Heterogeneity was not explained by type of clinician performing SMT, type of manipulation, study quality, or whether SMT was given alone or as part of a package of therapies. Twelve RCTs (1381 patients) produced moderate-quality evidence that SMT has a statistically significant association with improvements in function (pooled mean effect size, -0.39 ). Of 26 eligible RCTs identified, 15 RCTs (1711 patients) provided moderate-quality evidence that SMT has a statistically significant association with improvements in pain (pooled mean improvement in the 100-mm visual analog pain scale, -9.95 ). Pain (measured by either the 100-mm visual analog scale, 11-point numeric rating scale, or other numeric pain scale), function (measured by the 24-point Roland Morris Disability Questionnaire or Oswestry Disability Index ), or any harms measured within 6 weeks. The evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Prior research has shown the CBN Risk of Bias tool identifies studies at an increased risk of bias using a threshold of 5 or 6 as a summary score. This tool has 11 items in the following domains: randomization, concealment, baseline differences, blinding (patient), blinding (care provider ), blinding (outcome), co-interventions, compliance, dropouts, timing, and intention to treat. Study quality was assessed using the Cochrane Back and Neck (CBN) Risk of Bias tool. Observational studies were included to assess harms.ĭata extraction was done in duplicate. Search of MEDLINE, Cochrane Database of Systematic Reviews, EMBASE, and Current Nursing and Allied Health Literature from January 1, 2011, through February 6, 2017, as well as identified systematic reviews and RCTs, for RCTs of adults with low back pain treated in ambulatory settings with SMT compared with sham or alternative treatments, and that measured pain or function outcomes for up to 6 weeks. To systematically review studies of the effectiveness and harms of SMT for acute (≤6 weeks) low back pain. Randomized clinical trials (RCTs) and meta-analyses have reported different conclusions about the effectiveness of SMT. Acute low back pain is common and spinal manipulative therapy (SMT) is a treatment option.
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