Trial reportBMC complementary and alternative medicine2014
A path analysis of the effects of the doctor-patient encounter and expectancy in an open-label randomized trial of spinal manipulation for the care of low back pain.
Trial report in BMC complementary and alternative medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00376350 (Dose-Response/Efficacy of Manipulation for Chronic LBP), which is not on this map. Cited by 12 papers, 3 of them syntheses that pooled 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.
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.
Dose-Response/Efficacy of Manipulation for Chronic LBP
Who cites it
12 citing papers in PubMed, 3 syntheses or guidelines pooled it, 33 citations in OpenAlex.
- Mixed methods systematic review of the literature base exploring working alliance in the chiropractic profession.Chiropractic & manual therapies · 2022Pooled it
- Individual recovery expectations and prognosis of outcomes in non-specific low back pain: prognostic factor review.The Cochrane database of systematic reviews · 2019Pooled it
- Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis.The spine journal : official journal of the North American Spine Society · 2018Pooled it
- Mediators of the effect of chiropractic care on 12- and 52-week outcomes for U.S. active-duty military personnel with low back pain: secondary analysis of a clinical trial.Chiropractic & manual therapies · 2026Trial
- Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial.The spine journal : official journal of the North American Spine Society · 2018Trial
- Prediction of pain outcomes in a randomized controlled trial of dose-response of spinal manipulation for the care of chronic low back pain.BMC musculoskeletal disorders · 2015Trial
- Trial
- Cost analysis related to dose-response of spinal manipulative therapy for chronic low back pain: outcomes from a randomized controlled trial.Journal of manipulative and physiological therapeutics · 2014Trial
- Technologies to investigate the mechanisms of force-based manipulations: a narrative methods review.Frontiers in pain research (Lausanne, Switzerland) · 2026Review
- Factors that contribute to the perceived treatment effect of spinal manipulative therapy in a chiropractic teaching clinic: a qualitative study.Chiropractic & manual therapies · 2024Article
- A Preliminary Study of Chiropractors' Beliefs About Biomedical and Biopsychosocial Pain: A Survey of University of Western States Alumni.Journal of chiropractic medicine · 2018Article
- Dose-response of spinal manipulation for cervicogenic headache: study protocol for a randomized controlled trial.Chiropractic & manual therapies · 2016Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundThe doctor-patient encounter (DPE) and associated patient expectations are potential confounders in open-label randomized trials of treatment efficacy. It is therefore important to evaluate the effects of the DPE on study outcomes.
methodsFour hundred participants with chronic low back pain (LBP) were randomized to four dose groups: 0, 6, 12, or 18 sessions of spinal manipulation from a chiropractor. Participants were treated three times per week for six weeks. They received light massage control at visits when manipulation was not scheduled. Treating chiropractors were instructed to have equal enthusiasm for both interventions. A path analysis was conducted to determine the effects of dose, patient expectations of treatment success, and DPE on LBP intensity (100-point scale) at the end of care (6 weeks) and primary endpoint (12 weeks). Direct, indirect, and total standardized effects (βtotal) were computed. Expectations and DPE were evaluated on Likert scales. The DPE was assessed as patient-rated perception of chiropractor enthusiasm, confidence, comfort with care, and time spent.
resultsThe DPE was successfully balanced across groups, as were baseline expectations. The principal finding was that the magnitude of the effects of DPE on LBP at 6 and 12 weeks (|β|total = 0.22 and 0.15, p < .05) were comparable to the effects of dose of manipulation at those times (|β|total = 0.11 and 0.12, p < .05). In addition, baseline expectations had no notable effect on follow-up LBP. Subsequent expectations were affected by LBP, DPE, and dose (p < .05).
conclusionsThe DPE can have a relatively important effect on outcomes in open-label randomized trials of treatment efficacy. Therefore, attempts should be made to balance the DPE across treatment groups and report degree of success in study publications. We balanced the DPE across groups with minimal training of treatment providers.
trial registrationClinicalTrials.gov NCT00376350.
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What OpenQuestion holds
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.