title: The efficacy of manual therapy and exercise for different stages of non-specific low back pain: an update of systematic reviews.
abstract: OBJECTIVE
  to review and update the evidence for different forms of manual therapy (MT) for patients with different stages of non-specific low back pain (LBP).
  
  
  METHODS
  MEDLINE, Cochrane-Register-of-Controlled-Trials, PEDro, EMBASE.
  
  
  METHODS
  A systematic review of MT with a literature search covering the period of January 2000 to April 2013 was conducted by two independent reviewers according to Cochrane and PRISMA guidelines. A total of 360 studies were evaluated using qualitative criteria. Two stages of LBP were categorized; combined acute-subacute and chronic. Further sub-classification was made according to MT intervention: MT1 (manipulation); MT2 (mobilization and soft-tissue-techniques); and MT3 (MT1 combined with MT2). In each sub-category, MT could be combined or not with exercise or usual medical care (UMC). Consequently, quantitative evaluation criteria were applied to 56 eligible randomized controlled trials (RCTs), and hence 23 low-risk of bias RCTs were identified for review. Only studies providing new updated information (11/23 RCTs) are presented here.
  
  
  RESULTS
  Acute-subacute LBP: STRONG-evidence in favour of MT1 when compared to sham for pain, function and health improvements in the short-term (1-3 months). MODERATE-evidence to support MT1 and MT3 combined with UMC in comparison to UMC alone for pain, function and health improvements in the short-term. Chronic LBP: MODERATE to STRONG-evidence in favour of MT1 in comparison to sham for pain, function and overall-health in the short-term. MODERATE-evidence in favour of MT3 combined with exercise or UMC in comparison to exercise and back-school was established for pain, function and quality-of-life in the short and long-term. LIMITED-evidence in favour of MT2 combined with exercise and UMC in comparison to UMC alone for pain and function from short to long-term. LIMITED-evidence of no effect for MT1 with extension-exercise compared to extension-exercise alone for pain in the short to long-term.
  
  
  CONCLUSIONS
  This systematic review updates the evidence for MT with exercise or UMC for different stages of LBP and provides recommendations for future studies.
authors: Institute of Neuroscience, Faculty of Motor Sciences, University of Louvain, Brussels, Belgium.
authors: Benjamin
authors: B
authors: Hidalgo
authors: Institute of Neuroscience, Faculty of Motor Sciences, University of Louvain, Brussels, Belgium.
authors: Christine
authors: C
authors: Detrembleur
authors: School of Physiotherapy, Curtin Innovation Health Research Institute, Curtin University of Technology, Perth, WA, Australia.
authors: Toby
authors: T
authors: Hall
authors: Institute of Neuroscience, Faculty of Motor Sciences, University of Louvain, Brussels, Belgium ; Rehabilitation and Physical Medicine, Saint-Luc Hospital University of Louvain, Brussels, Belgium.
authors: Philippe
authors: P
authors: Mahaudens
authors: Institute of Neuroscience, Faculty of Motor Sciences, University of Louvain, Brussels, Belgium ; Rehabilitation and Physical Medicine, Saint-Luc Hospital University of Louvain, Brussels, Belgium.
authors: Henri
authors: H
authors: Nielens
keywords: Efficacy; Manual therapy; Non-specific low back pain; Randomized controlled trials; Spinal manipulation