A Cochrane review of combined chiropractic interventions for low-back pain.
METHODS
Cochrane systematic review of randomized controlled trials.


OBJECTIVE
To determine the effects of combined chiropractic interventions on pain, disability, back-related function, overall improvement, and patient satisfaction in adults with low-back pain (LBP).


BACKGROUND
Chiropractors commonly use a combination of interventions to treat people with LBP, but little is known about the effects of this care.


METHODS
We used a comprehensive search strategy. All randomized trials comparing combined chiropractic interventions (rather than spinal manipulation alone) with no treatment or other therapies were included. At least two authors selected studies, assessed bias risk, and extracted data. Descriptive synthesis and meta-analyses were performed.


RESULTS
We included 12 studies involving 2887 LBP participants. Three studies had low risk of bias. Included studies evaluated a range of chiropractic procedures in a variety of subpopulations with LBP. For acute and subacute LBP, chiropractic interventions improved short- and medium-term pain (standardized mean difference [SMD] -0.25 [95% CI: -0.46 to -0.04] and MD -0.89 [95%CI: -1.60 to -0.18]) compared with other treatments, but there was no significant difference in long-term pain (MD -0.46 [95% CI -1.18 to 0.26]). Short-term improvement in disability was greater in the chiropractic group compared to other therapies (SMD -0.36 [95% CI: -0.70 to -0.02]). However, the effect was small and studies contributing to these results had high risk of bias. There was no difference in medium- and long-term disability. No difference was demonstrated for combined chiropractic interventions for chronic LBP and studies that had a mixed population of LBP.


CONCLUSIONS
Combined chiropractic interventions slightly improved pain and disability in the short term and pain in the medium term for acute/subacute LBP. However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions.
Faculty of Health Sciences, School of Chiropractic and Sports Science, Murdoch University, Murdoch, Australia. bruce.walker@murdoch.edu.au
Bruce F
BF
Walker
Simon D
SD
French
William
W
Grant
Sally
S
Green
D006801:Humans; D017116:Low Back Pain / Q000453:epidemiology / Q000628:therapy*; D026882:Manipulation, Chiropractic / Q000379:methods* / Q000592:standards; D010147:Pain Measurement / Q000379:methods; D017060:Patient Satisfaction; D016032:Randomized Controlled Trials as Topic / Q000379:methods* / Q000592:standards; D016896:Treatment Outcome