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Journal article
The Effectiveness of Spinal Manipulative Therapy in Treating Spinal Pain Does Not Depend on the Application Procedures: A Systematic Review and Network Meta-Analysis
Journal of Orthopaedic & Sports Physical Therapy, Vol.55(2), pp.109-122
2025
Abstract
OBJECTIVES: To assess whether spinal manipulative therapy (SMT) application procedures (i.e., target, thrust, and region) impacted changes in pain and disability for adults with spine pain.
DESIGN: Systematic review with network meta-analysis.
LITERATURE SEARCH: We searched PubMed and Epistemonikos for systematic reviews indexed up to February 2022, and conducted a systematic search of five databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Physiotherapy Evidence Database (PEDro), and Index to Chiropractic Literature) from January 1, 2018, to September 12, 2023. We included randomized clinical trials (RCTs) from recent systematic reviews and newly identified RCTs published during the review process, and employed artificial intelligence to identify potentially relevant articles not retrieved by our electronic database searches.
STUDY SELECTION CRITERIA: We included RCTs of the effects of high-velocity, low-amplitude SMT, compared to other SMT approaches, interventions, or control, in adults with spine pain.
DATA SYNTHESIS: The outcomes were spinal pain intensity and disability measured at short-term (end of treatment) and long-term follow-up (closest to 12 months). Risk of bias was assessed using Cochrane Risk of Bias tool v.2. Results were presented as network plots, evidence rankings, and league tables.
RESULTS: We included 161 RCTs (11,849 participants). Most SMT procedures were equal to clinical guideline interventions and were slightly more effective than other treatments. When comparing Inter-SMT procedures, effects were small and not clinically relevant. A general and non-specific, rather than a specific and targeted, SMT approach had the highest probability of achieving the largest effects. Results were based on very low to low certainty evidence, mainly downgraded owing to large within-study heterogeneity, high risk of bias, and an absence of direct comparisons.
CONCLUSION: There was low certainty evidence that clinicians could apply SMT according to their preferences and patients’ preferences and comfort. Differences between SMT approaches appear small and likely not clinically-relevant.
Details
- Title
- The Effectiveness of Spinal Manipulative Therapy in Treating Spinal Pain Does Not Depend on the Application Procedures: A Systematic Review and Network Meta-Analysis
- Authors/Creators
- Casper Nim - Region of Southern DenmarkSasha Aspinall - Murdoch University, School of Allied HealthChad E Cook - Duke UniversityLeticia A Corrêa - Macquarie UniversityMegan Donaldson - Medical University of South CarolinaAron S Downie - Macquarie UniversitySteen Harsted - University of Southern DenmarkSimone Hansen - Nordic Life Science Pipeline (Canada)Hazel J Jenkins - Macquarie UniversityDavid McNaughton - Macquarie UniversityLuana Nyirö - University of Southern DenmarkStephen M Perle - Health Sciences UniversityEric J Roseen - Boston UniversityJames J Young - University Health NetworkAnika Young - Macquarie UniversityGong-He Zhao - Beijing Sport UniversityJan Hartvigsen - University of Southern DenmarkCarsten B Juhl - Copenhagen University Hospital
- Publication Details
- Journal of Orthopaedic & Sports Physical Therapy, Vol.55(2), pp.109-122
- Publisher
- JOSPT Inc. d/b/a Movement Science Media.
- Number of pages
- 14
- Grant note
- Foundation for Chiropractic Research and Post-graduate EducationRegion of Southern DenmarkNational Institutes of Health National Center for Complementary and Integrative Health (NCCIH) grantNCCIH: K23-AT010487 Arthritis Society CanadaCanadian Institutes of Health Research
Casper Nim is partly funded by The Foundation for Chiropractic Research and Post-graduate Education and the Region of Southern Denmark. Chad E. Cook is the director of the Duke Center of Excellence in Manual and Manipulative Therapy, is supported by a National Institutes of Health National Center for Complementary and Integrative Health (NCCIH) grant, and is an associate editor with JOSPT. Jan Hartvigsen has received multiple grants from The Foundation for Chiropractic Research and Post-graduate Education and has a part-time position at the Chiropractic Knowledge Hub in Odense, Denmark. Eric J. Roseen is supported by a career development award from the NCCIH (award number K23-AT010487). Stephen M. Perle is an associate editor of Chiropractic & Manual Therapies. James J. Young is supported by awards from Arthritis Society Canada, the Canadian Institutes of Health Research, and The Foundation for Chiropractic Research and Post-graduate Education.
- Identifiers
- 991005731785107891
- Copyright
- © 2025 The Authors.
- Murdoch Affiliation
- School of Allied Health
- Resource Type
- Journal article
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