Department of Veterans Affairs Health Services Research & Development Service Evidence-based Synthesis Program The Effectiveness and Harms of Spinal Manipulative Therapy for the Treatment of Acute Neck and Lower Back Pain: A Systematic Review April 2017 Prepared for: Investigators: Department of Veterans Affairs Principal Investigator: Veterans Health Administration Paul G. Shekelle, MD, PhD Quality Enhancement Research Initiative Co-investigators: Health Services Research & Development Service Neil M. Paige, MD, MSHS Washington, DC 20420 Prepared by: Research Associates: Isomi M. Miake-Lye, BA Evidence-based Synthesis Program (ESP) Jessica M. Beroes, BS West Los Angeles VA Medical Center Marika Suttorp Booth, MS Los Angeles, CA Roberta Shanman, MS Paul G. Shekelle, MD, PhD, Director 4 Effectiveness and Harms of Spinal Manipulative Therapy Evidence-based Synthesis Program for the Treatment of Acute Neck and Lower Back Pain PREFACE Quality Enhancement Research Initiative’s (QUERI) Evidence-based Synthesis Program (ESP) was established to provide timely and accurate syntheses of targeted healthcare topics of particular importance to Veterans Affairs (VA) clinicians, managers and policymakers as they work to improve the health and healthcare of Veterans. The ESP disseminates these reports throughout the VA, and some evidence syntheses inform the clinical guidelines of large professional organizations. QUERI provides funding for 4 ESP Centers and each Center has an active university affiliation. The ESP Centers generate evidence syntheses on important clinical practice topics, and these reports help: · develop clinical policies informed by evidence; · guide the implementation of effective services to improve patient outcomes and to support VA clinical practice guidelines and performance measures; and · set the direction for future research to address gaps in clinical knowledge. In 2009, the ESP Coordinating Center was created to expand the capacity of HSR&D Central Office and the 4 ESP sites by developing and maintaining program processes. In addition, the Center established a Steering Committee comprised of QUERI field-based investigators, VA Patient Care Services, Office of Quality and Performance, and Veterans Integrated Service Networks (VISN) Clinical Management Officers. The Steering Committee provides program oversight, guides strategic planning, coordinates dissemination activities, and develops collaborations with VA leadership to identify new ESP topics of importance to Veterans and the VA healthcare system. Comments on this evidence report are welcome and can be sent to Nicole Floyd, ESP Coordinating Center Program Manager, at [email protected]. Recommended citation: Shekelle PG, Paige NM, Miake-Lye IM, Beroes JM, Booth MS, Shanman R. The Effectiveness and Harms of Chiropractic Care for the Treatment of Acute Neck and Lower Back Pain: A Systematic Review. VA ESP Project #05-226; 2017. This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the West Los Angeles VA Medical Center, Los Angeles, CA, funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report. i Effectiveness and Harms of Spinal Manipulative Therapy Evidence-based Synthesis Program for the Treatment of Acute Neck and Lower Back Pain TABLE OF CONTENTS EXECUTIVE SUMMARY .......................................................................................................... 1 Introduction ................................................................................................................................. 1 Methods....................................................................................................................................... 1 Data Sources and Searches ..................................................................................................... 1 Study Selection ....................................................................................................................... 1 Data Abstraction and Quality Assessment .............................................................................. 2 Data Synthesis and Analysis ................................................................................................... 2 Results ......................................................................................................................................... 2 Results of Literature Search .................................................................................................... 2 Acute Low Back Pain without Sciatica .................................................................................. 3 Acute Low Back Pain with Sciatica ........................................................................................ 4 Adverse Events ....................................................................................................................... 4 Summary of Results for Key Questions and Strength of Evidence ........................................ 5 Discussion ................................................................................................................................... 6 Limitations .............................................................................................................................. 6 Study Quality .......................................................................................................................... 6 Heterogeneity .......................................................................................................................... 6 Applicability of Findings to the VA Population ..................................................................... 6 Research Gaps/Future Research ............................................................................................. 7 EVIDENCE REPORT .................................................................................................................. 8 INTRODUCTION......................................................................................................................... 8 METHODS .................................................................................................................................... 9 Topic Development ..................................................................................................................... 9 Search Strategy ........................................................................................................................... 9 Study Selection ......................................................................................................................... 10 Data Abstraction ....................................................................................................................... 10 Quality Assessment ................................................................................................................... 11 Data Synthesis ........................................................................................................................... 11 Rating the Body of Evidence .................................................................................................... 12 Peer Review .............................................................................................................................. 12 RESULTS .................................................................................................................................... 13 Literature Flow.......................................................................................................................... 13 Description of the Evidence .................................................................................................. 15 ii Effectiveness and Harms of Spinal Manipulative Therapy Evidence-based Synthesis Program for the Treatment of Acute Neck and Lower Back Pain Key Question 1: What are the benefits and harms of spinal manipulation/chiropractic services for acute lower back pain (less than 6 weeks duration) compared to usual care or other forms of acute pain management? ........... 17 Acute Low Back Pain without Sciatica ................................................................................ 17 Acute Low Back Pain with Sciatica ...................................................................................... 32 Adverse Events ..................................................................................................................... 32 Summary of Findings ............................................................................................................ 38 Quality of Evidence for Key Question 1............................................................................... 38 Key Question 1A: What is the relationship between the use of spinal manipulation/chiropractic