Studies reviewed
| Reference | Population characteristics (n) | MT limited to manipulation only | MT delivered by: | Clinically relevant, guideline based MT | Interventions, groups | Control group | Dose (MT or manipulation) | Results | Effect size for positive studies |
|---|---|---|---|---|---|---|---|---|---|
| MT, Manual therapy; ET, exercise therapy; LBP, low back pain. | |||||||||
| Aure et al1 | 20–60 years; chronic LBP>8 weeks, less than 6 months (49) | No | Physical therapists | Yes | 1. MT plus ET. 2. ET alone | No | 45 min (15 min MT); 2 sessions/week, 8 weeks | Significantly larger improvements in MT group (maintained at 1 year follow up) | 0.78 |
| Hoving et al2 | 18–70 years; pain or stiffness in the neck for at least 2 weeks (183) | No | Physical therapists | Yes | 1. MT plus specific exercise training. 2. Active exercise focused physical therapy. 3. Continued care by GP | No | 45 min; 1 session/week for up to 6 weeks | Physical therapy including MT more effective than physical therapy without MT or continued care by a GP | Not given |
| Jull et al3 | 18–60 years; cervicogenic headache at least 1×/week for 2 months–10 years (200) | No | Physical therapists | Yes | 1. MT. 2. ET (low load endurance training). 3. Combined MT and ET. 4. Control | Yes | 30 min, 8–12 sessions, 6 weeks | MT as effective as ET and both significantly better than control | 0.80 |
| Moseley4 | Chronic LBP>2 months (57) | No | Physical therapists | Yes with respect to clinical relevance (individualised and variety of techniques allowed but no references cited for MT techniques) | 1. MT, specific exercise training, and neurophysiology education. 2. Medical management by GP | No | 2×/week, 4 weeks | Combined physiotherapy treatment including MT, specific exercise training, and neurophysiology education resulted in improved function and pain at 1 and 12 months. | Not given |
| Giles & Muller5 | 17 years or older; mechanical back or neck pain for a minimum of 13 weeks (115) | Yes | Chiropractors | Yes for LBP. No for neck pain | 1. Spinal manipulation. 2. Sports physician follow up (limited) and medication. 3. Acupuncture (needle). | No | 20 min, 2×/week, maximum 9 weeks | Greater short term benefit for with manipulation, but not for neck pain. Acupuncture more effective for neck pain. | Not given |
| Andersson et al6 | 20–59 years; LBP lasting at least 3 weeks but less than 6 months (178) | No | Osteopaths | Yes | 1. Osteopathic treatment 2. “Standard care” by physicians | No | 1×/week for 4 weeks then 1×/2 weeks for 8 weeks | No significant difference between groups. Both groups improved | |
| Bronfort G et al.7 | 20–65 years; mechanical neck pain for at least 12 weeks (191) | Yes (but this group also received 45 min of sham microcurrent therapy) | Chiropractors | No. A reference for the use of spinal manipulation for LBP is cited, but only cervical and thoracic spine techniques were used. | 1. Spinal manipulation plus upper body and neck strengthening exercise. 2. Aerobic exercise plus MedX cervical extension and rotation machine. 3. Spinal manipulation | No | 20 × 1 hour sessions over 11 weeks | No significant difference between groups with respect to pain, neck disability, medication use | |
| Cherkin et al8 | 20–64 years; LBP minimum 7 days after seeing physician (321) | Yes | Chiropractors | No, side lying only | 1. Chiropractic manipulation. 2. Education booklet. 3. McKenzie exercises | No | Up to 9× over 1 month | No significant difference between groups | |
| Curtis et al9 | 21–65 years; acute LBP of less than 2 months (295) | No (manipulation plus muscle energy techniques) | Physicians with limited training (18 h) in manual therapy | No | 1. Manipulation and muscle energy techniques plus enhanced care 2. Enhanced care alone | No | Initial plus 4 follow ups; 2×/wk for 2 weeks | Only 43% of patients in the MT group actually received the planned treatment; no significant difference between groups | |
| Hsieh et al10 | 18 years or older; LBP>3 weeks and less than 6 months (200) | Yes | Chiropractors | No, limited techniques | 1. Back school. 2. Myofascial therapy. 3. Joint manipulation. 4. Combined joint manipulation & myofascial therapy | No | 3× week for 3 weeks | All groups improved; no significant between-group differences at 3 or 6 months | |
| Hurwitz et al11 | 18 years or older; LBP (681) | Yes | Chiropractors | Yes | 1. Medical care only. 2. Chiropractic care only. 3. Medical care with limited physical therapy. 4. Chiropractic care with modalities. | No | Treatment dose not prescribed | Chiropractic no better than other groups; physical therapy plus medical care group had less pain at 6 weeks and 6 months than medical care only | |
| Jordan et al12 | 20–60 years; chronic neck pain at least 3 months (167) | No | Mobilisation by physical therapists; manipulation by chiropractors | Yes with respect to clinical relevance (individualised) but no references cited for mobilisation or manipulation techniques. | 1. Manipulation. 2. Physiotherapy without manipulation. 3. Strength training (with a focus on neck muscle training). | No | Physiotherapy: 30 min, 2×/week, 6 weeks. Chiropractic: 15–20 min, 2×/week, 6 weeks | No significant difference between groups. | |
| David et al13 | 18–75 years; neck pain> 6 weeks duration (70) | No | Physical therapists | Not clear | 1. Physiotherapy. 2. Acupuncture. | No | 1×/week, 6 weeks (maximum) | No significant difference between acupuncture and physiotherapy groups. Both groups improved. | |