Twenty years of randomized clinical trials of manipulative therapy for back pain: a review.

Manipulative therapy has been one of the most intensively studied approaches to back pain management. This paper reviews 20 years of randomized clinical trials of manipulative therapy, and addresses the following issues: for what condition were these patients treated? What was the population studied, and were workers included? Was a specific technique, spinal manipulation, or a more global approach the object of the trial? Finally, were there long-term outcome measures? The 21 randomized clinical trials reviewed here provide some indication that manipulative therapy offers some positive short-term results; it is not clear at this point whether long-term effects of the treatment have been adequately evaluated. Lack of specificity in the description of samples makes it impossible to conclude on the benefit of spinal manipulation for workers. Whether manipulation is solely responsible for the changes mentioned in these studies, independently of the global approach put forth by its practitioners, is also an open question that awaits further study.