Evidence map›Paper›PMID 24139233›Full record

Trial reportThe spine journal : official journal of the North American Spine Society2014

Dose-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial.

Mitchell Haas, Darcy Vavrek, David Peterson, Nayak Polissar, Moni B Neradilek

4 registry-linked trialsAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The spine journal : official journal of the North American Spine Society, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 59 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
59citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00376350 phase2 / phase3completednot on this map

Dose-Response/Efficacy of Manipulation for Chronic LBP

TypeinterventionalSponsorUniversity of Western StatesRan2007 to 2011Enrolled400ConditionsLow Back PainArmsSpinal Manipulation, Light Massage, Pulsed Ultrasound
NCT02983435 nacompletednot on this mapstarted 2016, after this paper: background citation

Comparison Between Two Osteopathic Techniques for Chronic Low Back Pain Treatment: a Randomized Crossover Trial.

TypeinterventionalSponsorUniversidade Norte do ParanáRan2016 to 2017Enrolled10ConditionsLow Back Pain, Osteopathic Manipulative TreatmentArmsG1 - Thrust manipulation, G2 - Muscle Energy
NCT04744883 early_phase1active not recruitingnot on this mapstarted 2020, after this paper: background citation

Evaluating Specific and Non-Specific Mechanisms in Two Distinct Complementary/Integrative Interventions for Chronic Pain

TypeinterventionalSponsorRush University Medical CenterRan2020 to 2026Enrolled140ConditionsChronic Low-back PainArmsSpinal Manipulation Therapy (SMT), Naloxone, Placebo, Mindfulness Based Stress Reduction Therapy (MT)
NCT05986370 narecruitingnot on this mapstarted 2023, after this paper: background citation

The METRIC Study Protocol: an Explanatory Randomized Controlled Trial Investigating the Neurophysiological Mechanisms Underlying the Therapeutic Effects of Spinal Manipulative Therapy for Chronic Primary Low Back Pain

TypeinterventionalSponsorUniversité du Québec à Trois-RivièresRan2023 to 2026Enrolled112ConditionsChronic Low-back PainArmslumbar spinal manipulative therapy, sham spinal manipulative therapy, full spine spinal manipulative therapy
3 · Its place in the literature

Who cites it

59 citing papers in PubMed, 5 syntheses or guidelines pooled it.

  1. Advances in physiotherapy for chronic low-back pain: a level I systematic review.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2026
    Pooled it
  2. Impact of education in patients undergoing physiotherapy for lower back pain: a level I systematic review and meta-analysis.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025
    Pooled it
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  5. Massage for low-back pain.The Cochrane database of systematic reviews · 2015
    Pooled it
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors.

Mitchell HaasCenter for Outcomes Studies, University of Western States, 2700 NE 132nd Ave., Portland, OR 97230, USA. Electronic address: haasmitch@comcast.net.
Darcy VavrekCenter for Outcomes Studies, University of Western States, 2700 NE 132nd Ave., Portland, OR 97230, USA.
David PetersonDivision of Chiropractic Sciences, University of Western States, 2700 NE 132nd Ave., Portland, OR 97230, USA.
Nayak PolissarThe Mountain-Whisper-Light Statistics, 1827 23rd Ave. E., Seattle, WA 98122, USA.
Moni B NeradilekThe Mountain-Whisper-Light Statistics, 1827 23rd Ave. E., Seattle, WA 98122, USA.

Funding

Dose-Response/Efficacy of Manipulation for Chronic LBPU01AT001908 · NCCIH · UNIVERSITY OF WESTERN STATES · PI HAAS, MITCHELL · 2006 to 2010
$2.8M
NCCIH NIH HHS U01 AT001908
6 · The paper itself

Abstract

background contextThere have been no full-scale trials of the optimal number of visits for the care of any condition with spinal manipulation. PURPOSE: To identify the dose-response relationship between visits to a chiropractor for spinal manipulation and chronic low back pain (cLBP) outcomes and to determine the efficacy of manipulation by comparison with a light massage control. STUDY DESIGN/

settingPractice-based randomized controlled trial. PATIENT SAMPLE: Four hundred participants with cLBP. OUTCOME MEASURES: The primary cLBP outcomes were the 100-point modified Von Korff pain intensity and functional disability scales evaluated at the 12- and 24-week primary end points. Secondary outcomes included days with pain and functional disability, pain unpleasantness, global perceived improvement, medication use, and general health status.

methodsOne hundred participants with cLBP were randomized to each of four dose levels of care: 0, 6, 12, or 18 sessions of spinal manipulation from a chiropractor. Participants were treated three times per week for 6 weeks. At sessions when manipulation was not assigned, they received a focused light massage control. Covariate-adjusted linear dose effects and comparisons with the no-manipulation control group were evaluated at 6, 12, 18, 24, 39, and 52 weeks.

resultsFor the primary outcomes, mean pain and disability improvement in the manipulation groups were 20 points by 12 weeks and sustainable to 52 weeks. Linear dose-response effects were small, reaching about two points per six manipulation sessions at 12 and 52 weeks for both variables (p<.025). At 12 weeks, the greatest differences from the no-manipulation control were found for 12 sessions (8.6 pain and 7.6 disability points, p<.025); at 24 weeks, differences were negligible; and at 52 weeks, the greatest group differences were seen for 18 visits (5.9 pain and 8.8 disability points, p<.025).

conclusionsThe number of spinal manipulation visits had modest effects on cLBP outcomes above those of 18 hands-on visits to a chiropractor. Overall, 12 visits yielded the most favorable results but was not well distinguished from other dose levels.

Indexed as

AdultFemaleHumansLow Back PainMaleManipulation, SpinalMiddle AgedTreatment OutcomeChiropracticChronic low back painDose-responseRandomized controlled trialSpinal manipulation

Identifiers

PMID24139233
PMCPMC3989479

What OpenQuestion holds

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Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.