SynthesisEuropean journal of pain (London, England)2025
Exercise Therapy Versus Manual Therapy for the Management of Pain Intensity, Disability, and Physical Function in People With Chronic Low Back Pain: A Systematic Review With Meta-Analysis and Meta-Regression.
Synthesis in European journal of pain (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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
2 citing papers in PubMed.
- Comparative Effects of Therapeutic Exercise and Manual Therapy Techniques on Self-Reported Disability in Chronic Non-Specific Low Back Pain: A Network Meta-Analysis.Journal of clinical medicine · 2026Review
- From mechanotransduction to manual therapy: advances in piezo/TRP channels and lumbar degeneration.Frontiers in physiology · 2026Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
objectiveGuidelines recommend combining physical and psychological programmes for chronic low back pain (CLBP); however, exercise therapy (ET) and manual therapy (MT) are often delivered separately. This systematic review with meta-analysis and meta-regression of randomised controlled trials (RCTs) aimed to compare the efficacy of ET with MT in terms of pain intensity, disability and physical function in people with CLBP. DATABASES AND DATA TREATMENT: MEDLINE, Web of Science, PEDro, Cochrane Library and Scopus were searched July-August 2024 for RCTs comparing ET with MT in participants aged 18-54 years. Outcomes were extracted for the short-, medium- and long-term follow-up periods. Risk of bias (RoB 2.0 Cochrane Tool) and certainty of evidence (GRADE) were appraised.
resultsSix RCTs (743 patients) were included. Meta-analyses showed, albeit non-clinically relevant, a significant difference for long-term in favour of ET for disability (SMD = -0.25, 95% CI [-0.43, -0.07], p = 0.007). Meta-regression showed that the female-male ratio, treatment duration and mean age explain variability in pain intensity and disability.
conclusionsET had a small beneficial effect on long-term disability in people with CLBP. Nevertheless, evidence does not provide conclusive differences between both the treatments overall, influenced by heterogeneity and the number of studies included. Biopsychosocial factors may moderate the differences in outcomes. The GRADE assessment revealed very low certainty across all outcomes, highlighting the lack of high-quality research. SIGNIFICANCE STATEMENT: ET may offer small long-term benefits over MT for disability in people with CLBP. Differences seem to be influenced by sex, age and treatment duration. The choice of ET over MT, or vice versa, as a stand-alone treatment does not appear to be supported by current evidence. PROSPERO REGISTRATION NUMBER: CRD42024569120.
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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 Socratic graph.