SynthesisBMJ open2021
Sham treatment effects in manual therapy trials on back pain patients: a systematic review and pairwise meta-analysis.
Synthesis in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 5 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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 5 syntheses or guidelines pooled it, 74 citations in OpenAlex.
- Therapeutic Massage for Cancer Survivors: An Umbrella Review.Current oncology reports · 2026Pooled it
- The blinding status and characteristics in acupuncture clinical trials: a systematic reviews and meta-analysis.Systematic reviews · 2024Pooled it
- Use of Massage Therapy for Pain, 2018-2023: A Systematic Review.JAMA network open · 2024Pooled it
- Manual Therapy Effect in Placebo-Controlled Trials: A Systematic Review and Meta-Analysis.International journal of environmental research and public health · 2022Pooled it
- Massage and touch-based therapy : Clinical evidence, neurobiology and applications in older patients with psychiatric symptoms.Zeitschrift fur Gerontologie und Geriatrie · 2021Pooled it
- Mobilization with movement plus exercise versus exercise alone for patients with central sensitization associated with chronic subacromial pain syndrome: a sham-controlled randomized clinical trial.BMC complementary medicine and therapies · 2025Trial
- Aerobic high-intensity interval training and maximal strength training in patients with unspecific musculoskeletal disorders improve V̇OEuropean journal of sport science · 2024Trial
- One spinal manipulation session reduces local pain sensitivity but does not affect postural stability in individuals with chronic low back pain: a randomised, placebo-controlled trial.Chiropractic & manual therapies · 2024Trial
- Is blinding in studies of manual soft tissue mobilisation of the back possible? A feasibility randomised controlled trial with Swiss graduate students.Chiropractic & manual therapies · 2024Trial
- Neck-specific strengthening exercise compared with placebo sham ultrasound in patients with migraine: a randomized controlled trial.BMC neurology · 2022Trial
- Article
- Spinal Manipulative Therapy on a Healthy Population: Protocol for a Randomized Blinding Feasibility Trial.JMIR research protocols · 2026Article
- Review
- Evaluating Manual Therapy in Musculoskeletal Pain: Why Certain Trial Designs May Overestimate Effectiveness-A Scoping Review.European journal of pain (London, England) · 2025Article
- Sham treatment? Should it be redefined for its use in manual therapy clinical studies?The Journal of manual & manipulative therapy · 2025Article
- A critical review of the role of manual therapy in the treatment of individuals with low back pain.The Journal of manual & manipulative therapy · 2024Review
- A modern way to teach and practice manual therapy.Chiropractic & manual therapies · 2024Review
- Waste not, want not: call to action for spinal manipulative therapy researchers.Chiropractic & manual therapies · 2024Article
- Feasibility of blinding spinal manual therapy interventions among participants and outcome assessors: protocol for a blinding feasibility trial.Pilot and feasibility studies · 2024Article
- Efficacy and safety of the orthopaedic manipulation techniques of the Lin School of Lingnan Region in the treatment of adolescent idiopathic scoliosis: protocol of a participant-and-assessor-blinded randomized controlled study.BMC musculoskeletal disorders · 2024Article
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 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess the effects and reliability of sham procedures in manual therapy (MT) trials in the treatment of back pain (BP) in order to provide methodological guidance for clinical trial development.
designSystematic review and meta-analysis. METHODS AND ANALYSIS: Different databases were screened up to 20 August 2020. Randomised controlled trials involving adults affected by BP (cervical and lumbar), acute or chronic, were included.Hand contact sham treatment (ST) was compared with different MT (physiotherapy, chiropractic, osteopathy, massage, kinesiology and reflexology) and to no treatment. Primary outcomes were BP improvement, success of blinding and adverse effect (AE). Secondary outcomes were number of drop-outs. Dichotomous outcomes were analysed using risk ratio (RR), continuous using mean difference (MD), 95% CIs. The minimal clinically important difference was 30 mm changes in pain score.
results24 trials were included involving 2019 participants. Very low evidence quality suggests clinically insignificant pain improvement in favour of MT compared with ST (MD 3.86, 95% CI 3.29 to 4.43) and no differences between ST and no treatment (MD -5.84, 95% CI -20.46 to 8.78).ST reliability shows a high percentage of correct detection by participants (ranged from 46.7% to 83.5%), spinal manipulation being the most recognised technique.Low quality of evidence suggests that AE and drop-out rates were similar between ST and MT (RR AE=0.84, 95% CI 0.55 to 1.28, RR drop-outs=0.98, 95% CI 0.77 to 1.25). A similar drop-out rate was reported for no treatment (RR=0.82, 95% 0.43 to 1.55).
conclusionsMT does not seem to have clinically relevant effect compared with ST. Similar effects were found with no treatment. The heterogeneousness of sham MT studies and the very low quality of evidence render uncertain these review findings.Future trials should develop reliable kinds of ST, similar to active treatment, to ensure participant blinding and to guarantee a proper sample size for the reliable detection of clinically meaningful treatment effects. PROSPERO REGISTRATION NUMBER: CRD42020198301.
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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.