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| Duration and cause of pain | Outcomes | GRADE* | Findings |
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| Manipulation + mobilization versus placebo |
|
| Acute/subacute nonspecific | Pain intensity (NRS 0–10) | Low
Design: RCT
ROB: Medium
Consistency: NA (one trial)
Directness: yes | In one trial [153] there were nonsignificant differences in pain intensity. Immediate posttreatment: −2.0 (95% CI: −0.7, 0.3) versus −0.1 (95% CI: −0.6, 0.4); short-term posttreatment: −0.2 (95% CI: −0.7, 0.3) versus 0.0 (95% CI: −0.5, 0.4). |
| Roland-Morris Disability score | Low
Design: RCT
ROB: Medium
Consistency: NA (one trial)
Directness: yes | In one trial [153] there were nonsignificant differences in disability. Immediate posttreatment: −1.0 (95% CI: −2.0, 0.1) versus −0.7 (95%CI: −1.8, 0.4); short-term: −0.5 (95% CI: −1.7, 0.7) versus −0.1 (95% CI: −1.3, 1.1). |
|
| Acute/subacute specific | NA | Insufficient
No trial | NA |
|
| Chronic, mixed, unknown (specific, nonspecific) | NA | Insufficient
No trial | NA |
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| Manipulation + mobilization versus physiotherapy |
|
| Acute/subacute, chronic, unknown (specific, nonspecific) | NA | Insufficient
No trial | NA |
|
| Mixed nonspecific | Pain intensity (NRS 0–10) | Low
Design: RCT
ROB: Medium
Consistency: NA (one trial)
Directness: yes | In one trial [154] the combination of manipulation and mobilization was associated with significantly greater improvements in intermediate- and long-term posttreatment pain intensity (numerical data not provided). |
|
| Mixed specific | NA | Insufficient
No trial | NA |
|
| Manipulation + mobilization versus usual care |
|
| Acute/subacute, Chronic (specific, nonspecific) | NA | Insufficient
No trial | NA |
|
|
Mixed nonspecific | Pain intensity (VAS score) | Low
Design: RCT
ROB: Medium
Consistency: NA (one trial)
Directness: yes | In one trial [156], the combination of manipulation and mobilization (with or without physical modalities) was not significantly different from medical care alone or medical care combined with physical modalities immediately posttreatment or in the long-term posttreatment measures of pain. |
| Roland-Morris Disability score | Low
Design: RCT
ROB: Medium
Consistency: NA (one trial)
Directness: yes | In one trial [156], the combination of manipulation and mobilization (with or without physical modalities) was not significantly different from medical care alone or medical care combined with physical modalities immediately posttreatment and in the long-term posttreatment measures of disability. |
|
| Mixed specific | NA | Insufficient
No trial | NA |
|
| Unknown nonspecific | Oswestry Disability Index | Low
Design: RCT
ROB: Medium
Consistency: NA (one trial)
Directness: yes | In one trial [212] subjects receiving manipulation plus mobilization had significantly improved long-term disability. The mean change was 1.03 in the manipulation group versus 0.67 in the hospital outpatient treatment group at short-term posttreatment followup, and 0.94 versus 0.73 at intermediate-term posttreatment followup, respectively. |
|
| Unknown specific | NA | Insufficient
No trial | NA |
|
| Manipulation + mobilization versus exercise |
|
| Acute/subacute, (specific, nonspecific) | NA | Insufficient
No trial | NA |
|
|
Chronic nonspecific | Pain intensity (VAS score) | Low
Design: RCT
ROB: Medium
Consistency: NA (one trial)
Directness: yes | In one trial [158] the manual therapy group showed significantly greater improvements than the exercise therapy group on pain intensity. The immediate posttreatment means (SD) in the manual therapy and exercise group were: 22 (18.56) and 37 (25.12), respectively.
The corresponding means (SD) at short-term posttreatment followup were 22 (19.88) versus 39 (22.53).
The corresponding means (SD) at intermediate-term posttreatment followup were 21 (14.58) versus 35 (35.89). |
| Oswestry Disability Index | Low
Design: RCT
ROB: Medium
Consistency: NA (one trial)
Directness: yes | In one trial [158] the manual therapy group showed significantly greater improvements than the exercise therapy group on disability. The posttreatment mean (SD) in the manual therapy versus exercise group were:
(a) immediate followup: 18 (13.26) versus 30 (10.77)
(b) short-term followup: 18 (11.93) versus 30 (14.36)
(c) intermediate-term followup: 17 (13.25) versus 26 (14.36). |
|
| Chronic specific | NA | Insufficient
No trial | NA |
|
| Mixed, Unknown (specific, nonspecific) | NA | Insufficient
No trial | NA |
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