title: The effectiveness of complementary manual therapies for pregnancy-related back and pelvic pain: A systematic review with meta-analysis.
abstract: BACKGROUND
  Low back pain and pelvic girth pain are common in pregnancy and women commonly utilize complementary manual therapies such as massage, spinal manipulation, chiropractic, and osteopathy to manage their symptoms.
  
  
  OBJECTIVE
  The aim of this systematically review was to critically appraise and synthesize the best available evidence regarding the effectiveness of manual therapies for managing pregnancy-related low back and pelvic pain.
  
  
  METHODS
  Seven databases were searched from their inception until April 2015 for randomized controlled trials. Studies investigating the effectiveness of massage and chiropractic and osteopathic therapies were included. The study population was pregnant women of any age and at any time during the antenatal period. Study selection, data extraction, and assessment of risk of bias were conducted by 2 reviewers independently, using the Cochrane tool. Separate meta-analyses were conducted to compare manual therapies to different control interventions.
  
  
  RESULTS
  Out of 348 nonduplicate records, 11 articles reporting on 10 studies on a total of 1198 pregnant women were included in this meta-analysis. The therapeutic interventions predominantly involved massage and osteopathic manipulative therapy. Meta-analyses found positive effects for manual therapy on pain intensity when compared to usual care and relaxation but not when compared to sham interventions. Acceptability did not differ between manual therapy and usual care or sham interventions.
  
  
  CONCLUSIONS
  There is currently limited evidence to support the use of complementary manual therapies as an option for managing low back and pelvic pain during pregnancy. Considering the lack of effect compared to sham interventions, further high-quality research is needed to determine causal effects, the influence of the therapist on the perceived effectiveness of treatments, and adequate dose-response of complementary manual therapies on low back and pelvic pain outcomes during pregnancy.
authors.affiliation: Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney Faculty of Medicine, Nursing and Health Sciences, School of Nursing & Midwifery Monash University, Frankston, Australia Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany Department of Neurobiolgy, Care Sciences and Society, Karolinska Institutet The Integrative Care Science Centre, Stockholm, Sweden Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Hall
authors.forename: Holger
authors.initials: H
authors.lastname: Cramer
authors.forename: Tobias
authors.initials: T
authors.lastname: Sundberg
authors.forename: Lesley
authors.initials: L
authors.lastname: Ward
authors.forename: Jon
authors.initials: J
authors.lastname: Adams
authors.forename: Craig
authors.initials: C
authors.lastname: Moore
authors.forename: David
authors.initials: D
authors.lastname: Sibbritt
authors.forename: Romy
authors.initials: R
authors.lastname: Lauche
mesh_terms: D000328:Adult; D001416:Back Pain / Q000628:therapy*; D000529:Complementary Therapies / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D026882:Manipulation, Chiropractic / Q000706:statistics & numerical data; D026301:Manipulation, Osteopathic / Q000706:statistics & numerical data; D020393:Manipulation, Spinal / Q000706:statistics & numerical data; D008405:Massage / Q000706:statistics & numerical data; D017699:Pelvic Pain / Q000628:therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D016896:Treatment Outcome