Immediate or Short-term Effects of Thrust Manipulation on Acute to Subacute Low Back Pain: A Systematic Review and Meta-Analysis

Abstract

Objective: Clinical practice guidelines for chronic low back pain (LBP) strongly recommend thrust manipulation; however, its effectiveness for acute and subacute nonspecific LBP is controversial. Therefore, the aim of this systematic review and meta-analysis was to synthesize the immediate or short-term effects of thrust manipulation on pain in patients with acute and subacute LBP. Design: Asystematic review and meta-analysis. Methods: A literature search was performed in international databases (CINAHL, Embase, MEDLINE, PubMed) in June 2023. Search terms were set according to PICOSD (participants, intervention, comparison, outcomes, study design). Risk of bias (RoB) assessment was performed using the RoB tool and quantitative analysis was performed using RevMan 5.4. The effect measure was standard mean difference (SMD) and the analysis model was random effect model. Results: The database was searched for 249 studies and six randomized controlled trials (RCTs) were finally synthesized after independent review by researchers. Only pain intensity was found to have a significant effect on pain intensity and disability (p<0.05). The pooled results showed a small effect size for pain intensity in acute to subacute LBP with thrust manipulation in sixRCTs(SMD= -0.44; 95% CI, -0.80 to -0.08) and a large effect size for disability in three RCTs (SMD= -0.96; 95% CI, -2.67 to 0.76). Conclusions: In conclusion, this review provides evidence supporting the effectiveness of thrust manipulation in reducing pain intensity and disability in patients with acute and subacute LBP. It highlights the potential benefits of incorporating thrust manipulation as a treatment option for LBP.