⊝
very low1,2

Small, not clinically‐relevant effect.

Functional status at one month
Oswestry Disability Index. Scale from: 0 (no dysfunction) to 100 (worse function)

The mean functional status at one month in the control groups was
16.3 points

The mean functional status at one month in the intervention groups was
0.4 standard deviations lower
(0.8 lower to 0.1 higher)

94
(1 study)

⊕⊝⊝⊝
very low1,2

Small, not clinically‐relevant effect.

Recovery at one month

Study population

Not estimable

0 studies

No data were available.

Serious adverse events

Study population

Not estimable

0 studies

No data were available.

CI: Confidence interval; RR: Risk ratio;⊕⊕⊝⊝ = these symbols indicate how many of the items were fulfilled (for each ⊕, one item was fulfilled and corresponds to the different levels of evidence).

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 High RoB
2 Only one study reported the outcome; therefore, the data are inconsistent and imprecise.

Figuras y tablas -
Summary of findings 4. Spinal manipulative therapy (SMT) compared to sham SMT for acute low‐back pain
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Table 1. Specific clinical and treatment characteristics of the individual studies

Author

Presence/absence of radiating pain

Duration LBP
(according to inclusion criteria)

Duration LBP (current episode)

Type of manipulator (n= # of manipulators); experience (if stated)

Type of manipulation

No. txs SMT allowed and duration

Bergquist‐Ullman 1977

No radiation below knee

< 8 wks

>50% less than 4 wks

Physiotherapist (n=?)

Manipulation/MOB according to Cyriax

4 tx's (mean), 10 (max)

Brennan 2006

Absence of nerve root compression

<3 mo.

Median (IQR): 16d (10, 41)

Physiotherapist (n=?)

Thrust manipulation or low‐amplitude mobilization

? median range: 6.5 to 7 sessions

Cherkin 1998

No sciatica

Duration was not listed in inclusion criteria

78% < 6 wks

Chiropractors (n=?); collectively 6 to14 yrs. experience

Short‐lever HVLA SMT

6.9 tx's (mean)

Childs 2004

Absence of nerve root compression

?

Median = 27 d

Physiotherapist (n=14)

HVLA SMT

?

Cleland 2009

Absence of nerve root compression

Duration was not per se an inclusion criteria

Median (IQR) = 45 (27 to 60)

Physiotherapists (n=17); collectively avg. 9 yrs. experience

HVLA SMT or low‐amplitude mobilization

Total 2 sessions

Cramer 1993

Without compressive neuropathy

< 2 wks

?

Chiropractors (n=?)

Side‐lying (short‐lever?) HVLA? SMT

3 to 5 times over a 10‐d period

Farrell 1982

Without neurological signs

< 3 wks

?

Physiotherapists (n=?)

Manipulation/MOB according to Maitland

3x/wk for 3 weeks. Tx was continued, prn

Glover 1974

Without neurological signs

?

52% <7 d

Osteopathic physician? (n=1)

Rotational manipulation

1 tx (followed by 4d of detuned diathermy)

Hadler 1987

With or without signs of radiculopathy

< 4 wks

?

Osteopathic physician? (n=1)

Long‐lever high‐velocity SMT

One visit?

Hallegraeff 2009

No symptoms distal to the knee

<16 d.

69% <3 wks

Manual therapists (n=?)

HVLA SMT

4 visits over 2 1/2 wks

Hancock 2007

Absence of nerve root compromise

< 6 wks

Mean = 9.13 d

Physiotherapists (n=15)

Most (97%) received low‐velocity mobilization; a small proportion (5%) also received high‐velocity thrusts

2 to 3x/wk for a max. of 12 txs. over 4 wks

Hoehler 1981

?

Duration was not listed in the inclusion criteria

52% of SMT grp & 48% of ctrl. grp < 1 mo

?

High‐velocity thrust

?

Hoiriis 2004

No neuropathy

2 to 6 wks

Total for all subjects = 3.7 wks

Chiropractors (n=?)

HVLA SMT

Most attended 7 chiropractic visits

Juni 2008

Absence of nerve root compression, no radiation below the knee

< 4 wks

54% of SMT grp & 75% of ctrl. grp <7d with LBP

Medical manipulator (n=2), osteopathy (n=1)

HVLA SMT

Median (IQR): 3 (2, 4)

MacDonald 1990

Absence of nerve root compromise

?

55% of both grps<14d LBP

Osteopathy (n=?)

HVLA SMT

4.7 tx's (mean), 87% were delivered within the first 2.5 wks.

Postacchini 1988

With or without radiation to the knee

grp.A="acute"

Mean duration: 15d & 17d

Chiropractor (n=?)

Manipulation

12 over 6 wks

Rasmussen 1979

Without signs of nerve root pressure

< 3 wks

?

Physiotherapist (n=1?) or medical manipulator (n=1?)

Rotational manipulation in the pain‐free direction

3x/wk for 2 wks

Seferlis 1998

With or without sciatica

< 2 wks

?

Physiotherapist (n=?)

"Manipulation of the lumbar facet and SI joint"

10 txs (mean)

Skagren 1997

Absence of nerve root signs

Duration was not listed in the inclusion criteria

55% of SMT grp. & 48% of control grp <4 wks with LBP

Chiropractors (n=6), collectively 9.9 yrs experience (range 1‐15)

HVLA SMT

4.9 txs (mean) in 4.1 wks

Sutlive 2009

Absence of nerve root compression

Duration was not a required item

62% w/ LBP <16d

Physiotherapist (n=1?)

HVLA SMT

1 tx only

ctrl.=control group; d=day; HVLA=high‐velocity low‐amplitude; prn=as necessary; SI=sacroiliac joint; SMT=spinal manipulative therapy; tx=treatment; wk(s)=week or weeks; ?=unclear or unspecified. Note: The description of the type of radiating pain allowed in the individual trials is reflective of the language used in those reports.

Figuras y tablas -
Table 1. Specific clinical and treatment characteristics of the individual studies
Ir a la tabla de la revisión
Comparison 1. Spinal manipulative therapy versus inert interventions

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Pain at 1 week

3

311

Mean Difference (IV, Random, 95% CI)

0.14 [‐0.69, 0.96]

1.2 Pain at 1 month

1

178

Mean Difference (IV, Random, 95% CI)

‐1.20 [‐2.01, ‐0.39]

1.3 pain at 3 months

1

181

Mean Difference (IV, Random, 95% CI)

‐1.20 [‐2.11, ‐0.29]

2 Functional status Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Functional status at 1 week

2

205

Std. Mean Difference (IV, Random, 95% CI)

‐0.08 [‐0.37, 0.21]

2.2 Functional status at 1 month

1

178

Std. Mean Difference (IV, Random, 95% CI)

‐0.27 [‐0.58, 0.04]

2.3 Functional status at 3 months

1

181

Std. Mean Difference (IV, Random, 95% CI)

‐0.28 [‐0.59, 0.02]

3 Recovery Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 Recovery at 1 week

2

263

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.50, 1.85]

3.2 Recovery at 1 month

1

239

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.85, 1.10]

3.3 Recovery at 3 months

1

239

Risk Ratio (M‐H, Random, 95% CI)

1.0 [0.98, 1.02]
Figuras y tablas -
Comparison 1. Spinal manipulative therapy versus inert interventions
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Comparison 2. Spinal manipulative therapy versus sham SMT

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Pain at 1 month

1

74

Mean Difference (IV, Random, 95% CI)

‐0.5 [‐1.39, 0.39]

2 Functional status Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Functional status at 1 month

1

94

Std. Mean Difference (IV, Random, 95% CI)

‐0.35 [‐0.76, 0.06]
Figuras y tablas -
Comparison 2. Spinal manipulative therapy versus sham SMT
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Comparison 3. Spinal manipulative therapy versus all other therapies

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain Show forest plot

4

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Pain at 1 week

3

383

Mean Difference (IV, Random, 95% CI)

0.06 [‐0.53, 0.65]

1.2 Pain at 1 month

3

606

Mean Difference (IV, Random, 95% CI)

‐0.15 [‐0.49, 0.18]

1.3 Pain at 3 to 6 months

2

548

Mean Difference (IV, Random, 95% CI)

‐0.20 [‐1.13, 0.73]

1.4 Pain at 12 months

1

314

Mean Difference (IV, Random, 95% CI)

0.40 [‐0.08, 0.88]

2 Functional status Show forest plot

3

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Functional status at 1 week

1

241

Std. Mean Difference (IV, Random, 95% CI)

0.07 [‐0.18, 0.33]

2.2 Functional status at 1 month

3

681

Std. Mean Difference (IV, Random, 95% CI)

‐0.11 [‐0.26, 0.05]

2.3 Functional status at 3 to 6 months

2

548

Std. Mean Difference (IV, Random, 95% CI)

‐0.09 [‐0.33, 0.15]

2.4 Functional status at 12 months

2

437

Std. Mean Difference (IV, Random, 95% CI)

0.06 [‐0.14, 0.25]

3 Recovery Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 Recovery at 1 month

2

117

Risk Ratio (M‐H, Random, 95% CI)

1.06 [0.94, 1.21]

3.2 Recovery at 3 months

1

58

Risk Ratio (M‐H, Random, 95% CI)

1.29 [0.96, 1.74]

4 Return‐to‐work Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

4.1 return to work at 1 month

1

311

Risk Ratio (M‐H, Random, 95% CI)

1.01 [0.91, 1.12]

4.2 Return‐to‐work at 6 months

1

313

Risk Ratio (M‐H, Random, 95% CI)

1.07 [0.98, 1.16]
Figuras y tablas -
Comparison 3. Spinal manipulative therapy versus all other therapies
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Comparison 4. Spinal manipulative therapy plus any intervention versus that same intervention alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Pain at 1 week

1

102

Mean Difference (IV, Random, 95% CI)

0.84 [‐0.04, 1.72]

1.2 Pain at 3 to 6 months

1

104

Mean Difference (IV, Random, 95% CI)

0.65 [‐0.32, 1.62]

2 Functional status Show forest plot

3

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Functional status at 1 week

2

225

Std. Mean Difference (IV, Random, 95% CI)

‐0.41 [‐0.73, ‐0.10]

2.2 Functional status at 1 month

3

322

Std. Mean Difference (IV, Random, 95% CI)

‐0.09 [‐0.39, 0.21]

2.3 Functional status at 3 to 6 months

2

225

Std. Mean Difference (IV, Random, 95% CI)

‐0.22 [‐0.61, 0.16]

3 Recovery Show forest plot

3

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 Recovery at 1 week

2

196

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.36, 2.19]

3.2 Recovery at 1 month

2

225

Risk Ratio (M‐H, Random, 95% CI)

1.15 [0.60, 2.19]

3.3 Recovery at 3 to 6 months

2

195

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.71, 1.31]

4 Return‐to‐work Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

4.1 Return‐to‐work at 6 months

1

92

Risk Ratio (M‐H, Random, 95% CI)

1.21 [0.99, 1.47]
Figuras y tablas -
Comparison 4. Spinal manipulative therapy plus any intervention versus that same intervention alone
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Comparison 5. Spinal manipulative therapy (SMT) versus another SMT technique

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Totals not selected

1.1 Pain at 1 week

2

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Pain at 1 month

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

1.3 Pain at 3 to 6 months

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2 Functional status Show forest plot

3

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

2.1 Functional status at 1 week

3

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Functional status at 1 month

2

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2.3 Functional status at 3 to 6 months

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3 Recovery Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3.1 Recovery at 1 week

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Recovery at 1 month

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3.3 Recovery at 3 to 6 months

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]
Figuras y tablas -
Comparison 5. Spinal manipulative therapy (SMT) versus another SMT technique
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Comparison 6. SMT versus all comparisons ‐ for construction of funnel plot

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain ‐ For funnel plot Show forest plot

8

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Pain at 1 week

6

704

Mean Difference (IV, Random, 95% CI)

‐0.13 [‐0.82, 0.56]

1.2 Pain at 1 month

5

809

Mean Difference (IV, Random, 95% CI)

‐0.56 [‐1.07, ‐0.06]

1.3 pain at 3 to 6 months

3

676

Mean Difference (IV, Random, 95% CI)

‐0.42 [‐1.00, 0.17]

1.4 Pain at 12 months

1

314

Mean Difference (IV, Random, 95% CI)

0.40 [‐0.08, 0.88]

2 Functional status ‐ For funnel plot Show forest plot

10

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Functional status at 1 week

6

683

Std. Mean Difference (IV, Random, 95% CI)

‐0.31 [‐0.59, ‐0.03]

2.2 Functional status at 1 month

9

1280

Std. Mean Difference (IV, Random, 95% CI)

‐0.23 [‐0.42, ‐0.03]

2.3 Functional status at 3 to 6 months

5

901

Std. Mean Difference (IV, Random, 95% CI)

‐0.26 [‐0.49, ‐0.02]

2.4 Functional status at 12 months

2

437

Std. Mean Difference (IV, Random, 95% CI)

0.06 [‐0.14, 0.25]
Figuras y tablas -
Comparison 6. SMT versus all comparisons ‐ for construction of funnel plot
Ir a la tabla de la revisión