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BMJ. 1991 November 23; 303(6813): 1298–1303. | PMCID: PMC1671430 |
Spinal manipulation and mobilisation for back and neck pain: a blinded review. B W Koes, W J Assendelft, G J van der Heijden, L M Bouter, and P G Knipschild Department of Epidemiology and Biostatistics, University of Limburg, Maastricht, The Netherlands. Abstract OBJECTIVE--To assess the efficacy of spinal manipulation for patients with back or neck pain. DESIGN--Computer aided search for published papers and blinded assessment of the methods of the studies. SUBJECTS--35 randomised clinical trials comparing spinal manipulation with other treatments. MAIN OUTCOME MEASURES--Score for quality of methods (based on four main categories: study population, interventions, measurement of effect, and data presentation and analysis) and main conclusion of author(s) with regard to spinal manipulation. RESULTS--No trial scored 60 or more points (maximum score 100) suggesting that most were of poor quality. Eighteen studies (51%) showed favourable results for manipulation. In addition, five studies (14%) reported positive results in one or more subgroups. Of the four studies with 50-60 points, one reported that manipulation was better, two reported that manipulation was better in only a subgroup, and one reported that manipulation was no better or worse than reference treatment. Eight trials attempted to compare manipulation with some placebo, with inconsistent results. CONCLUSIONS--Although some results are promising, the efficacy of manipulation has not been convincingly shown. Further trials are needed, but much more attention should be paid to the methods of study. Full text Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.3M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References. These references are in PubMed. This may not be the complete list of references from this article. - Kelsey JL, White AA., 3rd Epidemiology and impact of low-back pain. Spine (Phila Pa 1976). 1980 Mar–Apr;5(2):133–142. [PubMed]
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