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A Cochrane Review of Combined Chiropractic Interventions for Low-Back Pain

Walker, Bruce F, DC, MPH, DrPH*; French, Simon D, PhD*,†,‡; Grant, William, EdD§; Green, Sally, PhD

doi: 10.1097/BRS.0b013e318202ac73
Cochrane Collaboration

Study Design. Cochrane systematic review of randomized controlled trials.

Objective. To determine the effects of combined chiropractic interventions on pain, disability, back-related function, overall improvement, and patient satisfaction in adults with low-back pain (LBP).

Summary of Background Data. Chiropractors commonly use a combination of interventions to treat people with LBP, but little is known about the effects of this care.

Methods. We used a comprehensive search strategy. All randomized trials comparing combined chiropractic interventions (rather than spinal manipulation alone) with no treatment or other therapies were included. At least two authors selected studies, assessed bias risk, and extracted data. Descriptive synthesis and meta-analyses were performed.

Results. We included 12 studies involving 2887 LBP participants. Three studies had low risk of bias. Included studies evaluated a range of chiropractic procedures in a variety of subpopulations with LBP. For acute and subacute LBP, chiropractic interventions improved short- and medium-term pain (standardized mean difference [SMD] −0.25 [95% CI: −0.46 to −0.04] and MD −0.89 [95%CI: −1.60 to −0.18]) compared with other treatments, but there was no significant difference in long-term pain (MD −0.46 [95% CI −1.18 to 0.26]). Short-term improvement in disability was greater in the chiropractic group compared to other therapies (SMD −0.36 [95% CI: −0.70 to −0.02]). However, the effect was small and studies contributing to these results had high risk of bias. There was no difference in medium- and long-term disability. No difference was demonstrated for combined chiropractic interventions for chronic LBP and studies that had a mixed population of LBP.

Conclusion. Combined chiropractic interventions slightly improved pain and disability in the short term and pain in the medium term for acute/subacute LBP. However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions.

Combined chiropractic interventions slightly improve pain and disability in the short term and pain in the medium term for acute and subacute low back pain. However any effect sizes were small.

*School of Chiropractic and Sports Science, Murdoch University, Faculty of Health Sciences, Murdoch, Australia

School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia

Primary Care Research Unit, University of Melbourne, Carlton, Australia

§Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY.

Address correspondence and reprint requests to Bruce F. Walker, DC, MPH, DrPH, School of Chiropractic and Sports Science, Faculty of Health, Sciences, ECL Building, Murdoch University, Murdoch, Western Australia 6150; E-mail:

Acknowledgment date: September 6, 2010. Acceptance date: October 20, 2010

Sources of support: None. No funding was received for this study.

This review is adapted from the Cochrane Review: Walker B.F., French S.D., Grant W., Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010;(4):CD005427. DOI: 10.1002/14651858.CD005427.pub2. Copyright Cochrane Library, adapted with permission.

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© 2011 Lippincott Williams & Wilkins, Inc.