Author Names
Ruddock,J Sallis,H Ness,A MPhil R
Reviewer Name
Moya Nadège Koua
Reviewer Affiliation(s)
Duke Doctor of Physical Therapy
Paper Abstract
The purpose of this systematic review was to identify and critically evaluate randomized controlled trials of spinal manipulation vs sham manipulation in the treatment of nonspecific low back pain.Four electronic databases were searched from their inception to March 2015 to identify all relevant trials. Reference lists of retrieved articles were hand-searched. All data were extracted by 2 independent reviewers, and risk of bias was assessed using the Cochrane Back Review Group Risk of Bias tool. Nine randomized controlled trials were included in the systematic review, and 4 were found to be eligible for inclusion in a meta-analysis. Participants in the SM group had improved symptoms compared with participants receiving sham treatment. The majority of studies were of low risk of bias; however, several of the studies were small, the practitioner could not be blinded, and some studies did not conduct intention-to-treat analysis and had a high level of dropouts.There is some evidence that SM has specific treatment effects and is more effective at reducing nonspecific low back pain when compared with an effective sham intervention. However, given the small number of studies included in this analysis, we should be cautious of making strong inferences based on these results.
NIH Risk of Bias Tool
Quality Assessment of Systematic Reviews and Meta-Analyses
1. Is the review based on a focused question that is adequately formulated and described?
Yes
2. Were eligibility criteria for included and excluded studies predefined and specified?
Yes
3. Did the literature search strategy use a comprehensive, systematic approach?
Yes
4. Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
Yes
5. Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
Yes
6. Were the included studies listed along with important characteristics and results of each study?
Yes
7. Was publication bias assessed?
Yes
8. Was heterogeneity assessed? (This question applies only to meta-analyses.)
Yes
Key Finding #1
Greater reduction in pain scores among SM participants than those who received a sham placebo.When pain was examined immediately posttreatment and at follow-up, this conclusion held true.
Key Finding #2
According to seven trials, no evidence of between-group differences were reported and may have lacked power because sample sizes were small and did not report a priori power calculations.
Please provide your summary of the paper
This summary showed that when SM is compared to a successful sham intervention, it has particular treatment effects and reduces NSLBP more effectively. A comparable benefit was observed both immediately posttreatment and at follow-up despite the effect having a small-medium level of clinical importance. The use of various therapies, controls, and outcome measures, as well as varying standards of methodology between research, may be the cause of results that are inconsistent across all of the studies.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
As of right now , there is not enough data to guide practice but there is evidence that SM has some effects. Therefore, it could be beneficial to try SM to reduce NSLBP in the plan care.
