The effect of spinal manipulative therapy on pain relief and function in patients with chronic low back pain: an individual participant data meta-analysis

被引:19
作者
de Zoete, Annemarie [1 ,2 ]
Rubinstein, Sidney M. [1 ,2 ]
de Boer, Michiel R. [8 ]
Ostelo, Raymond [1 ,2 ]
Underwood, Martin [3 ,4 ]
Hayden, Jill A. [5 ]
Buffart, Laurien M. [6 ]
van Tulder, Maurits W. [1 ,2 ,7 ]
Bronfort, G.
Foster, N. E.
Maher, C. G.
Hartvigsen, J.
Balthazard, P.
Cecchi, F.
Ferreira, M. L.
Gudavalli, M. R.
Haas, M.
Hidalgo, B.
Hondras, M. A.
Hsieh, C. Y.
Learman, K.
McCarthy, P. W.
Petersen, T.
Rasmussen-Barr, E.
Skillgate, E.
Walker, B. F.
Xia, T.
Zaproudina, N.
机构
[1] Vrije Univ, Fac Sci, Dept Hlth Sci, De Boelelaan 1085,Room WN U-454, NL-1081 HV Amsterdam, Netherlands
[2] Vrije Univ, Amsterdam Movement Sci Res Inst, Amsterdam, Netherlands
[3] Univ Warwick, Warwick Med Sch, Warwick Clin Trials Unit, Coventry CV4 7AL, W Midlands, England
[4] Univ Hosp Coventry & Warwickshire, Coventry CV2 2DX, W Midlands, England
[5] Dalhousie Univ, Dept Community Hlth & Epidemiol, Halifax, NS B3H 1V7, Canada
[6] Radboud UMC, Nijmegen, Netherlands
[7] Aarhus Univ Hosp, Dept Physiotherapy & Occupat Therapy, Aarhus, Denmark
[8] Univ Med Ctr Groningen, Dept Gen Practice & Elderly Care Med, Groningen, Netherlands
基金
英国医学研究理事会;
关键词
Spinal manipulative therapy; Individual participant data; Low back pain; SYSTEMATIC REVIEWS; RANDOMIZED-TRIAL; HOME EXERCISE; COCHRANE BACK; NECK PAIN; SUBACUTE; CARE; GUIDELINES; MANAGEMENT; ADVICE;
D O I
10.1016/j.physio.2021.03.006
中图分类号
R49 [康复医学];
学科分类号
100215 ;
摘要
Background A 2019 review concluded that spinal manipulative therapy (SMT) results in similar benefit compared to other interventions for chronic low back pain (LBP). Compared to traditional aggregate analyses individual participant data (IPD) meta-analyses allows for a more precise estimate of the treatment effect. Purpose To assess the effect of SMT on pain and function for chronic LBP in a IPD meta-analysis. Data sources Electronic databases from 2000 until April 2016, and reference lists of eligible trials and related reviews. Study selection Randomized controlled trials (RCT) examining the effect of SMT in adults with chronic LBP compared to any comparator. Data extraction and data synthesis We contacted authors from eligible trials. Two review authors independently conducted the study selection and risk of bias. We used GRADE to assess the quality of the evidence. A one-stage mixed model analysis was conducted. Negative point estimates of the mean difference (MD) or standardized mean difference (SMD) favors SMT. Results Of the 42 RCTs fulfilling the inclusion criteria, we obtained IPD from 21 (n = 4223). Most trials (s = 12, n = 2249) compared SMT to recommended interventions. There is moderate quality evidence that SMT vs recommended interventions resulted in similar outcomes on pain (MD -3.0, 95%CI: -6.9 to 0.9, 10 trials, 1922 participants) and functional status at one month (SMD: -0.2, 95% CI -0.4 to 0.0, 10 trials, 1939 participants). Effects at other follow-up measurements were similar. Results for other comparisons (SMT vs non-recommended interventions; SMT as adjuvant therapy; mobilization vs manipulation) showed similar findings. SMT vs sham SMT analysis was not performed, because we only had data from one study. Sensitivity analyses confirmed these findings. Limitations Only 50% of the eligible trials were included. Conclusions Sufficient evidence suggest that SMT provides similar outcomes to recommended interventions, for pain relief and improvement of functional status. SMT would appear to be a good option for the treatment of chronic LBP. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of Chartered Society of Physiotherapy.
引用
收藏
页码:121 / 134
页数:14
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