Assessing the impact of manual therapy in the management of low back pain: a scoping review of outcomes used in clinical trials
Mathis BRIER, RMeS UMR1229, Nantes Université
Introduction: Low Back Pain (LBP) is the leading cause of disability worldwide, 90% of which is non-specific[1,2]. Manual therapy is one of the recommended treatment modalities[3,4]. However, reported outcomes may be variable. This review aims to identify their scope in the context of the development of a Core Outcome Set (COS), which is defined as “an agreed standardised set of outcomes that should be measured and reported, as a minimum, in all clinical trials in specific areas of health or health care”[5].
Methods: A systematic review registered on PROSPERO and the COMET Database[6,7] of clinical trials of manual therapy for LBP was conducted using MEDLINE, CENTRAL, PEDro, WebOfScience and ClinicalTrials.gov, including articles from 2010 up to August 2024. Manual treatments were considered to be the use, alone or in combination, of manipulations (high velocity, low amplitude), mobilisations (low-grade velocity, small-to-large amplitude) or soft tissue relaxation (especially massage, trigger points, muscle contractions). The review emphasized on the type of LBP (acute, subacute, chronic), outcomes, outcome measures and their type.
Results (preliminary – selection ongoing): Out of 3966 articles, almost 200 were included in the review. Two main outcomes emerged: pain intensity (mostly assessed by numerical rating or visual analogue scale) and disability (mostly assessed by Rolland-Morris Disability Questionnaire or Oswestry Disability Index). However, physical and mental function, days of incapacity and medication use are also commonly used in outcomes. Most of the outcomes were patient-reported outcomes.
Conclusion (preliminary): As in other COS for LBP, pain intensity and disability seem to be crucial. However, other outcomes are recurrent and may be relevant to patients seeking care with manual therapy. These will be discussed in a participatory research approach to reach a consensus between patients, clinicians and researchers on the minimum outcomes to be systematically assessed in the management of LBP with manual therapy.