Spinal Manipulative Therapy for Nonspecific Low Back Pain: Does Targeting a Specific Vertebral Level Make a Difference?: A Systematic Review With Meta-analysis

Peter Westlund Sørensen; Casper Glissmann Nim; Erik Poulsen; Carsten Bogh Juhl

doi:10.2519/jospt.2023.11962

Spinal Manipulative Therapy for Nonspecific Low Back Pain: Does Targeting a Specific Vertebral Level Make a Difference?: A Systematic Review With Meta-analysis

J Orthop Sports Phys Ther. 2023 Sep;53(9):529–539. doi: 10.2519/jospt.2023.11962.

Authors

Peter Westlund Sørensen¹, Casper Glissmann Nim^{2

3

4}, Erik Poulsen¹, Carsten Bogh Juhl^{1

5}

Affiliations

¹ Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
² Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Denmark.
³ Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
⁴ Research Unit of Clinical Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
⁵ Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Denmark.

PMID: 37506306
DOI: 10.2519/jospt.2023.11962

Abstract

OBJECTIVE: We aimed to examine whether targeting spinal manipulative therapy (SMT), by applying the intervention to a specific vertebral level, produces superior clinical outcomes than a nontargeted approach in patients with nonspecific low back pain. DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: MEDLINE, Embase, CENTRAL, CINAHL, Scopus, PEDro, and Index to Chiropractic Literature were searched up to May 31, 2023. STUDY SELECTION CRITERIA: Randomized controlled trials comparing targeted SMT (mobilization or manipulation) to a nontargeted approach in patients with nonspecific low back pain, and measuring the effects on pain intensity and patient-reported disability. DATA SYNTHESIS: Data extraction, risk of bias, and evaluation of the overall certainty of evidence using the GRADE approach were performed by 2 authors independently. Meta-analyses were performed using the restricted maximum likelihood method. RESULTS: Ten randomized controlled trials (n = 931 patients) were included. There was moderate-certainty evidence of no difference between targeted SMT and a nontargeted approach for pain intensity at postintervention (weighted mean difference = -0.20 [95% CI: -0.51, 0.10]) and at follow-up (weighted mean difference = 0.05 [95% CI: -0.26, 0.36]). For patient-reported disability, there was moderate-certainty evidence of no difference at postintervention (standardized mean difference = -0.04 [95% CI: -0.36, 0.29]) and at follow-up (standardized mean difference = -0.05 [95% CI: -0.24, 0.13]). Adverse events were reported in 4 trials, and were minor and evenly distributed between groups. CONCLUSION: Targeting a specific vertebral level when administering SMT for patients with nonspecific low back pain did not result in improved outcomes on pain intensity and patient-reported disability compared to a nontargeted approach. J Orthop Sports Phys Ther 2023;53(9):1-11. Epub: 28 July 2023. doi:10.2519/jospt.2023.11962.

Keywords: low back/lumbar spine; manual therapy/spine; pain; systematic review/meta-analysis.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Back Pain / etiology
Bias
Humans
Low Back Pain* / etiology
Low Back Pain* / therapy
Manipulation, Spinal* / methods
Pain Measurement