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Evidence-Based Resource Summary

Strength of Evidence: 
4 out of 4
4 out of 4
Year Published: 

Cochrane Summary – Spinal Manipulative Therapy for Chronic Low-Back Pain

Description of Resource: 
Spinal manipulative therapy (SMT) is an intervention that is widely practiced by a variety of health care professionals worldwide. The effectiveness of this form of therapy for the management of chronic low-back pain has come under dispute. In this updated review, 26 randomized controlled trials (representing 6,070 participants) were identified that assessed the effects of SMT in patients with chronic low-back pain. Treatment was delivered by a variety of practitioners, including chiropractors, manual therapists, and osteopaths. Only 9 trials were considered to have a low risk of bias—in other words, they had results in which some confidence existed. The results of this review demonstrate that SMT appears to be as effective as other common therapies prescribed for chronic low-back pain such as exercise therapy, standard medical care, or physiotherapy. However, less clear is how SMT compares with inert interventions or sham (placebo) treatment because only a few studies, typically with a high risk of bias, investigated these factors. Approximately 2/3 of the studies had a high risk of bias, which means researchers cannot be completely confident with the results. SMT appears to be no better or worse than other existing therapies for patients with chronic low-back pain.

Evidence-Based Resource Details

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Developed By: 
Cochrane collaboration
Developer Type: 
Non-Federal Government
Healthy People 2020 Topic Area(s): 
Arthritis, Osteoporosis, and Chronic Back Conditions
Healthy People 2020 Objectives: 
Resource Type: 
Systematic Review
Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews [Internet]. 2013 Jan 31 [cited 2013 Feb 28]. Available from: