Spinal manipulation and mobilisation for back and neck pain: a blinded review.
OBJECTIVE
To assess the efficacy of spinal manipulation for patients with back or neck pain.


METHODS
Computer aided search for published papers and blinded assessment of the methods of the studies.


METHODS
35 randomised clinical trials comparing spinal manipulation with other treatments.


METHODS
Score for quality of methods (based on four main categories: study population, interventions, measurement of effect, and data presentation and analysis) and main conclusion of author(s) with regard to spinal manipulation.


RESULTS
No trial scored 60 or more points (maximum score 100) suggesting that most were of poor quality. Eighteen studies (51%) showed favourable results for manipulation. In addition, five studies (14%) reported positive results in one or more subgroups. Of the four studies with 50-60 points, one reported that manipulation was better, two reported that manipulation was better in only a subgroup, and one reported that manipulation was no better or worse than reference treatment. Eight trials attempted to compare manipulation with some placebo, with inconsistent results.


CONCLUSIONS
Although some results are promising, the efficacy of manipulation has not been convincingly shown. Further trials are needed, but much more attention should be paid to the methods of study.
Koes
B W
BW
Department of Epidemiology and Biostatistics, University of Limburg, Maastricht, The Netherlands.
Assendelft
W J
WJ
van der Heijden
G J
GJ
Bouter
L M
LM
Knipschild
P G
PG
D000208:Acute Disease; D001416:Back Pain / Q000628:therapy*; D002684:Chiropractic; D004311:Double-Blind Method; D006801:Humans; D008349:Manipulation, Orthopedic; D015201:Meta-Analysis as Topic; D009333:Neck; D059408:Pain Management; D016032:Randomized Controlled Trials as Topic; D013122:Spinal Diseases / Q000628:therapy