Evidence map›Paper›PMID 34862434›Full record

SynthesisScientific reports2021

The importance of selecting the correct site to apply spinal manipulation when treating spinal pain: Myth or reality? A systematic review.

Casper G Nim, Aron Downie, Søren O'Neill, Gregory N Kawchuk, Stephen M Perle, Charlotte Leboeuf-Yde

Open access · goldAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Scientific reports, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
33citing papers in PubMed, 4 pooled it
6.8field-weighted citation impact, top 2% of its field
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

33 citing papers in PubMed, 4 syntheses or guidelines pooled it, 59 citations in OpenAlex.

  1. Manual physical therapy for neck disorders: an umbrella review.The Journal of manual & manipulative therapy · 2025
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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

6 authors at 4 institutions in 4 countries.

Casper G NimMedical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark. casper.nim@rsyd.dk.
Aron DownieDepartment of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, Australia.
Søren O'NeillMedical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark.
Gregory N KawchukDepartment of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.
Stephen M PerleSchool of Chiropractic, College of Health Sciences, University of Bridgeport, Bridgeport, USA.
Charlotte Leboeuf-YdeDepartment of Regional Health Research, University of Southern Denmark, Odense, Denmark.
University of Southern Denmark · DKMacquarie University · AUUniversity of Alberta · CAUniversity of Bridgeport · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The concept that spinal manipulation therapy (SMT) outcomes are optimized when the treatment is aimed at a clinically relevant joint is commonly assumed and central to teaching and clinical use (candidate sites). This systematic review investigated whether clinical effects are superior when this is the case compared to SMT applied elsewhere (non-candidate sites). Eligible study designs were randomized controlled trials that investigated the effect of spinal manipulation applied to candidate versus non-candidate sites for spinal pain. We obtained data from four different databases. Risk of bias was assessed using an adjusted Cochrane risk of bias tool, adding four items for study quality. We extracted between-group differences for any reported outcome or, when not reported, calculated effect sizes from the within-group changes. We compared outcomes for SMT applied at a 'relevant' site to SMT applied elsewhere. We prioritized methodologically robust studies when interpreting results. Ten studies, all of acceptable quality, were included that reported 33 between-group differences-five compared treatments within the same spinal region and five at different spinal regions. None of the nine studies with low or moderate risk of bias reported statistically significant between-group differences for any outcome. The tenth study reported a small effect on pain (1.2/10, 95%CI - 1.9 to - 0.5) but had a high risk of bias. None of the nine articles of low or moderate risk of bias and acceptable quality reported that "clinically-relevant" SMT has a superior outcome on any outcome compared to "not clinically-relevant" SMT. This finding contrasts with ideas held in educational programs and clinical practice that emphasize the importance of joint-specific application of SMT.

Indexed as

BiasDatabases, FactualHumansLow Back PainManipulation, SpinalRandomized Controlled Trials as TopicTreatment Outcome

Identifiers

PMID34862434
PMCPMC8642385
OpenAlexW3216997405

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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 Socratic graph.