The impact of pragmatic vs. prescriptive study designs on the outcomes of low back and neck pain when using mobilization or manipulation techniques: a systematic review and meta-analysis.

Objective: The purpose of this systematic review and meta-analysis was to examine the impact of pragmatic versus prescriptive study designs on the outcomes of low back and neck pain when using mobilization or manipulation techniques.

Methods: This study design was a systematic review and meta-analysis, which was performed according to the PRISMA guidelines. A search of MEDLINE and CINAHL complete databases was performed. Article titles and abstracts were reviewed to identify studies comparing mobilization and manipulation in low back or neck pain that met eligibility criteria. Validity of studies was examined using the Cochrane Risk of Bias tool. Data analysis was performed using RevMan 5.3. Forest plots were constructed after data were analyzed to determine effect sizes.

Results: Thirteen studies with a total of 1313 participants were included in the systematic review, and 12 studies with 977 participants in the meta-analysis. For most time-points prescriptive studies found manipulation to be superior to mobilization for both pain and disability. At no time-point did pragmatic designs find a difference between mobilization and manipulation for either pain or disability.

Discussion: When a pragmatic design was used, representing actual clinical practice, patients improved with both techniques with no difference between mobilization and manipulation. When clinicians were prescribed techniques, not representing true clinical practice, manipulation showed better outcomes than mobilization for pain and disability.

Level of Evidence: 1a.