A 2011 Cochrane review concluded that spinal manipulative therapy (SMT) is no better than other interventions for reducing pain and improving function in chronic low back pain (CLBP). Using individual participant data (IPD) from trials has advantages, among others: a more precise estimate of the effect and the potential to identify moderators. Our objective was to assess the effect of SMT in adults with CLBP and to identify relevant moderators. All trials from the 2011 Cochrane review were included in this IPD. We updated the search (April 2016) IPD from eligible studies was requested. Primary outcomes were pain intensity (VAS/NRS) and back-specific function (RMDQ). Risk of bias was assessed. For the treatment effect, an one-stage approach (mixed model technique, intention-to-treat principle) was used; a second-stage approach was conducted as confirmation. For the moderator analyses, one-stage approach was conducted for 19 variables.Purpose of the study and background
Methods
The objective of this overview was to evaluate the available evidence from systematic reviews on the effectiveness of surgical interventions for sciatica due to disc herniation. The last search was conducted in 2011. Since then new reviews have been published or existing reviews have been updated. A comprehensive search was performed in multiple databases including Cochrane database of systematic reviews (CDSR), Database of Reviews of Effectiveness (DARE) and Pubmed. Included are Cochrane and non-Cochrane systematic reviews on sciatica due to disc herniation published in peer-reviewed journals. We evaluated surgery versus conservative care and different surgical techniques compared to one another. The methodological quality of the systematic reviews was evaluated using AMSTAR by two independent reviewers. Nine, mostly high quality, systematic reviews on surgical interventions for disc herniation were included. Four reviews compared surgery with conservative treatment and concluded consistently that surgery has only short term benefits while the long term results showed no difference in effect. Four reviews compared open discectomy with micro(endo)scopic discectomy and found no significant and/or clinically relevant differences. The quality of evidence on alternative minimal invasive techniques (laser discectomy, automated percutaneous discectomy, and nucleoplasty or coblation) is consistently low in four recent reviews.Purposes of the study and background
Summary of the methods used and results
