Does Clinician Treatment Choice Improve the Outcomes of Manual Therapy for Nonspecific Low Back Pain? A Metaanalysis

Subgrouping Patients With Low Back Pain: Evolution of a Classification Approach to Physical Therapy

“…29 It is possible that the choice of a specific manipulation technique may not be as important as previously thought. 76 Originally the manipulation classification proposed by Delitto and colleagues 35 incorporated traditional biomechanical approaches to technique selection, distinguishing techniques directed towards the sacroiliac or lumbar region (taBLe 2). Recent evidence, however, suggests that the effects of manipulation may not be as specific as once believed.…”

“…Haas et al 58 examined short-term outcomes of patients with neck pain randomized to receive manipulation targeted to spinal segments thought to have increased stiffness based on clinical examination or targeted to randomly selected segments, and found no differences in patient-reported pain or stiffness. Kent et al 76 systematically reviewed the evidence on the effect of the discretion given to clinicians to choose techniques for a particular patient on outcomes in randomized trials examining manual therapy and found that although the evidence was limited, there was no suggestion that allowing clinicians to select techniques for patients improved outcomes compared with studies using predefined manipulation protocols. 76 Ac- […”

“…Kent et al 76 systematically reviewed the evidence on the effect of the discretion given to clinicians to choose techniques for a particular patient on outcomes in randomized trials examining manual therapy and found that although the evidence was limited, there was no suggestion that allowing clinicians to select techniques for patients improved outcomes compared with studies using predefined manipulation protocols. 76 Ac- […”

Placebo response to manual therapy: something out of nothing?

“…Manual therapists continue to follow this model of clinical practice 3,4 despite literature suggesting that these evaluative techniques are unreliable 5 and their findings do not affect clinical outcomes. 6 Neurophysiological responses accompany manual therapy interventions and are suggested as pertinent to the mechanisms. 7,8 Currently, neurophysiological responses to manual therapy have been studied primarily as an immediate within session response, [9][10][11][12] and the relevance of these findings to clinical outcomes is not well established.…”

How Spinal Manipulative Therapy Works: Why Ask Why?

“…studies suggest that successful outcome is not linked to specific spinal manipulative therapy techniques 5,17 or joint cavitation. 12 Rather, the recent clinical literature emphasizes the importance of identifying characteristics of individuals likely to respond favorably to spinal manipulative therapy.…”