Global Journal of Medicine and Medical Sciences received 470 citations as per Google Scholar report
El-Olemy AT*, Tawfik MB, El-Olemy AT1, El-Olemy MA, Hasanain MA and Nashwa MR
Objective: To estimate the extent to which spinal manipulation is effective for adult patients with chronic non-specific low back pain (CNSLBP) Design: Systematic review and meta-analysis of randomized controlled trials. Data sources: Ovid Medline, Ovid AMED, Ovid EMBASE, CINAHL, Index to Chiropractic Literature (ICL); Cochrane Library, PubMed, and Trip database. Eligibility criteria for selecting studies: Randomized controlled trials examining the effect of spinal manipulation therapy (SMT) in adults (�?� 18 years) with chronic non-specific low back pain. Review methods: Two reviewers independently selected studies, extracted data, and assessed risk of bias and quality of the evidence. The effect of SMT was compared with recommended therapies, non-recommended therapies, sham (placebo) SMT, and SMT as an adjuvant therapy. Main outcomes were pain and back specific functional status, examined as mean differences and standardized mean differences (SMD), respectively. Outcomes were examined at 6, 12, 18, 24 weeks and one year. Quality of evidence was assessed using GRADE. Risk of bias, statistical heterogeneity and precision was explored. Results: Nine randomized controlled trials including a total of 1777 participants were identified, who were on average middle aged (18-65 years). The trials had considerable percentages of risk of bias. Moderate quality evidence suggested that the pooled estimate of pain intensity after one year and functional disability after 6 weeks of SMT is significantly effective (MD=- 9.88, CI=-16.51, -3.24) and (MD=-7.59, CI=-8.47, -6.71) respectively. Regarding pain intensity, no statistically significant difference was recorded between experimental and control groups at 6 and 24 weeks after SMT (MD=1.16, CI=-15.25, 17.56, MD=-5.12, CI=-12.86, 2.63 respectively). Regarding functional disability, no significant difference was recorded between both groups at 18 and 24 weeks after SMT (MD=-4.05, CI=-18.47, 10.37, MD=-3.90, CI=-14.60, 6.80 respectively). Also, no significant difference was detected between both studied groups regarding physical and mental health at 12 weeks, 24 weeks and 1 year of SMT and mean satisfaction with SMT. Conclusion: It is difficult from the included studies to conclude that spinal manipulation is superior to conventional treatment for CNSLBP in short term effect but adding spinal manipulation with other conventional therapies may be beneficial for longterm benefit. However, given the small number of studies included in this analysis, we should be cautious of making strong inferences based on these results. The research to date is still heterogeneous, and questions remain about optimal treatment duration, number of sessions, practitioners to be involved, and the kinds of patients who may benefit the most.
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