Spinal manipulative therapy for adults with chronic low back pain

Area of Science:

• Orthopedics and Sports Medicine
• Rehabilitation and Physical Therapy
• Evidence-Based Medicine

Background:

• Chronic low back pain (LBP) is a prevalent condition with numerous treatment options.
• Spinal manipulative therapy (SMT) is a widely practiced intervention for LBP.
• The efficacy of SMT for chronic LBP remains a subject of ongoing research and debate.

Purpose of the Study:

• To systematically evaluate the benefits and harms of SMT for chronic LBP.
• To compare SMT against sham interventions, no treatment, and other conservative therapies.
• To update previous Cochrane systematic reviews on SMT for chronic LBP.

Main Methods:

• Inclusion of randomized controlled trials (RCTs) comparing SMT to sham, no treatment, or other conservative interventions in adults with chronic LBP.
• Comprehensive literature search across multiple databases up to October 2024.
• Meta-analysis and narrative synthesis of outcomes including pain, functional status, and adverse events, assessed using GRADE criteria.

Main Results:

• SMT showed very low-certainty evidence for small pain reduction and medium functional improvement versus sham.
• SMT demonstrated very low to low-certainty evidence for medium pain reduction and large functional improvement versus no treatment.
• SMT yielded low-certainty evidence for little to no difference in pain and small functional improvement versus other conservative interventions, with high heterogeneity.

Conclusions:

• SMT may offer modest benefits for pain and function in chronic LBP, but the evidence is of low to very low certainty.
• Limitations in study design, heterogeneity in interventions, and populations contribute to the uncertainty of findings.
• Further high-quality RCTs are needed to strengthen the evidence base for SMT in chronic LBP management.