DOI: 10.3886/e213221v1
title: THE EFFECT OF SPINAL MANIPULATION ON LOWER EXTREMITY RADICULAR PAIN: A SYSTEMATIC REVIEW AND META-ANALYSIS

description: The purpose of the study was to analyze the current body of evidence on SMT as an intervention for pain, disability, and LE neural mobility range of motion (ROM) for individuals with LBP and LE radicular pain.Randomized controlled trials (RCTs) evaluating the effectiveness of spinal manipulation for patients with lower back pain and lower extremity radicular pain were searched using four electronic databases from June to July 2024. The databases searched were EBSCO, Cochrane Library, PubMed, and Google Scholar. Inclusion criteria included: RCT, pilot RTC, or QUASI-experimental studies published 2009-2024 and limited to English language. Additional criteria included radiating symptoms distal to lumbar spine and age &gt;18 years old. Data extraction was carried out by two authors using a customized spreadsheet and discrepancies in the extracted data were reviewed and resolved by the lead author. The following data elements were extracted from the included studies: sample size, age, diagnosis, intervention protocols, control protocols, timeframe, and raw statistical data pertaining to the outcomes of interest. The specific outcomes of interest were self-reported pain, self-reported disability, and lower extremity neural range of motion measurements. For the identified outcomes, the mean and standard deviation (SD) at the final time point after the intervention were extracted for both the intervention group and the control or comparison group. Random-effects meta-analysis was performed, where appropriate, using Comprehensive Meta-Analysis 4.0. The pooled mean difference between the SMT and control groups with 95% confidence intervals (CI) was calculated for all outcomes. Effect size was calculated and measured using Cohen’s d. These data, which will be submitted to ICPSR, fit within the scope of the ICPSR Collection Development Policy. A letter of support describing ICPSR’s commitment to the data as they have been described is provided.
description: The PEDro scale is a tool designed to facilitate evidence-based practice in physical therapy by evaluating the impact of interventions and the validity of studies, thereby guiding clinical reasoning and practice [23]. It consists of 11 items, and a score of 7 or higher indicates a high-quality randomized controlled trial (RCT), while a score of 5 or 6 out of 10 indicates moderate quality, and a score below 5 out of 10 indicates a low-quality study.<br>Welcome to PEDro, the physiotherapy evidence database. PEDro.org. Published online October 10, 2022. Available from: https://pedro.org.au <br><br>The GRADE method is a systematic approach for evaluating the evidence in systematic reviews, enabling the grading of recommendation strength for various outcomes in a study. The evidence from each study was graded as high, moderate, low, or very low based on criteria such as study design, risk of bias, consistency, directness, precision within the study, and publication bias.<br>Malmivaara A. Methodological considerations of the GRADE method. Ann Med. 2015;47(1):1-5. doi:10.3109 <br><br>
description: Presence of Common Scales: Effect size was calculated and measured using Cohen’s d, where a small effect is classified as d=0.2, a medium effect as d=0.5, and a large effect as d=0.8.<br><br>Lakens D. Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol. 2013;4:863. doi:10.3389/fpsyg.2013.00863 <br>
description: This systematic review is presented according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered on PROSPERO with the following registration #: CRD42024557686.<br><br>Page MJ, McKenzie JE, Boutron I, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(71). doi:10.1136/bmj.n71 <br>
description: Adults &gt;18 years of age with lower back pain and/or radiating leg pain; articles written in English, full text available; spinal manipulation performed as the intervention and compared to sham and/or other passive interventions.
description: other;