Dr Paul Sutcliffe led a systematic review to establish the effectiveness and cost effectiveness of manual therapies for The Royal College of Chiropractors.
Despite a noted shortfall in the quality of the evidence, one of the main findings was “moderate (positive)” evidence in favour of spinal manipulation/mobilisation for acute low back pain. The review also found “moderate (positive)” evidence for:
- The use of manipulation and/or mobilisation combined with exercise for neck pain of any duration;
- The use of combined chiropractic care for low back pain;
- The management of acute whiplash-associated disorder with a combination of mobilisation and exercise;
- The use of manual mobilisation combined with exercise for knee osteoarthritis;
- The use of manipulation/mobilisation for hip osteoarthritis;
- The use of manipulation/mobilisation with exercise for plantar fasciitis;
- The use of manipulation/mobilisation combined with exercise therapy in patellofemoral pain syndrome;
- The use of spinal manipulative therapy in migraine.
The review concluded that, for patients with neck pain, low back pain, and shoulder pain, osteopathic spinal manipulation, physiotherapy and chiropractic manipulation appeared to be more cost effective than:
- Usual GP care (alone or with exercise);
- Spinal stabilisation;
- GP advice;
- Advice to remain active;
- Brief pain management.
If the complexities of this important discipline in health care are to be addressed, further research and good-quality evidence from well-conducted studies will be essential to draw more definitive conclusions and to provide valid recommendations for policy making.
Please refer to the full report for more details.