Meta-analysis highlights benefits of spinal manipulative therapy for older adults with chronic low back pain

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Alan Jenks

Spinal manipulative therapy (SMT) is equally as effective as recommended interventions for reducing pain and increasing functional status in older adults who suffer chronic low back pain (LBP) and, as such, should be considered as a viable standalone treatment option for this patient population. This is according to a recent meta-analysis, the findings of which were published by Alan Jenks (Vrije Universiteit Amsterdam, Amsterdam, The Netherlands) et al in the European Spine Journal.

The individual participant data (IPD) meta-analysis included randomised controlled trials that examined the effects of SMT in adults with chronic LBP compared to interventions recommended in international LBP guidelines from electronic databases from 2000 until June 2020, and reference lists of eligible trials and related reviews.

Authors of eligible trials were contacted and asked to share their data. Two review authors conducted a risk of bias assessment. Primary results were examined in a one-stage mixed model, and a two-stage analysis was conducted in order to confirm findings.

The main outcome measures were pain and functional status at four, 13, 26, and 52 weeks. In total, 10 studies were retrieved, which together included a total of 786 individuals, of which 261 were between 65 and 91 years of age.

The meta-analysis highlighted that there is moderate quality evidence that SMT has similar benefits to recommended interventions at all time points for pain. The mean difference for SMT compared to recommended interventions is −2.56 (95% confidence interval [CI], −5.78 to 0.66; scale 0–100) after one month, and these effects appear similar over the subsequent 12 months.

Further analysis on the group of patients 65 and older showed similar effects: −2.46 (95% CI, −7.41 to 2.48; scale 0–100) after one month and appear similar over the subsequent 12 months.

In addition, the study identified that there is also moderate quality evidence that SMT has similar benefits to recommended interventions at all time points for functional status.

The comparison of SMT and recommended interventions for functional status outcome demonstrated a standardised mean difference (SMD) of −0.18 (95% CI, −0.41. to 0.05; scale 0–100; −0.85 on the Roland‐Morris Disability Questionnaire [RMDQ] 24-point scale) after one month and remained similar over the subsequent 12 months (SMD −0.15; 95% CI, −0.38 to 0.08; scale 0–100; −0.76 on RMDQ 24-point scale).

Further analysis on the group of patients 65 and older showed similar effects: −0.32 (95% CI, −0.57 to −0.08; scale 0–100; −0.79 on RMDQ 24-point scale) after one month and appear similar over the subsequent 12 months: –0.40 (95% CI, −0.77 to −0.02; −0.73 on RMDQ 24-point scale). Second-stage and sensitivity analysis confirmed the findings.

The study authors note that future research “should focus on identifying which older adults are best suited for SMT, taking lifestyle factors, comorbidities, and level of physical activity into account”.


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