The Impact of Pragmatic vs. Prescriptive Study Designs on the Outcomes of Low Back and Neck Pain When Using Mobilization or Manipulation Techniques

Roenz D et al. The impact of pragmatic vs. prescriptive study designs on the outcomes of low back pain and neck pain when using mobilization or manipulation techniques: a systematic review and meta-analysis. Journal of Manual & Manipulative Therapy. 2017

  • While manual therapy and exercise has been shown to be effective for treating nonspecific spinal pain, evidence has been conflicting as to whether mobilization or manipulation is superior to the other as a treatment choice.

  • A recent meta-analysis by Kent et al investigated whether clinician choice improves the outcome of manual therapy for nonspecific LBP. 2/3 of the included RCTs had clinician choice of treatment and there appeared to be no significant differences favoring studies that allowed for clinician preference to those that did not.

  • The purpose of this systematic review and meta-analysis was to examine pragmatic vs prescriptive study designs on low back and neck pain when using mobilization or manipulation techniques.

  • Of over 29,000 potential studies, 13 were deemed relevant and included in the systematic review of 1313 participants while 12 studies of 977 participants were included in the meta-analysis.

  • Short term results (1-6 weeks) indicated that when using a prescriptive design, manipulation was superior to mobilization when using pain as an outcome measure. At 5-11 weeks, there was no significant differences b/w the two interventions but at longer term follow-up, (3-6 months), manipulation was shown to be more effective than mobilization for pain relief.

  • In terms of disability, there was no statistically significant differences at the immediate and 5-11 week follow-up, but prescriptive manipulation did show a significant improvement compared to prescriptive mobilization at the 1-6 days, 1-4 weeks, and 3-6 month follow-ups.

  • In the pragmatic study designs, there was no significant differences when comparing outcomes for pain and disability between the mobilization or manipulation groups at any of the time points.

  • The results of this meta-analysis suggest that when using a prescriptive approach comparing mobilization vs manipulation for spinal pain and disability, the results favored manipulation. However, when a pragmatic approach was utilized, mobilization and manipulation were found to be equivalent.

  • Overall, the authors conclude that when mobilization and manipulation are performed as they would be in regular clinical practice, there is no difference in outcomes for pain and disability between the two interventions.