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Table 4
Summary findings from systematic review for MT combined or not with exercise or usual medical care for LBP. Strength of new and updated evidence is shown in underlined and in bold text. Confirmation of previous evidence shown in bold text
| Categories of MT interventions vs comparison group | Quality of evidence (A = high; B = moderate) | Strength of evidence for interventions | |||
| ACUTE (<6 weeks) and SUBACUTE (6–12 weeks) LBP | |||||
| MT1 vs Sham MT1 | 3 RCTs, Level A57–59 n = 395 | STRONG evidence in favour of MT1 in comparison to sham MT1 for acute LBP, for PAIN, function, overall-health and quality of life improvements in the short-term (<3 months). | |||
| MT1 and MT3 combined with UMC vs UMC alone | 2 RCTs Level B60,61 n = 151 | MODERATE evidence in favour of MT1 and MT3 combined with UMC in comparison to UMC alone for PAIN, functional improvement and quality of life from very-short to short-term in patients with acute LBP. | |||
| MT1 with ROM exercise vs MT2 with exercise or exercise alone | 2 RCTs Level B n = 243 (Cleland et al., 2009; Childs et al., 2004) | MODERATE evidence in favour of MT1 with exercise as compared to MT2 with exercise or exercise alone for pain relief and function improvement at very-short-term and short-term. Functional improvement is also present at intermediate-term (6 months) in a specific subgroup of patients with acute–subacute LBP. | |||
| MT3 combined with exercise ‘early’ vs the same intervention ‘delayed’ | 1 RCT Level B n = 102 (Wand et al., 2004) | LIMITED evidence in favour of an early intervention of MT3 combined with exercise in comparison to the same intervention delayed, on functional status and overall improvement at very-short-term and on overall improvement at intermediate-term in patients with acute LBP. | |||
| MT3 with UMC vs UMC alone | 2 RCTs Level B n = 339 (Curtis et al., 2000; Juni et al., 2009) | MODERATE evidence for no difference between MT3 combined with IMC in comparison to UMC alone, for pain reduction, functional recovery, and improvement in quality of life for very-short to intermediate-term in acute LBP. | |||
| MT3 combined with exercise vs UMC alone | 1 RCT Level B n = 402 (Hay et al., 2005) | LIMITED evidence for no difference between MT3 combined with exercise vs UMC alone in terms of pain reduction and improvements of function from short to long-term in patients with acute–subacute LBP | |||
| MT2 vs Sham ultra sound | 1 RCT Level A n = 240 (Hancock et al., 2007) | MODERATE evidence for no difference between MT2 and sham ultra sound in terms of pain reduction and functional improvements from very-short to short-term in acute LBP population. | |||
| MT3 combined with interferential therapy vs MT3 or interferential therapy alone | 1 RCT Level B n = 240 (Hurley et al., 2004) | LIMITED evidence for no difference between MT3 associated with interferential therapy and MT3 alone or interferential therapy alone in terms of pain reduction, functional improvements, and quality of life improvement in patients with acute–subacute LBP. | |||
| CHRONIC LBP (>12 weeks ) | |||||
| MT1 vs Sham MT1 | 2 RCTs Level A62,63 n = 157 | MODERATE-STRONG evidence in favour of MT1 as compared to sham MT1, in terms of pain reduction, functional improvements and overall-health improvement at SHORT-term to INTERMEDIATE-term in patients with chronic LBP. | |||
| MT3 combined with exercise or with UMC vs exercise alone and back school | 2 RCTs level B34,49 n = 259 | MODERATE evidence in favour of MT3 combined with exercise or with UMC as compared to exercise alone and back school in terms of pain and function and quality of life improvement from short to long-term in patients with chronic LBP. | |||
| MT2 combined with exercise and UMC vs UMC alone | 1 RCT Level B32 n = 204 | LIMITED evidence in favour of MT2 combined with exercise and UMC in comparison to UMC alone in terms of pain reduction and function improvement from short to long-term in patients with chronic LBP. | |||
| MT1 with extension exercise vs extension exercise alone | 1 RCT Level B64 n = 72 | LIMITED evidence for no difference between MT1 combined with extension exercise in comparison to extension exercise alone in improving pain in the short-term and long-term in patients with chronic LBP. | |||
| MT2 vs UMC MT2 vs acupuncture | 1 RCT Level B n = 262 (Cherkin et al., 2001) | LIMITED evidence in favour of MT2 as compared to UMC and acupuncture in terms of pain, function, and quality of life from short-term to long-term in patients with chronic LBP. | |||
| MT3 vs exercise | 2 RCTs Level B n = 452 (Ferreira et al., 2007; Critchley et al., 2007) | MODERATE evidence for no difference between interventions in terms of pain reduction, functional recovery and quality of life improvement in patients with chronic LBP. | |||
| MT3 vs Sham MT3 | 1 RCT Level A n = 91 (Licciardone et al., 2003) | MODERATE evidence for no difference between interventions in terms of pain reduction, functional improvement, and patient satisfaction with care in very short-term and intermediate-term for patients with chronic LBP. | |||
MT = manual therapy;
MT1 = manipulation;
MT2 = mobilization and soft-tissue-techniques;
MT3 = MT1+MT2.
UMC = usual medical care; exercise = specific and/or general exercise.