Does the inclusion of spinal manipulative therapy in multimodal treatment regimens result in better outcomes in chronic low back pain? A systematic review

Abstract

Low back pain (LBP) is the most common musculoskeletal disorder. It is costly, both health wise and socioeconomically. Spinal manipulative therapy (SMT) is a popular and well researched conservative management of chronic LBP. However, little is known about its role cum effectiveness as part of multimodal treatment regimens. The aim of this systematic review is to examine the evidence of the effectiveness of SMT as part of a multimodal regimen in the management of chronic LBP. Eligible studies were identified by searching Medline, Embase, PEDro, CINAHL, AMED, and the Cochrane Central Register of controlled trials. Randomized controlled trials (RCTs) on patients with chronic mechanical LBP were considered. Data from four RCTs (430 participants) were included in this review. All four had a low risk of bias. Three studies found a statistically significant improvement in pain and function at both short term and long term in the group that received SMT as part of a multimodal treatment regimen. Heterogeneity in the nature of the interventions that made up the treatment regimen, comparison interventions, duration of treatment and follow-up periods were identified. There is moderate quality evidence that the addition of SMT to multimodal treatment regimens for chronic LBP results in better outcomes in terms of pain and function as compared to other conservative interventions.