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Spinal manipulation and mobilisation for back and neck pain: a blinded review


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Clinical trial


Structural and chiropractic

BMJ.1991 Nov 23;303(6813):1298-303.


B W Koes, W J Assendelft, G J v d Heijden, L M Bouter, P G Knipschild


Objective: To assess the efficacy of spinal manipulation for patients with back or neck pain. Design: Computer aided search for published papers and blinded assessment of the methods of the studies. Subjects: 35 randomised clinical trials comparing spinal manipulation with other treatments. Main outcome measures: Score for quality of methods (based on four main categories: study population, interventions, measurement of effect, and data presentation and analysis) and main conclusion of author(s) with regard to spinal manipulation. Results: No trial scored 60 or more points (maximum score 100) suggesting that most were of poor quality. Eighteen studies (51%) showed favourable results for manipulation. In addition, five studies (14%) reported positive results in one or more subgroups. Of the four studies with 50-60 points, one reported that manipulation was better, two reported that manipulation was better in only a subgroup, and one reported that manipulation was no better or worse than reference treatment. Eight trials attempted to compare manipulation with some placebo, with inconsistent results. Conclusions: Although some results are promising, the efficacy of manipulation has not been convincingly shown. Further trials are needed, but much more attention should be paid to the methods of study.

Publication Date: 

1991 Nov



Koes, WB., Assendelft, JW., Heijden, dvJG., Bouter, ML., Knipschild, GP. (1991) 'Spinal manipulation and mobilisation for back and neck pain: a blinded review', BMJ.1991 Nov 23;303(6813):1298-303.

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