No Clinical Difference With Spinal Manipulative Therapy

Evidence suggests no clinically-relevant difference between SMT, other interventions for chronic LBP

THURSDAY, June 30 (HealthDay News) -- Despite having a small but significant effect, spinal manipulative therapy (SMT) does not appear to offer clinically relevant short-term pain relief and improved function for patients with chronic low-back pain compared to other interventions, according to a review published in the June 1 issue of Spine.

Sidney M. Rubinstein, D.C., Ph.D., from the VU Medical Center in Amsterdam, Netherlands, and colleagues reviewed available literature to evaluate the effects of SMT for chronic low-back pain. The analysis included 26 randomized controlled trials published through June 2009, which included 6,070 participants randomly assigned to SMT, mobilization, or placebo (sham SMT). The outcomes studied included pain, functional status, perceived recovery, return-to-work, and quality of life. The quality of evidence was graded.

The investigators found that, compared to other interventions, there was high-quality evidence that SMT had a small, significant but not clinically relevant, short-term effect on both functional status and pain relief. Evidence to show that combining SMT with other interventions had a significant short-term effect on pain relief and functional status was of variable quality. Very low-quality evidence existed for SMT not being more effective than inert interventions or sham SMT for short-term pain relief or functional status. There were insufficient data on recovery, return to work, quality of life, and costs of care. SMT was not associated with serious complications.

"There is high-quality evidence that SMT has a small, statistically significant but not clinically relevant, short-term effect on pain relief and functional status in comparison with other interventions," the authors write.

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Physician's Briefing

Updated on July 06, 2011

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