Directed vertebral manipulation is not better than generic vertebral manipulation in patients with chronic low back pain: a randomised trial

Oliveira, Ronaldo Fernando de; Costa, Leonardo Oliveira Pena; Nascimento, Leonardo Penteado; Rissato, Lívia Leticia

doi:10.1016/j.jphys.2020.06.007

Cited by 20 publications

(26 citation statements)

References 43 publications

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“…As shown in Fig. 1 , we screened 3,288 articles, from which nine were included for analysis 23 – 31 . One additional article was found using backward citation tracking 32 , which resulted in ten included studies.…”

Section: Resultsmentioning

confidence: 99%

“…All articles were in English and published between 2003 and 2020. All but three authors 25 – 27 reported if there were any conflicts of interest, and four reported that they received funding 23 , 24 , 31 , 32 . We contacted the authors of three articles 30 , 33 , 34 with insufficient data to estimate effect sizes.…”

Section: Resultsmentioning

confidence: 99%

“…Figure 2 shows that only one study was assessed as having high RoB 28 , four as moderate RoB 27 , 29 , 31 , 32 , and five as low RoB 23 – 26 , 30 . Items that commonly were deficient were “naïve study subjects” (to SMT) and “other sources of bias” (statistical analysis was performed blinded) (Fig.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…The remaining five studies compared SMT applied at a candidate site in the symptomatic area to SMT applied at a non-candidate site at a remote region 26 , 27 , 29 – 31 . Two investigated low back pain and compared SMT at the symptomatic lumbar spine versus SMT in the asymptomatic thoracic spine 27 , 31 . Two compared symptomatic cervical SMT to asymptomatic thoracic SMT for neck pain 26 , 29 , and one study examined upper cervical SMT to a series of SMTs at non-candidate sites: lower cervical, cervicothoracic, and mid-thoracic 30 .…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

The importance of selecting the correct site to apply spinal manipulation when treating spinal pain: Myth or reality? A systematic review

Nim

Downie

O’Neill

et al. 2021

Sci Rep

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The concept that spinal manipulation therapy (SMT) outcomes are optimized when the treatment is aimed at a clinically relevant joint is commonly assumed and central to teaching and clinical use (candidate sites). This systematic review investigated whether clinical effects are superior when this is the case compared to SMT applied elsewhere (non-candidate sites). Eligible study designs were randomized controlled trials that investigated the effect of spinal manipulation applied to candidate versus non-candidate sites for spinal pain. We obtained data from four different databases. Risk of bias was assessed using an adjusted Cochrane risk of bias tool, adding four items for study quality. We extracted between-group differences for any reported outcome or, when not reported, calculated effect sizes from the within-group changes. We compared outcomes for SMT applied at a ‘relevant’ site to SMT applied elsewhere. We prioritized methodologically robust studies when interpreting results. Ten studies, all of acceptable quality, were included that reported 33 between-group differences—five compared treatments within the same spinal region and five at different spinal regions. None of the nine studies with low or moderate risk of bias reported statistically significant between-group differences for any outcome. The tenth study reported a small effect on pain (1.2/10, 95%CI − 1.9 to − 0.5) but had a high risk of bias. None of the nine articles of low or moderate risk of bias and acceptable quality reported that “clinically-relevant” SMT has a superior outcome on any outcome compared to “not clinically-relevant” SMT. This finding contrasts with ideas held in educational programs and clinical practice that emphasize the importance of joint-specific application of SMT.

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Section: Resultsmentioning

confidence: 99%