STUDY DESIGN: Systematic review of interventions. OBJECTIVE: To assess the effects of spinal manipulative therapy (SMT) for chronic @entity1643 . SUMMARY OF BACKGROUND DATA: SMT is one of the many therapies for the treatment of @entity1643 , which is a worldwide, extensively practiced intervention. METHODS: Search methods. An experienced librarian searched for @entity23 ( @entity23 ) in multiple databases up to June 2009. Selection criteria. @entity23 that examined manipulation or mobilization in adults with chronic @entity1643 were included. The primary outcomes were @entity158 , functional status, and perceived recovery. Secondary outcomes were return-to-work and quality of life. Data collection and analysis. Two authors independently conducted the study selection, risk of bias assessment, and data extraction. GRADE was used to assess the quality of the evidence. RESULTS: We included 26 @entity23 (total @entity1 = 6070), 9 of which had a low risk of bias. Approximately two-thirds of the included studies (N = 18) were not evaluated in the previous review. There is a high-quality evidence that SMT has a small, significant, but not clinically relevant, short-term effect on @entity158 relief (mean difference -4.16, 95% confidence interval -6.97 to -1.36) and functional status (standardized mean difference -0.22, 95% confidence interval -0.36 to -0.07) in comparison with other interventions. There is varying quality of evidence that SMT has a significant short-term effect on @entity158 relief and functional status when added to another intervention. There is a very low-quality evidence that SMT is not more effective than inert interventions or sham SMT for short-term @entity158 relief or functional status. Data were particularly sparse for recovery, return-to-work, quality of life, and costs of care. No serious complications were observed with SMT. CONCLUSIONS: High-quality evidence suggests that there is no clinically relevant difference between SMT and other interventions for reducing @entity158 and improving function in @entity1 with chronic @entity1643 . Determining cost-effectiveness of care has high priority.

Spinal manipulative therapy for chronic XXXX : an update of a Cochrane review.

@entity1 :: ('9606', 'Species') :: ['participants', 'patients'] @entity23 :: ('MESH:D007174', 'Disease') :: ['randomized controlled trials', 'RCTs'] @entity1643 :: ('MESH:D017116', 'Disease') :: ['low-back pain'] @entity158 :: ('MESH:D010146', 'Disease') :: ['pain']
@entity1643 :: (MESH:D017116,Disease) :: ['low-back pain']
