Evidence map›Paper›PMID 42007408›Full record

ArticleMethodsX2026

The association between risk of bias and effect sizes of spinal manipulative therapy in low back pain trials: meta-epidemiological protocol.

Justine Tilborghs, Annemarie de Zoete, Michiel de Boer, Tiziano Innocenti, Javier Muñoz Laguna, Bayden J McKenzie, Raymond Ostelo, Casper Nim, Jan Hartvigsen, Sidney M Rubinstein

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In one paragraph

Article in MethodsX, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Justine TilborghsDepartment of Health Sciences, Faculty of Science and Amsterdam Movement Sciences Research Institute - Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Annemarie de ZoeteDepartment of General Practice, Erasmus MC University Medical Center, Rotterdam, Netherlands.
Michiel de BoerDepartment of Primary and Long-term Care, University Medical Center Groningen, Groningen, Netherlands.
Tiziano InnocentiDepartment of Health Sciences, Faculty of Science and Amsterdam Movement Sciences Research Institute - Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Javier Muñoz LagunaMusculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland.
Bayden J McKenzieMusculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Raymond OsteloDepartment of Health Sciences, Faculty of Science and Amsterdam Movement Sciences Research Institute - Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Casper NimMedical Research Unit, Spine Centre of Southern Denmark, Lillebaelt Hospital, University Hospital of Southern Denmark, Middelfart, Denmark.
Jan HartvigsenCenter for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
Sidney M RubinsteinDepartment of Health Sciences, Faculty of Science and Amsterdam Movement Sciences Research Institute - Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Systematic error undermines the internal validity of randomized controlled trials (RCTs). Elucidating how risk of bias (RoB) domains distort effect estimates strengthens evidence trustworthiness. Low back pain (LBP) research provides a representative field for this investigation, with spinal manipulative therapy (SMT) serving as a widely utilized intervention. Objective: To explore the association between risk of bias domains and effect estimates of SMT treatment in LBP trials. Methods: RCTs from the Cochrane systematic reviews which have examined the effect of SMT for acute and chronic LBP will be included. The Cochrane RoB 2 tool will be used. The influence of RoB domains on effect estimates for pain intensity and physical functioning will be explored through univariable and multivariable meta-regression models. Models will be adjusted for confounders identified through a directed acyclic graph, including sample size, trial registration, country income level, and comparator type, while exploring interactions. Significance: This study builds upon research in exercise therapy, investigating whether the association between RoB and effect estimates is consistent across other non-pharmacological LBP interventions. Findings may help refine the application of GRADE on SMT, and improve evidence synthesis and decision-making for researchers and policymakers.

Indexed as

Effect sizesLow back painMeta-epidemiological studyRandomized controlled trialsRisk of biasSpinal manipulative therapy

Identifiers

PMID42007408
PMCPMC13091211

What OpenQuestion holds

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Registered trials

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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.