Introduction
Methods
Criteria for considering studies for this review
Types of studies
Types of participants
Types of interventions
Types of outcome measures
Primary outcomes
Search methods for identification of studies
Electronic searches
Searching other resources
Data collection and analysis
Selection of studies
Assessment of risk of bias of included studies
Data extraction
Statistical analysis
Effect size calculations
Quality of the evidence
Clinical relevance
Results
Description of studies
Results of the search
Included studies
Spinal manipulative therapy
Acupuncture
Herbal medicine
Risk of bias
Author | A | B | C | D | E | F | G | H | I | J | K | Total | Comments |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Spinal manipulative therapy | |||||||||||||
Chown et al. [16]a
| + | ? | + | − | − | − | ? | − | − | + | ? | 3 | Fatal flaw |
Ferreira et al. [26] | + | + | + | − | − | − | + | + | + | + | + | 8 | |
Goldby et al. [35] | + | ? | + | − | − | − | ? | − | + | + | ? | 4 | |
Gudavalli et al. [37]b
| + | + | + | − | − | − | ? | ? | − | + | ± | 4+ | |
Licciardone et al. [52] | + | + | + | + | − | + | − | ? | − | + | ? | 6 | |
Mohseni-Bandpei et al. [59] | ? | ? | + | − | − | − | ? | ? | − | + | ? | 2 | |
Muller and Giles [60]c
| ? | + | + | − | − | − | ? | − | − | + | + | 4 | Fatal flaw |
Wilkey et al. [77] | ? | + | − | − | − | − | ? | − | + | + | ? | 3 | |
Acupuncture | |||||||||||||
+ | ? | + | − | − | − | + | ? | + | + | + | 6 | ||
Carlsson and Sjolund [15]d
| + | + | ? | + | − | + | ? | ? | ± | + | + | 6+ | |
Coan et al [22] | + | + | ? | − | − | − | ? | − | − | − | − | 2 | |
Ding [24] | ? | − | ? | + | − | + | ? | ? | + | + | − | 4 | |
Giles and Muller [33]c
| + | + | + | − | − | − | + | ? | − | + | + | 6 | Fatal flaw |
Giles and Muller [34]c
| ? | + | ? | − | − | − | ? | − | − | + | − | 2 | Fatal flaw |
Grant et al. [36]e
| + | + | − | − | − | − | + | ? | + | + | ? | 5 | Fatal flaw |
Gunn et al. [38] | − | ? | ? | − | − | − | ? | ? | + | − | − | 1 | |
Haake et al. [40] | + | + | + | + | − | + | ? | ? | + | + | + | 8 | |
Itoh et al. [42] | + | ? | + | + | − | + | + | ? | − | + | ? | 6 | |
Itoh et al. [43] | + | ? | + | + | − | + | ? | ? | − | + | ? | 5 | |
Kerr et al. [46]f
| + | ? | ? | + | − | + | ? | ? | − | + | − | 4 | |
Lehmann et al. [49] | ? | ? | ? | − | − | − | + | ? | − | + | − | 2 | |
Leibing et al. [50] | + | + | + | + | − | + | + | ? | − | + | ? | 7 | |
MacDonald et al. [53] | ? | ? | + | + | − | + | ? | ? | + | ? | + | 4 | |
Mendelson et al. [57] | ? | ? | + | + | − | + | ? | ? | + | + | − | 5 | |
Meng et al. [58]g
| + | + | ± | − | − | − | + | ? | + | + | + | 6+ | |
Muller and Giles [60]c
| + | + | + | − | − | − | ? | − | − | + | + | 5 | Fatal flaw |
Sator-Katzenschlager et al. [64] | + | ? | + | + | + | + | ? | ? | + | + | + | 8 | |
Thomas and Lundberg [67] | ? | ? | + | − | − | − | − | + | ? | + | + | 4 | |
Witt et al. [78] | + | ? | + | − | − | − | ? | ? | + | + | ? | 4 | |
Yeung et al. [79] | ? | + | + | − | − | − | + | + | + | + | + | 7 | |
Herbal medicine | |||||||||||||
Chrubasik et al. [20] | + | ? | + | + | + | + | ? | ? | + | + | + | 8 | |
Chrubasik et al. [19] | + | + | + | − | − | − | + | ? | + | + | − | 6 | |
Chrubasik et al. [17] | + | ? | − | + | + | + | ? | ? | + | + | + | 7 | |
Chrubasik et al. [18] | + | ? | + | + | + | + | ? | ? | + | + | + | 8 | |
Chrubasik et al. [21] | + | ? | + | + | + | + | ? | ? | + | + | − | 7 | |
Frerick et al. [27] | + | + | ? | ? | ? | ? | + | + | + | ? | + | 6 | |
Keitel et al. [45] | ? | ? | ? | + | ? | + | + | + | + | + | + | 7 |
Spinal manipulative therapy
Acupuncture
Herbal medicine
Effects of interventions
Spinal manipulative therapy
Outcome or subgroup | Studies | Participants | Statistical method | Effect estimate |
---|---|---|---|---|
1. Spinal manipulative therapy versus no treatment or waiting list control | ||||
No studies were identified | ||||
2. Spinal manipulative therapy versus sham/placebo/passive modalities | ||||
2.1 Pain | 3 | Mean difference (IV, Random, 95% CI) | Subtotals only | |
2.1.1 Pain at 1 month | 2 | 177 | Mean difference (IV, Random, 95% CI) | −4.32 [−25.36, 16.73] |
2.1.2 Pain at 3 months | 2 | 177 | Mean difference (IV, Random, 95% CI) | 1.81 [−7.13, 10.75] |
2.1.3 Pain at 6 months | 3 | 225 | Mean difference (IV, Random, 95% CI) | −0.41 [−15.05, 14.23] |
2.1.4 Pain at 12 months | 1 | 102 | Mean difference (IV, Random, 95% CI) | 5.20 [−9.56, 19.96] |
2.2 Disability | 3 | Std. Mean difference (IV, Random, 95% CI) | Subtotals only | |
2.2.1 Disability at 1 month | 2 | 177 | Std. Mean Difference (IV, Random, 95% CI) | −0.36 [−0.66, −0.06] |
2.2.2 Disability at 3 months | 2 | 177 | Standard mean difference (IV, Random, 95% CI) | 0.13 [−0.19, 0.45] |
2.2.3 Disability at 6 months | 3 | 225 | Standard mean difference (IV, Random, 95% CI) | 0.06 [−0.26, 0.39] |
2.2.4 Disability at 12 months | 1 | 102 | Standard mean difference (IV, Random, 95% CI) | 0.13 [−0.30, 0.57] |
2.3 Recovery | 0 | 0 | Risk ratio (M-H, Random, 95% CI) | Not estimable |
3. Spinal manipulative therapy + intervention versus intervention alone | ||||
3.1 Pain | 1 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
3.1.1 Pain at 1 month | 1 | 59 | Mean difference (IV, Random, 95% CI) | −8.80 [−21.43, 3.83] |
3.1.2 Pain at 3 months | 1 | 52 | Mean difference (IV, Random, 95% CI) | −14.20 [−26.89, −1.51] |
3.1.3 Pain at 6 months | 1 | 47 | Mean difference (IV, Random, 95% CI) | −4.90 [−18.68, 8.88] |
3.1.4 Pain at 12 months | 0 | 0 | Mean difference (IV, Random, 95% CI) | Not estimable |
3.2 Disability | 1 | Standard mean difference (IV, Random, 95% CI) | Subtotals only | |
3.2.1 Disability at 1 month | 1 | 59 | Std. Mean Difference (IV, Random, 95% CI) | −0.27 [−0.84, 0.29] |
3.2.2 Disability at 3 months | 1 | 52 | Standard mean difference (IV, Random, 95% CI) | 0.04 [−0.55, 0.63] |
3.2.3 Disability at 6 months | 1 | 47 | Standard mean difference (IV, Random, 95% CI) | −0.19 [−0.80, 0.43] |
3.2.4 Disability at 12 months | 0 | 0 | Standard mean difference (IV, Random, 95% CI) | Not estimable |
3.3 Recovery | 0 | 0 | Risk ratio (M-H, Random, 95% CI) | Not estimable |
4. Spinal manipulative therapy versus any other intervention | ||||
4.1 Pain | 4 | Mean difference (IV, Random, 95% CI) | Subtotals only | |
4.1.1 Pain at 1 month | 2 | 265 | Mean difference (IV, Random, 95% CI) | −3.28 [−5.73, −0.82] |
4.1.2 Pain at 3 months | 4 | 580 | Mean difference (IV, Random, 95% CI) | −1.91 [−5.37, 1.55] |
4.1.3 Pain at 6 months | 3 | 524 | Mean difference (IV, Random, 95% CI) | 1.04 [−10.50, 12.58] |
4.1.4 Pain at 12 months | 3 | 530 | Mean difference (IV, Random, 95% CI) | −0.32 [−4.92, 4.29] |
4.2 Disability | 4 | Standard mean difference (IV, Random, 95% CI) | Subtotals only | |
4.2.1 Disability at 1 month | 2 | 226 | Standard mean difference (IV, Random, 95% CI) | −0.49 [−1.41, 0.43] |
4.2.2 Disability at 3 months | 4 | 579 | Standard mean difference (IV, Random, 95% CI) | −0.20 [−0.54, 0.14] |
4.2.3 Disability at 6 months | 3 | 528 | Standard mean difference (IV, Random, 95% CI) | −0.05 [−0.34, 0.24] |
4.2.4 Disability at 12 months | 3 | 529 | Standard mean difference (IV, Random, 95% CI) | 0.04 [−0.15, 0.23] |
4.3 Recovery | 0 | 0 | Risk ratio (M-H, Random, 95% CI) | Not estimable |
Versus no treatment or waiting list control
Versus sham, placebo or passive modalities
SMT plus an intervention versus intervention alone
Versus any other intervention
Versus other types of SMT
Acupuncture
Outcome or subgroup | Studies | Participants | Statistical method | Effect estimate |
---|---|---|---|---|
5 Acupuncture versus no treatment or waiting list control | ||||
5.1 Pain | 1 | 214 | Mean difference (IV, Random, 95% CI) | −24.10 [−31.52, −16.68] |
5.1.1 Pain at 1 month | 0 | 0 | Mean difference (IV, Random, 95% CI) | Not estimable |
5.1.2 Pain at 3 months | 1 | 214 | Mean difference (IV, Random, 95% CI) | −24.10 [−31.52, −16.68] |
5.1.3 Pain at 6 months | 0 | 0 | Mean difference (IV, Random, 95% CI) | Not estimable |
5.1.4 Pain at 12 months | 0 | 0 | Mean Difference (IV, Random, 95% CI) | Not estimable |
5.2 Disability | 1 | 214 | Standard mean difference (IV, Random, 95% CI) | −0.61 [−0.90, −0.33] |
5.2.1 Disability at 1 month | 0 | 0 | Standard mean difference (IV, Random, 95% CI) | Not estimable |
5.2.2 Disability at 3 months | 1 | 214 | Std. Mean Difference (IV, Random, 95% CI) | −0.61 [−0.90, −0.33] |
5.2.3 Disability at 6 months | 0 | 0 | Standard mean difference (IV, Random, 95% CI) | Not estimable |
5.2.4 Disability at 12 months | 0 | 0 | Standard mean difference (IV, Random, 95% CI) | Not estimable |
5.3 Recovery | 0 | 0 | Risk ratio (M-H, Random, 95% CI) | Not estimable |
6 Acupuncture versus sham/placebo/passive modalities | ||||
6.1 Pain | 6 | Mean difference (IV, Random, 95% CI) | Subtotals only | |
6.1.1 Pain at 1 month | 4 | 918 | Mean difference (IV, Random, 95% CI) | −5.88 [−11.20, −0.55] |
6.1.2 Pain at 3 months | 4 | 1076 | Mean difference (IV, Random, 95% CI) | −7.27 [−12.66, −1.89] |
6.1.3 Pain at 6 months | 3 | 989 | Mean difference (IV, Random, 95% CI) | −3.26 [−6.28, −0.23] |
6.1.4 Pain at 12 months | 2 | 290 | Mean difference (IV, Random, 95% CI) | −4.74 [−10.50, 1.02] |
6.2 Disability | 3 | Standard mean difference (IV, Random, 95% CI) | Subtotals only | |
6.2.1 Disability at 1 month | 1 | 745 | Standard mean difference (IV, Random, 95% CI) | −0.18 [−0.32, −0.04] |
6.2.2 Disability at 3 months | 3 | 1044 | Standard mean difference (IV, Random, 95% CI) | −0.28 [−0.41, −0.16] |
6.2.3 Disability at 6 months | 2 | 962 | Standard mean difference (IV, Random, 95% CI) | −0.27 [−0.40, −0.15] |
6.2.4 Disability at 12 months | 2 | 290 | Standard mean difference (IV, Random, 95% CI) | −0.22 [−0.46, 0.03] |
6.3 Recovery | 2 | Risk ratio (M-H, Random, 95% CI) | Subtotals only | |
6.3.1 Recovery at 1 month | 2 | 90 | Risk ratio (M-H, Random, 95% CI) | 1.92 [0.41, 9.09] |
6.3.2 Recovery at 3 months | 1 | 50 | Risk ratio (M-H, Random, 95% CI) | 3.53 [0.91, 13.62] |
6.3.3 Recovery at 6 months | 2 | 83 | Risk ratio (M-H, Random, 95% CI) | 1.82 [0.72, 4.61] |
6.3.4 Recovery at 12 months | 0 | 0 | Risk ratio (M-H, Random, 95% CI) | Not estimable |
7 Acupuncture + intervention versus intervention alone | ||||
7.1 Pain | 3 | Mean difference (IV, Random, 95% CI) | Subtotals only | |
7.1.1 Pain at 1 month | 2 | 99 | Mean difference (IV, Random, 95% CI) | −9.80 [−14.93, −4.67] |
7.1.2 Pain at 3 months | 3 | 185 | Mean difference (IV, Random, 95% CI) | −16.91 [−25.18, −8.64] |
7.1.3 Pain at 6 months | 0 | 0 | Mean difference (IV, Random, 95% CI) | Not estimable |
7.1.4 Pain at 12 months | 1 | 86 | Mean Difference (IV, Random, 95% CI) | −14.00 [−21.83, −6.17] |
7.2 Disability | 4 | Standard mean difference (IV, Random, 95% CI) | Subtotals only | |
7.2.1 Disability at 1 month | 2 | 99 | Standard mean difference (IV, Random, 95% CI) | −1.04 [−1.46, −0.61] |
7.2.2 Disability at 3 months | 4 | 2824 | Standard mean difference (IV, Random, 95% CI) | −0.66 [−0.74, −0.58] |
7.2.3 Disability at 6 months | 0 | 0 | Standard mean difference (IV, Random, 95% CI) | Not estimable |
7.2.4 Disability at 12 months | 1 | 131 | Standard mean difference (IV, Random, 95% CI) | −0.28 [−0.66, 0.09] |
7.3 Recovery | 1 | Risk ratio (M-H, Random, 95% CI) | Subtotals only | |
7.3.1 at 1 month | 0 | 0 | Risk ratio (M-H, Random, 95% CI) | Not estimable |
7.3.2 at 3 months | 1 | 56 | Risk ratio (M-H, Random, 95% CI) | 5.90 [1.96, 17.70] |
7.3.3 at 6 months | 0 | 0 | Risk ratio (M-H, Random, 95% CI) | Not estimable |
7.3.4 at 12 months | 0 | 0 | Risk ratio (M-H, Random, 95% CI) | Not estimable |
8 Acupuncture versus any other intervention | ||||
8.1 Pain | 1 | Mean difference (IV, Random, 95% CI) | Subtotals only | |
8.1.1 Pain at 1 month | 1 | 731 | Mean difference (IV, Random, 95% CI) | −8.50 [−11.04, −5.96] |
8.1.2 Pain at 3 months | 1 | 734 | Mean difference (IV, Random, 95% CI) | −9.40 [−12.13, −6.67] |
8.1.3 Pain at 6 months | 1 | 741 | Mean difference (IV, Random, 95% CI) | −12.10 [−15.25, −8.95] |
8.1.4 Pain at 12 months | 0 | 0 | Mean difference (IV, Random, 95% CI) | Not estimable |
8.2 Disability | 1 | Standard mean difference (IV, Random, 95% CI) | Subtotals only | |
8.2.1 Disability at 1 month | 1 | 731 | Standard mean difference (IV, Random, 95% CI) | −0.53 [−0.67, −0.38] |
8.2.2 Disability at 3 months | 1 | 734 | Standard mean difference (IV, Random, 95% CI) | −0.64 [−0.79, −0.49] |
8.2.3 Disability at 6 months | 1 | 741 | Standard mean difference (IV, Random, 95% CI) | −0.76 [−0.91, −0.61] |
8.2.4 Disability at 12 months | 0 | 0 | Standard mean difference (IV, Random, 95% CI) | Not estimable |
8.3 Recovery | 0 | 0 | Risk ratio (M-H, Random, 95% CI) | Not estimable |
Versus no treatment or waiting list control
Versus sham, placebo or passive modalities
Acupuncture plus an intervention versus intervention alone
Versus any other intervention
Versus other types of acupuncture
Herbal medicine
Outcome or subgroup | Studies | Participants | Statistical Method | Effect Estimate |
---|---|---|---|---|
9 Herbal medicine versus no treatment or waiting list control | ||||
No studies were identified | ||||
10 Herbal medicine versus sham/placebo/passive modalities | ||||
10.1 Pain | 0 | 0 | Mean difference (IV, Random, 95% CI) | Not estimable |
10.2 Disability | 0 | 0 | Standard mean difference (IV, Random, 95% CI) | Not estimable |
10.3 Recovery | 5 | Risk ratio (M-H, Random, 95% CI) | Subtotals only | |
10.3.1 Recovery at 1 month | 5 | 841 | Risk ratio (M-H, Random, 95% CI) | 1.92 [1.31, 2.81] |
11 Herbal medicine + intervention versus intervention alone | ||||
No studies were identified | ||||
12 Herbal medicine versus any other intervention | ||||
12.1 Pain | 2 | 271 | Mean difference (IV, Random, 95% CI) | −2.56 [−8.38, 3.25] |
12.1.1 Pain at 1 month | 2 | 271 | Mean difference (IV, Random, 95% CI) | −2.56 [−8.38, 3.25] |
12.2 Disability | 0 | 0 | Mean difference (IV, Random, 95% CI) | Not estimable |
12.3 Recovery | 2 | Risk ratio (M-H, Random, 95% CI) | Subtotals only | |
12.3.1 Recovery at 1 month | 2 | 271 | Risk ratio (M-H, Random, 95% CI) | 0.88 [0.70, 1.10] |