A Systematic Review and Meta-Analysis of Efficacy, Cost-Effectiveness, and Safety of Selected Complementary and Alternative Medicine for Neck and Low-Back Pain

Table 7

Summary of findings of mobilization for neck pain (only pain and functional outcomes).

Duration and cause of pain	Outcomes	GRADE*	Findings
Mobilization versus no treatment
Acute/subacute or unknown (specific, nonspecific)	NA	Insufficient; No trial	NA
Chronic specific	NA	Insufficient; No trial	NA
Chronic nonspecific	Pain intensity score (VAS)	Low; Design: RCT; ROB: Medium; Consistency: NA (only 1 trial); Directness: yes	In one trial [135], mobilization was significantly better than “no treatment” group immediately after treatment (𝑃=0.04); the mean VAS score decrease in mobilization group was from 0.68±0.42 to 0.33±0.02 mm. Corresponding numerical data for “no treatment” group was not reported.
Mixed specific	NA	Insufficient; No trial	NA
Mixed nonspecific	Pain intensity score (VAS)	Low; Design: RCT; ROB: High; Consistency: NA (only 1 trial); Directness: yes	In one study [136], the use of bone-setting resulted in a significantly greater mean VAS reduction compared to “no treatment” immediately (18.5, 95% CI: 12.0, 25.1 versus 4.0, 95% CI: −3.1, 11.1; 𝑃=0.002), short- (21.2, 95% CI: 12.7, 29.7 versus 6.2, 95% CI: −1.4, 13.8; 𝑃=0.01), and intermediate-term (22.9, 95% CI: 13.1, 32.7 versus 5.4, 95% CI: −1.9, 12.8; 𝑃=0.005) after treatment; the between-group difference was not significant (14.2, 95% CI: 5.3, 23.1 versus 5.5, 95% CI: −4.9, 15.5; 𝑃=0.2) at long-term followup (1 year posttreatment).; Similarly, the proportion of improved subjects (> 50% on VAS) in bone setting group was significantly greater compared to “no treatment” group immediately (𝑃=0.04) and intermediate-term (𝑃=0.002) after treatment. This difference was not statistically significant after one year (𝑃=0.2).
Mobilization versus placebo
Acute/subacute specific	NA	Insufficient; No trial	NA
Acute/subacute nonspecific	Pain intensity score (VAS)	Low; Design: RCT; ROB: Medium; Consistency: NA (only 1 trial); Directness: yes	In one trial [114], mobilization was significantly (numerical data not reported; 𝑃<0.01) better than placebo (hand placement without any pressure or tension).
Chronic specific	NA	Insufficient; No trial	NA
Chronic nonspecific	Pain intensity score (VAS)	Low; Design: RCT; ROB: Medium; Consistency: NA (only 1 trial); Directness: yes	In one trial [135], mobilization was not significantly (𝑃=0.09) different from placebo (hand placement without movement of vertebral segment). The mean VAS score decrease in mobilization group was from 0.68±0.42 to 0.33±0.02 mm. Corresponding numerical data for placebo group was not reported.
Mixed or unknown (specific, nonspecific)	NA	Insufficient; No trial	NA
Mobilization versus pain medication
Acute/subacute, chronic, mixed, or unknown (specific, nonspecific)	NA	Insufficient; No trial	NA
Mobilization versus Massage
Acute/subacute, mixed, or unknown (specific, nonspecific)	NA	Insufficient; No trial	NA
Chronic specific	NA	Insufficient; No trial	NA
Chronic nonspecific	Pain intensity score (VAS)	Low; Design: RCT; ROB: Medium; Consistency: NA (only 1 trial); Directness: yes	In one trial [137], bone setting was significantly better than massage at intermediate-term after treatment (mean VAS score: 17.9±18.0 versus 25.4±22.0, 𝑃<0.05).
	Disability score (NDI)	Low; Design: RCT; ROB: Medium; Consistency: NA (only 1 trial); Directness: yes	In one trial [137], bone setting was significantly better than massage at intermediate-term after treatment (mean NDI score: 11.7±9.0 versus 15.3±10.0, 𝑃<0.05).
Mobilization versus manipulation (see Table 5 for manipulation for neck pain)
Mobilization versus usual care
Acute/subacute, chronic or unknown (specific, nonspecific)	NA	Insufficient; No trial	NA
Mixed specific	NA	Insufficient; No trial	NA
Mixed nonspecific	Pain intensity score (VAS)	Low; Design: RCT; ROB: High; Consistency: NA (only 1 trial); Directness: yes	In one trial [138], spinal mobilization was not significantly different from usual care (counseling and advice on staying active, role of psychosocial factors, self-care such as heat application, home exercises, and ergonomic advice) at intermediate-term posttreatment followup (between-group difference in mean VAS score reduction: 0.5, 95% CI: −0.4, 1.3).
	Disability score (NDI)	Low; Design: RCT; ROB: High; Consistency: NA (only 1 trial); Directness: yes	In one trial [138] spinal mobilization was not significantly different from usual care (counseling and advice on staying active, role of psychosocial factors, self-care such as heat application, home exercises, and ergonomic advice) at intermediate-term posttreatment followup (between-group difference in mean NDI score reduction: −0.02, 95% CI: −2.3, 2.3).
Mobilization versus physiotherapy
Acute/subacute or unknown (specific, nonspecific)	NA	Insufficient; No trial	NA
Chronic specific	NA	Insufficient; No trial	NA
Chronic nonspecific	Pain intensity score (VAS)	Low; Design: RCT; ROB: Medium; Consistency: NA (only 1 trial); Directness: yes	In one trial, [137] bone setting was significantly better than physiotherapy (massage, therapeutic stretching, and exercise therapy) at intermediate-term after treatment (mean VAS score: 17.9±18.0 versus 29.6±23.0, 𝑃<0.05).
	Disability score (NDI)	Low; Design: RCT; ROB: Medium; Consistency: NA (only 1 trial); Directness: yes	In one trial, [137] bone setting was significantly better than physiotherapy (massage, therapeutic stretching, and exercise therapy) at intermediate-term after treatment (mean NDI score: 11.7±9.0 versus 18.4±10.0, 𝑃<0.05).
Mixed specific	NA	Insufficient; No trial	NA
Mixed nonspecific	Pain intensity score (VAS)	Low; Design: RCT; ROB: High; Consistency: NA (only 1 trial); Directness: yes	In one trial [138] spinal mobilization was significantly better than physiotherapy (including specific exercises) at intermediate-term posttreatment followup (between-group difference in mean VAS score reduction: 1.0, 95% CI: 0.1, 1.9).
	Disability score (NDI)	Low; Design: RCT; ROB: High; Consistency: NA (only 1 trial); Directness: yes	In one trial [138] spinal mobilization was not significantly different physiotherapy at intermediate-term posttreatment followup (between-group difference in mean NDI score reduction: 1.1, 95% CI: −1.3, 3.4).
Mobilization versus exercise
Acute/subacute, chronic, mixed, or unknown (specific, nonspecific)	NA	Insufficient; No trial	NA
Mobilization versus acupuncture
Acute/subacute, chronic, mixed, or unknown (specific, nonspecific)	NA	Insufficient; No trial	NA

*Precision in formal grading was applied only to pooled results.
VAS: visual analog scale; RMDQ: Roland-Morris disability scale; NHP: Nottingham health profile; MPQ: McGill pain questionnaire; PDI: pain disability index; NPQ: neck pain questionnaire; SF-PQ: short form pain questionnaire; PRI: pain rating index; PPI: present pain intensity; NA: not applicable; NDI: neck disability index; IQR: interquartile range.