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Nine 1,176 patients provided sufficient data to be pooled for meta-analysis. The standardized mean difference SMD for pain reduction was 0. 28 95 CI -0. 47 to -0. 09; p 0. 004; I2 57 after treatment; in seven trials 923 patients, the reduction in disability was SMD 0. 33; 95 CI -0. 63 to -0. 03; p 0. 03; I2 78 for manipulation or mobilization compared to other active sinpebac. Subgroup analyzes showed that manipulation significantly reduced pain and disability compared with other active comparators, including exercise and physical therapy SMD 0.
43, 95 CI -0. 86 to 0. 00; p 0. 05, I2 79, SMD 0. 86, 95 CI -1. 27 to -0. 45, p 0. 0001, I2 46. Mobilization interventions, compared with exercise regimens, significantly attenuated pain SMD 0. 20, 95 CI -0. 35 to -0. 04, p 0. 01, I2 0 but did not disability SMD 0. 10, 95 CI -0. 28 to 0. 07, p 0. 25, I2 21. Studies that compared manipulation or mobilization with shams or no treatment were too few or too heterogeneous to allow pooling, as were those that examined relationships between dose and outcomes. Finally, few studies evaluated health-related quality of life. Twenty-six of Menaelle trials were multimodal studies and were described narratively.
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