Does the addition of manual therapy to exercise therapy improve pain and disability outcomes in chronic low back pain: A systematic review
Bibliographic record
Abstract
BACKGROUND: Low back pain (LBP) is a common musculoskeletal problem and the leading cause of disability worldwide. Manual therapy and exercise therapy are used by physiotherapists to treat LBP. The evidence base for exercise is strong, however less so for manual therapy. We investigated whether manual therapy in addition to exercise provides improvements in pain and disability outcomes over exercise alone for LBP. METHODS: A PRISMA guided systematic review protocol was developed. PubMed, Ovid and Web of Science were searched for randomised controlled trials (RCTs) which compared manual therapy plus exercise with exercise alone for LBP patients. Participants consisted of adults and older adults suffering from chronic back pain for over three months, recruited by researchers following examination by a health professional. Exercise prescriptions consisted of strengthening, stretching and stabilisation exercises. Manual therapies included spinal manipulation, massage, soft tissue mobilisation, myofascial release and muscle energy technique. The main outcome measures were pain (VAS, The McGill Pain Questionnaire) and disability (ODI, Quebec Back Pain Disability Scale). Secondary outcome measures included quality of life, flexibility, strength, spinal mobility, satisfaction. RESULTS: Ten studies met the inclusion criteria: eight reported pain and/or disability improvements with the addition of manual therapy, two reported no benefit. CONCLUSIONS: This systematic review found that manual therapy as an adjunct to exercise provides increased improvements in short-term pain, function and disability outcomes than exercise alone in the management of LBP. The addition of manual therapy is recommended for at least short-term pain and disability relief in LBP patients.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".