Effect of spinal manipulative therapy on adults with low back pain meeting a clinical prediction rule. A systematic review

Background: Spinal manipulative therapy (SMT) is one of many therapies used to treat low back pain. Reviews have concluded that SMT is no more effective than other recommended therapies. Subgrouping patients using clinical prediction rules have been suggested to potentially increase the effect of SMT in the treatment of low back pain. Objective: To review the effect of spinal manipulative therapy on adults with low back pain meeting a clinical prediction rule compared to those who do not meet a clinical prediction rule. Methods: An experienced librarian and the master student searched for randomized controlled trials (RCTs) in multiple databases up to 27th of august 2014. RCTs that examined the effect of manipulation or mobilization in adults with low back pain and using a clinical prediction rule to subgroup the patients were included. The outcomes were pain and function. Two reviewers independently conducted the study selection, risk of bias assessment and data extraction. Results: We identified 2 RCTs (total participants = 370). Both studies had a low risk of bias. One study found that patients who were positive on the clinical prediction rule and received manipulation experienced significantly better effects on pain and function at 1 week, 4 weeks and 6 months than patients who were rule negative and received manipulation. The results, in the other study, showed no significant differences in effects on pain and function between status on the rule and manipulation at 1 week, 2 weeks, 4 weeks and 12 weeks. Conclusion: There are conflicting results whether patients who are rule positive have a better effect of manipulation than rule negative patients. More studies including both rule positive and rule negative patients are needed to find out more about the effect of manipulation in subgroups of LBP patients