Spinal manipulative therapy for chronic XXXX .

@entity1 @entity1643 @entity7126 @entity23 @entity601 @entity158
BACKGROUND: Many therapies exist for the treatment of @entity1643 including spinal manipulative therapy (SMT), which is a worldwide, extensively practiced intervention. OBJECTIVES: To assess the effects of SMT for chronic @entity1643 . SEARCH STRATEGY: An updated search was conducted by an experienced librarian to June 2009 for @entity23 ( @entity23 ) in CENTRAL (The Cochrane Library 2009, issue 2), MEDLINE, EMBASE, CINAHL, PEDro, and the Index to Chiropractic Literature.    SELECTION CRITERIA: @entity23 which examined the effectiveness of spinal manipulation or mobilisation in adults with chronic @entity1643 were included. No restrictions were placed on the setting or type of @entity158 ; studies which exclusively examined sciatica were excluded. The primary outcomes were @entity158 , functional status and perceived recovery. Secondary outcomes were return-to-work and quality of life. DATA COLLECTION AND ANALYSIS: Two review authors independently conducted the study selection, risk of bias assessment and data extraction. GRADE was used to assess the quality of the evidence. Sensitivity analyses and investigation of heterogeneity were performed, where possible, for the meta-analyses. MAIN RESULTS: We included 26 @entity23 (total @entity1 = 6070), nine of which had a low risk of bias. Approximately two-thirds of the included studies (N = 18) were not evaluated in the previous review. In general, there is high quality evidence that SMT has a small, statistically significant but not clinically relevant, short-term effect on @entity158 relief ( @entity601 : -4.16, 95% CI -6.97 to -1.36) and functional status ( @entity7126 : -0.22, 95% CI -0.36 to -0.07) compared to other interventions. Sensitivity analyses confirmed the robustness of these findings. There is varying quality of evidence (ranging from low to high) that SMT has a statistically significant short-term effect on @entity158 relief and functional status when added to another intervention. There is very low quality evidence that SMT is not statistically significantly more effective than inert interventions or sham SMT for short-term @entity158 relief or functional status. Data were particularly sparse for recovery, return-to-work, quality of life, and costs of care. No serious complications were observed with SMT. AUTHORS' CONCLUSIONS: High quality evidence suggests that there is no clinically relevant difference between SMT and other interventions for reducing @entity158 and improving function in @entity1 with chronic @entity1643 . Determining cost-effectiveness of care has high priority. Further research is likely to have an important impact on our confidence in the estimate of effect in relation to inert interventions and sham SMT, and data related to recovery.
