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

Annemarie de Zoete; Sidney M. Rubinstein; Michiel R. de Boer; Raymond Ostelo; Martin Underwood; Jill A. Hayden; Laurien M. Buffart; Maurits W. van Tulder; G. Bronfort; N. E. Foster; C. G. Maher; J. Hartvigsen; P. Balthazard; F. Cecchi; M. L. Ferreira; M. R. Gudavalli; M. Haas; B. Hidalgo; M. A. Hondras; C. Y. Hsieh; K. Learman; P. W. McCarthy; T. Petersen; E. Rasmussen-Barr; E. Skillgate; Y. Verma; L. Vismara; B. F. Walker; T. Xia; N. Zaproudina

doi:10.1016/j.physio.2021.03.006

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

Annemarie de Zoete, Sidney M. Rubinstein, Michiel R. de Boer, Raymond Ostelo, Martin Underwood, Jill A. Hayden, Laurien M. Buffart, Maurits W. van Tulder, G. Bronfort, N. E. Foster, C. G. Maher, J. Hartvigsen, P. Balthazard, F. Cecchi, M. L. Ferreira, M. R. Gudavalli, M. Haas, B. Hidalgo, M. A. Hondras, C. Y. HsiehK. Learman, P. W. McCarthy, T. Petersen, E. Rasmussen-Barr, E. Skillgate, Y. Verma, L. Vismara, B. F. Walker, T. Xia, N. Zaproudina

Center for Spirituality and Healing

Research output: Contribution to journal › Review article › peer-review

17 Scopus citations

Abstract

STUDY DESIGN: Individual participant data (IPD) meta-analysis.

OBJECTIVE: The aim of this study was to identify which participant characteristics moderate the effect of spinal manipulative therapy (SMT) on pain and functioning in chronic LBP.

SUMMARY OF BACKGROUND: The effects of SMT are comparable to other interventions recommended in guidelines for chronic low back pain (LBP); however, it is unclear which patients are more likely to benefit from SMT compared to other therapies.

METHODS: IPD were requested from randomized controlled trials (RCTs) examining the effect of SMT in adults with chronic LBP for pain and function compared to various other therapies (stratified by comparison). Potential patient moderators (n = 23) were a priori based on their clinical relevance. We investigated each moderator using a one-stage approach with IPD and investigated this interaction with the intervention for each time point (1, 3, 6, and 12 months).

RESULTS: We received IPD from 21 of 46 RCTs (n = 4223). The majority (12 RCTs, n = 2249) compared SMT to recommended interventions. The duration of LBP, baseline pain (confirmatory), smoking, and previous exposure to SMT (exploratory) had a small moderating effect across outcomes and follow-up points; these estimates did not represent minimally relevant differences in effects; for example, patients with <1 year of LBP demonstrated more positive point estimates for SMT versus recommended therapy for the outcome pain (mean differences ranged from 4.97 (95% confidence interval, CI: -3.20 to 13.13) at 3 months, 10.76 (95% CI: 1.06 to 20.47) at 6 months to 5.26 (95% CI: -2.92 to 13.44) at 12 months in patients with over a year LBP. No other moderators demonstrated a consistent pattern across time and outcomes. Few moderator analyses were conducted for the other comparisons because of too few data.

CONCLUSION: We did not identify any moderators that enable clinicians to identify which patients are likely to benefit more from SMT compared to other treatments.Level of Evidence: 2.

Original language	English (US)
Pages (from-to)	121-134
Number of pages	14
Journal	Physiotherapy (United Kingdom)
Volume	112
DOIs	https://doi.org/10.1016/j.physio.2021.03.006
State	Published - Apr 15 2021

Bibliographical note

Publisher Copyright:
© 2021 The Author(s)

Keywords

Individual participant data
Low back pain
Spinal manipulative therapy
Chronic Pain/diagnosis
Pain Management/methods
Humans
Middle Aged
Randomized Controlled Trials as Topic/methods
Recovery of Function/physiology
Male
Treatment Outcome
Pain Measurement/methods
Manipulation, Spinal/methods
Data Analysis
Adult
Female
Low Back Pain/diagnosis

PubMed: MeSH publication types

Meta-Analysis
Journal Article

Publisher link

10.1016/j.physio.2021.03.006

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de Zoete, A., Rubinstein, S. M., de Boer, M. R., Ostelo, R., Underwood, M., Hayden, J. A., Buffart, L. M., van Tulder, M. W., 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., ... Zaproudina, N. (2021). The effect of spinal manipulative therapy on pain relief and function in patients with chronic low back pain: an individual participant data meta-analysis. Physiotherapy (United Kingdom), 112, 121-134. https://doi.org/10.1016/j.physio.2021.03.006

The effect of spinal manipulative therapy on pain relief and function in patients with chronic low back pain: an individual participant data meta-analysis. / de Zoete, Annemarie; Rubinstein, Sidney M.; de Boer, Michiel R. et al.
In: Physiotherapy (United Kingdom), Vol. 112, 15.04.2021, p. 121-134.

Research output: Contribution to journal › Review article › peer-review

de Zoete, A, Rubinstein, SM, de Boer, MR, Ostelo, R, Underwood, M, Hayden, JA, Buffart, LM, van Tulder, MW, Bronfort, G, Foster, NE, Maher, CG, Hartvigsen, J, Balthazard, P, Cecchi, F, Ferreira, ML, Gudavalli, MR, Haas, M, Hidalgo, B, Hondras, MA, Hsieh, CY, Learman, K, McCarthy, PW, Petersen, T, Rasmussen-Barr, E, Skillgate, E, Verma, Y, Vismara, L, Walker, BF, Xia, T & Zaproudina, N 2021, 'The effect of spinal manipulative therapy on pain relief and function in patients with chronic low back pain: an individual participant data meta-analysis', Physiotherapy (United Kingdom), vol. 112, pp. 121-134. https://doi.org/10.1016/j.physio.2021.03.006

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abstract = "STUDY DESIGN: Individual participant data (IPD) meta-analysis.OBJECTIVE: The aim of this study was to identify which participant characteristics moderate the effect of spinal manipulative therapy (SMT) on pain and functioning in chronic LBP.SUMMARY OF BACKGROUND: The effects of SMT are comparable to other interventions recommended in guidelines for chronic low back pain (LBP); however, it is unclear which patients are more likely to benefit from SMT compared to other therapies.METHODS: IPD were requested from randomized controlled trials (RCTs) examining the effect of SMT in adults with chronic LBP for pain and function compared to various other therapies (stratified by comparison). Potential patient moderators (n = 23) were a priori based on their clinical relevance. We investigated each moderator using a one-stage approach with IPD and investigated this interaction with the intervention for each time point (1, 3, 6, and 12 months).RESULTS: We received IPD from 21 of 46 RCTs (n = 4223). The majority (12 RCTs, n = 2249) compared SMT to recommended interventions. The duration of LBP, baseline pain (confirmatory), smoking, and previous exposure to SMT (exploratory) had a small moderating effect across outcomes and follow-up points; these estimates did not represent minimally relevant differences in effects; for example, patients with <1 year of LBP demonstrated more positive point estimates for SMT versus recommended therapy for the outcome pain (mean differences ranged from 4.97 (95% confidence interval, CI: -3.20 to 13.13) at 3 months, 10.76 (95% CI: 1.06 to 20.47) at 6 months to 5.26 (95% CI: -2.92 to 13.44) at 12 months in patients with over a year LBP. No other moderators demonstrated a consistent pattern across time and outcomes. Few moderator analyses were conducted for the other comparisons because of too few data.CONCLUSION: We did not identify any moderators that enable clinicians to identify which patients are likely to benefit more from SMT compared to other treatments.Level of Evidence: 2.",

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author = "{de Zoete}, Annemarie and Rubinstein, {Sidney M.} and {de Boer}, {Michiel R.} and Raymond Ostelo and Martin Underwood and Hayden, {Jill A.} and Buffart, {Laurien M.} and {van Tulder}, {Maurits W.} and G. Bronfort and Foster, {N. E.} and Maher, {C. G.} and J. Hartvigsen and P. Balthazard and F. Cecchi and Ferreira, {M. L.} and Gudavalli, {M. R.} and M. Haas and B. Hidalgo and Hondras, {M. A.} and Hsieh, {C. Y.} and K. Learman and McCarthy, {P. W.} and T. Petersen and E. Rasmussen-Barr and E. Skillgate and Y. Verma and L. Vismara and Walker, {B. F.} and T. Xia and N. Zaproudina",

note = "Publisher Copyright: {\textcopyright} 2021 The Author(s)",

year = "2021",

month = apr,

day = "15",

doi = "10.1016/j.physio.2021.03.006",

language = "English (US)",

volume = "112",

pages = "121--134",

journal = "Physiotherapy (United Kingdom)",

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TY - JOUR

T1 - The effect of spinal manipulative therapy on pain relief and function in patients with chronic low back pain

T2 - an individual participant data meta-analysis

AU - de Zoete, Annemarie

AU - Rubinstein, Sidney M.

AU - de Boer, Michiel R.

AU - Ostelo, Raymond

AU - Underwood, Martin

AU - Hayden, Jill A.

AU - Buffart, Laurien M.

AU - van Tulder, Maurits W.

AU - Bronfort, G.

AU - Foster, N. E.

AU - Maher, C. G.

AU - Hartvigsen, J.

AU - Balthazard, P.

AU - Cecchi, F.

AU - Ferreira, M. L.

AU - Gudavalli, M. R.

AU - Haas, M.

AU - Hidalgo, B.

AU - Hondras, M. A.

AU - Hsieh, C. Y.

AU - Learman, K.

AU - McCarthy, P. W.

AU - Petersen, T.

AU - Rasmussen-Barr, E.

AU - Skillgate, E.

AU - Verma, Y.

AU - Vismara, L.

AU - Walker, B. F.

AU - Xia, T.

AU - Zaproudina, N.

PY - 2021/4/15

Y1 - 2021/4/15

N2 - STUDY DESIGN: Individual participant data (IPD) meta-analysis.OBJECTIVE: The aim of this study was to identify which participant characteristics moderate the effect of spinal manipulative therapy (SMT) on pain and functioning in chronic LBP.SUMMARY OF BACKGROUND: The effects of SMT are comparable to other interventions recommended in guidelines for chronic low back pain (LBP); however, it is unclear which patients are more likely to benefit from SMT compared to other therapies.METHODS: IPD were requested from randomized controlled trials (RCTs) examining the effect of SMT in adults with chronic LBP for pain and function compared to various other therapies (stratified by comparison). Potential patient moderators (n = 23) were a priori based on their clinical relevance. We investigated each moderator using a one-stage approach with IPD and investigated this interaction with the intervention for each time point (1, 3, 6, and 12 months).RESULTS: We received IPD from 21 of 46 RCTs (n = 4223). The majority (12 RCTs, n = 2249) compared SMT to recommended interventions. The duration of LBP, baseline pain (confirmatory), smoking, and previous exposure to SMT (exploratory) had a small moderating effect across outcomes and follow-up points; these estimates did not represent minimally relevant differences in effects; for example, patients with <1 year of LBP demonstrated more positive point estimates for SMT versus recommended therapy for the outcome pain (mean differences ranged from 4.97 (95% confidence interval, CI: -3.20 to 13.13) at 3 months, 10.76 (95% CI: 1.06 to 20.47) at 6 months to 5.26 (95% CI: -2.92 to 13.44) at 12 months in patients with over a year LBP. No other moderators demonstrated a consistent pattern across time and outcomes. Few moderator analyses were conducted for the other comparisons because of too few data.CONCLUSION: We did not identify any moderators that enable clinicians to identify which patients are likely to benefit more from SMT compared to other treatments.Level of Evidence: 2.

AB - STUDY DESIGN: Individual participant data (IPD) meta-analysis.OBJECTIVE: The aim of this study was to identify which participant characteristics moderate the effect of spinal manipulative therapy (SMT) on pain and functioning in chronic LBP.SUMMARY OF BACKGROUND: The effects of SMT are comparable to other interventions recommended in guidelines for chronic low back pain (LBP); however, it is unclear which patients are more likely to benefit from SMT compared to other therapies.METHODS: IPD were requested from randomized controlled trials (RCTs) examining the effect of SMT in adults with chronic LBP for pain and function compared to various other therapies (stratified by comparison). Potential patient moderators (n = 23) were a priori based on their clinical relevance. We investigated each moderator using a one-stage approach with IPD and investigated this interaction with the intervention for each time point (1, 3, 6, and 12 months).RESULTS: We received IPD from 21 of 46 RCTs (n = 4223). The majority (12 RCTs, n = 2249) compared SMT to recommended interventions. The duration of LBP, baseline pain (confirmatory), smoking, and previous exposure to SMT (exploratory) had a small moderating effect across outcomes and follow-up points; these estimates did not represent minimally relevant differences in effects; for example, patients with <1 year of LBP demonstrated more positive point estimates for SMT versus recommended therapy for the outcome pain (mean differences ranged from 4.97 (95% confidence interval, CI: -3.20 to 13.13) at 3 months, 10.76 (95% CI: 1.06 to 20.47) at 6 months to 5.26 (95% CI: -2.92 to 13.44) at 12 months in patients with over a year LBP. No other moderators demonstrated a consistent pattern across time and outcomes. Few moderator analyses were conducted for the other comparisons because of too few data.CONCLUSION: We did not identify any moderators that enable clinicians to identify which patients are likely to benefit more from SMT compared to other treatments.Level of Evidence: 2.

KW - Individual participant data

KW - Low back pain

KW - Spinal manipulative therapy

KW - Chronic Pain/diagnosis

KW - Pain Management/methods

KW - Humans

KW - Middle Aged

KW - Randomized Controlled Trials as Topic/methods

KW - Recovery of Function/physiology

KW - Male

KW - Treatment Outcome

KW - Pain Measurement/methods

KW - Manipulation, Spinal/methods

KW - Data Analysis

KW - Adult

KW - Female

KW - Low Back Pain/diagnosis

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U2 - 10.1016/j.physio.2021.03.006

DO - 10.1016/j.physio.2021.03.006

M3 - Review article

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SN - 0031-9406

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JO - Physiotherapy (United Kingdom)

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ER -

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

Abstract

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Keywords

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