• 17 JUL 18

    Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain

    A recent study published in JAMA, which is the Jounal of the American Medical association, did a systematic review and meta-analysis to determine the effectiveness and potential harm of spinal manipulation therapy (SMT) in the treatment of lower back pain. It found that SMT was not only the most effective treatment in the first 6 weeks abut also relatively harmless when compared to the use of pharmaceuticals.

    Dr Jason Karalus from Darlinghurst Chiropractic Centre is a specialist in SMT and has over 25 years experience. he would recommend that you consult your local chiropractor as your first point of call ASAP if suffering from lower back pain. He utilities a number of techniques including; diversified, gonstead, terminal point, flexion distraction, activator, cold laser, infrared, ultrasound, interferential and various muscle release techniques.

    The conclusion from the study posted in JAMA is below and a link to the full abstract can be found at the end.

    The principal conclusion of this review was that SMT treatments for acute low back pain were associated with statistically significant benefit in pain and function at up to 6 weeks, that was, on average, clinically modest. The size of the benefit for pain (−9.95 mm) is about the same as the benefit for nonsteroidal anti-inflammatory drugs in acute low back pain (−8.39 mm) according to the Cochrane review on this topic.27 For function, the effect size of −0.39 is approximately equivalent to an improvement in the RMDQ score of between 1 and 2.5 points, using the range of SDs for the RMDQ in the included studies. However, heterogeneity was high, and could not be explained by differences in patients, clinicians, type of manipulation, study quality, or timing of the outcome. Evaluation of these differences was limited by the quality of reporting in the primary studies.

    This review adds to the existing literature by including a greater number of eligible RCTs in the pooled analysis than prior reviews, and also providing a higher level of precision to the pooled analysis. For example, 2 prior reviews included 37 and 45 RCTs and did not perform a pooled analysis. Another review included 27 studies,6 but patients could have had pain for up to 3 months’ duration, and it is unclear how many RCTs were included in their pooled analysis and whether or not they pooled sham-controlled studies with active therapy comparisons. The most recent Cochrane review on SMT for acute low back pain reports pooled results for pain and function at 4-week follow-up that included only 3 studies for each outcome.4 In the current review, 10 studies for pain and 6 studies for function were included in pooled analyses for short-term outcomes.

    The studies reporting the largest benefits were 3 studies that used clinical criteria to select patients as more likely to benefit.3234 In a recent RCT, the physical therapy research team reported statistically significant benefits of much smaller magnitude.9 Possible hypotheses include that the comparison group (usual care along with education and reassurance based on The Back Book) was more effective than the exercises given to the comparison groups in the prior studies or that it is due to patient selection, as the most recent study recruited patients directly from primary care and not from patients already referred to physical therapy (and therefore possibly having less successful spontaneous improvement). The recent study also selected patients using a modification of the prediction rule that is more pragmatic for clinical implementation but is known to sacrifice specificity in identifying likely SMT responders.

    For a full copy of the abstract  https://jamanetwork.com/journals/jama/fullarticle/2616395