title: Effectiveness of physical therapist administered spinal manipulation for the treatment of low back pain: a systematic review of the literature.
abstract: BACKGROUND
  Low back pain (LBP) is a prevalent disorder in society that has been associated with increased loss of work time and medical expenses. A common intervention for LBP is spinal manipulation, a technique that is not specific to one scope of practice or profession.
  
  
  OBJECTIVE
  The purpose of this systematic review was to examine the effectiveness of physical therapy spinal manipulations for the treatment of patients with low back pain.
  
  
  METHODS
  A search of the current literature was conducted using PubMed, CINAHL, SPORTDiscus, Pro Quest Nursing and Allied Health Source, Scopus, and Cochrane Controlled Trials Register. Studies were included if each involved: 1) individuals with LBP; 2) spinal manipulations performed by physical therapists compared to any control group that did not receive manipulations; 3) measurable clinical outcomes or efficiency of treatment measures, and 4) randomized control trials. The quality of included articles was determined by two independent authors using the criteria developed and used by the Physiotherapy Evidence Database (PEDro).
  
  
  RESULTS
  Six randomized control trials met the inclusion criteria of this systematic review. The most commonly used outcomes in these studies were some variation of pain rating scales and disability indexes. Notable results included varying degrees of effect sizes favoring physical therapy spinal manipulations and minimal adverse events resulting from this intervention. Additionally, the manipulation group in one study reported statistically significantly less medication use, health care utilization, and lost work time.
  
  
  CONCLUSIONS
  Based on the findings of this systematic review there is evidence to support the use of spinal manipulation by physical therapists in clinical practice. Physical therapy spinal manipulation appears to be a safe intervention that improves clinical outcomes for patients with low back pain.
authors: Walsh University, North Canton, OH, USA.
authors: John J
authors: JJ
authors: Kuczynski
authors: Braun
authors: B
authors: Schwieterman
authors: Kirby
authors: K
authors: Columber
authors: Darren
authors: D
authors: Knupp
authors: Lauren
authors: L
authors: Shaub
authors: Chad E
authors: CE
authors: Cook
keywords: Low back pain; manipulation; manual therapy; spine