Psychological Response in Spinal Manipulation (PRISM):
A Systematic Review of Psychological Outcomes
in Randomised Controlled Trials

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:   Frankp@chiro.org

FROM:   Complementary Therapies in Medicine 2007 (Dec); 15 (4): 271–283

OPEN ACCESS

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Nefyn H. Williams, Maggie Hendry, Ruth Lewis, Ian Russell,
Alex Westmoreland and Clare Wilkinson

Department of General Practice,
Cardiff University,
Centre for Health Services Research/North Wales Clinical School,
Gwenfro Building, Wrecsam Technology Park,
Wrecsam LL13 7YP, United Kingdom

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Background   The most important risk factors for back and neck pain are psychosocial. Nevertheless, systematic reviews of spinal manipulation have concentrated on pain and spine related disability, and ignored psychological outcomes.

Objective   To assess whether spinal manipulation was effective in improving psychological outcome.

Design   Systematic review of randomised controlled trials (RCTs).

Methods   RCTs were identified by searching Medline, CINAHL, Embase, CENTRAL, AMED, PsycINFO until November 2005. Trials reporting psychological outcomes including the mental health components of generic outcomes were extracted, and combined where appropriate in meta-analyses.

Results   One hundred and twenty nine RCTs of spinal manipulation were identified; 12 had adequately reported psychological outcomes. Six trials with a verbal intervention comparator were combined in a meta-analysis, and found a mean benefit from spinal manipulation equivalent to 0.34 of the population standard deviation (S.D.) [95% confidence interval (CI) 0.23–0.45] at 1–5 months; 0.27 of the S.D. [95% CI 0.14–0.40] at 6–12 months. Eight trials with a physical treatment comparator were combined in a meta-analysis and found a mean benefit of 0.13 of the S.D. [95% CI 0.01–0.24] in favour of manipulation at 1–5 months; 0.11 of the S.D. [95% CI -0.02 to 0.25] at 6–12 months.

Conclusions   There was some evidence that spinal manipulation improved psychological outcomes compared with verbal interventions.

Keywords:   Systematic review; Back pain; Neck pain; Spinal manipulation; Psychological outcome

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