DIAGNOSTIC TESTS FOR DEEP VEIN THROMBOSIS (HTA 02/03)



Additional file 3. Data tables for included papers – study characteristics, results and conclusions

Table A. Systematic reviews – study characteristics, results and conclusions

|Study |Inclusion criteria and methodology |Included studies |Results and Conclusions |

|Overarching reviews | | | |

|Brantingham 2012 |INCLUSION CRITERIA |N included trials: 48 studies on knee hip, |Evidence level of B (fair evidence) for MT combined with multimodal or exercise therapy|

| |Study design: any |ankle and foot conditions. |for short-term treatment of hip osteoarthritis and a level of C (limited evidence) for |

|Focus: manipulative therapy |Participants: peripheral (extremity diagnosis) |Study quality: no summary given but quality |MT combined with multimodal or exercise therapy for long-term treatment of hip |

|(MT) for lower extremity |Interventions: manipulative therapy |forms part of the evidence ratings |osteoarthritis |

|conditions |Outcomes: pain, function |Study characteristics: details given in the |Evidence level of B for MT of the knee and/or full kinetic chain and of the ankle |

| | |tables; n=5 hip, n=20 knee, n=13 ankle, n=11|and/or foot, combined with multimodal or exercise therapy for short-term treatment of |

|Quality: high |METHODOLOGY |foot |knee osteoarthritis, patellofemoral pain syndrome, and ankle inversion sprain and a |

| |5 relevant databases searched, 03/2008 to 5/2011 | |level of C for MT of the knee and/or full kinetic chain and of the ankle and/or foot, |

| |(review update), English studies only; details on |Excluded studies eligible for current |combined with multimodal or exercise therapy for long-term treatment of knee OA, |

| |study selection, data extraction, quality |review: not reported |patellofemoral pain syndrome, and ankle inversion sprain |

| |assessment; excluded studies not listed. | |Evidence level of B for MT of the ankle and/or foot combined with multimodal or |

| |Data analysis: text and tables | |exercise therapy for short-term treatment of plantar fasciitis but a level of C for MT |

| |Subgroups / sensitivity analyses: none | |of the ankle and/or foot combined with multimodal or exercise therapy for short-term |

| | | |treatment of metatarsalgia and hallux limitus/rigidus and (for a new category) for loss|

| | | |of foot and/or ankle proprioception and balance |

| | | |Evidence level of I (insufficient evidence) for MT of the ankle and/or foot combined |

| | | |with multimodal or exercise therapy for hallux abducto valgus |

|Ankle and foot conditions | | | |

|Lin 2012 |INCLUSION CRITERIA |N included trials: 2 RCTs of manual therapy |RESULTS |

| |Study design: RCTs |Study quality: Wilson 1991: 3/6 (high risk |Wilson 1991: after 5 weeks’ treatment, no statistically significant improvement in |

|Focus: rehabilitation for |Participants: patients presenting for rehabilitation|of bias), Lin 2008: 6/6 (low risk of bias) |activity limitation or ankle plantarflexion range of motion, ankle dorsiflexion range |

|ankle fractures in adults |following ankle fracture |Study characteristics: Wilson 1991: n=12, |of motion statistically significant in favour of manual therapy |

| |Interventions: any intervention employed by any |ankle fracture treated with or without |Lin 2008: no significant difference between groups in functional, pain or quality of |

|Quality: high |health professional to assist with rehabilitation |surgery, physiotherapy after cast removal, |life parameters at 24 weeks’ follow-up |

| |following ankle fracture |Kaltenborn-based manual therapy, 5 weeks; | |

| |Outcomes: activity limitation, quality of life, |Lin 2008: n=94; ankle fractures treated with|CONCLUSIONS |

| |patient satisfaction, ankle dorsiflexion and |cast immobilisation, start of manual therapy|no evidence that manual therapy after a period of immobilisation may improve ankle |

| |plantarflexion, strength, swelling, adverse events |within 7 days of cast removal, large |range of motion in patients after ankle fracture |

| | |anterior-posterior glides of the talus, 2 | |

| |METHODOLOGY |sessions a week for 4 weeks versus no manual| |

| |7 relevant databases searched, no date, language or |therapy; standard physiotherapy in both | |

| |publication restriction; duplicate study selection, |groups | |

| |data extraction and quality assessment; details on | | |

| |quality assessment and individual studies; excluded |Excluded studies eligible for current | |

| |studies listed |review: no | |

| |Data analysis: text, tables, meta-analysis | | |

| |Subgroups / sensitivity analyses: rehabilitation | | |

| |after surgical vs after conservative management; | | |

| |true vs quasi-randomisation, concealed versus | | |

| |unconcealed allocation, blind vs non-blind outcome | | |

| |assessment, minimal vs significant drop-outs | | |

|Carpal tunnel syndrome | | | |

|Huisstede 2010 |INCLUSION CRITERIA |N included trials: 4 RCTs of manual therapy |RESULTS |

| |Study design: systematic reviews or RCTs | |Tal Akabi 2000: carpal bone mobilisation led to significantly greater improvement in |

|Focus: effectiveness of |Participants: patients with carpal tunnel syndrome |Study quality: Bialosky 2009, Burke 2007: |symptoms than control; no significant difference between carpal bone mobilisation and |

|non-surgical treatments for |(not caused by acute trauma or systemic disease) |high quality; Davis 1998, Tal-Akabi 2000: |neural mobilisation (pain, function, improvement) |

|carpal tunnel syndrome |Interventions: any non-surgical |low quality |Bialosky 2009: no significant differences between groups with respect to pain, |

| |Outcomes: pain, function, recovery |Study characteristics: Tal Akabi 2000: n=21,|disability (Dash questionnaire) or grip strength |

|Quality: medium | |carpal bone mobilisation versus neurodynamic|Burke 2007: no significant difference between groups with respect to pain, range of |

| |METHODOLOGY |treatment (median nerve mobilisation) versus|motion, grip strength, the Boston Carpal Tunnel questionnaire |

| |5 relevant databases searched, no date or language |control, 3 weeks; Bialosky 2009: n=40, |Davis 1998: no significant difference for hand function |

| |limit; duplicate study selection, data extraction |neurodynamic technique plus splinting versus| |

| |and quality assessment; details on quality |splinting, 3 weeks; Burke 2007; n=22, |CONCLUSIONS |

| |assessment and individual studies; excluded studies |Graston-instrument assisted soft tissue |limited evidence that carpal bone mobilisation is more effective than no treatment in |

| |not listed. |mobilisation plus exercise versus manual |the short term |

| |Data analysis: text and tables |soft tissue mobilisation plus exercise, 6 |no evidence found for the effectiveness of neurodynamic versus carpal bone mobilisation|

| |Subgroups / sensitivity analyses: none |months; Davis 1998: n=91, chiropractic |in the short term, for the effectiveness of a neurodynamic technique plus splinting |

| | |treatment (manual thrusts, myofascial |compared with a sham therapy plus splinting group in the short term, or for the |

| | |massage and loading, ultrasound, wrist |effectiveness of Graston instrument-assisted soft tissue mobilisation plus home |

| | |splint versus medical treatment (ibuprofen) |exercises compared with soft tissue mobilisation plus home exercises to treat carpal |

| | |and wrist splint, 13 weeks |tunnel syndrome in the midterm |

| | | |no evidence for the effectiveness of chiropractic therapy compared with medical |

| | |Excluded studies eligible for current |treatment for carpal tunnel syndrome in the midterm |

| | |review: not reported | |

|Lateral epicondylitis (tennis | | | |

|elbow) | | | |

|Herd 2008 |INCLUSION CRITERIA |N included trials: 13 |RESULTS |

| |Study design: RCTs and non-RCTs |Study quality: mean PEDro score 5.15 (1-8) |Mulligan’s mobilisation with movement and MT to the cervical spine were effective |

|Focus: effectiveness of |Participants: adults with LE |Study characteristics: studies included | |

|manipulative therapy in |Interventions: joint manipulation/mobilisation |adult men/women with LE, 5 studies had |CONCLUSIONS |

|treating lateral |Outcomes: pain, grip strength, pressure pain |short-term follow-up (< 3months), 4 studies |The review identified paucity and low quality of evidence |

|epicondylalgia (LE) |threshold, range of motion |had long-term follow-up (6 months or | |

| | |longer), and 2 studies had a year-long | |

|Quality: medium |METHODOLOGY |follow-up | |

| |Data analysis: narrative, tables, methodological |Excluded studies eligible for current | |

| |quality assessment PEDro score |review: none | |

| |Subgroups / sensitivity analyses: not reported | | |

|Kohia 2008 |INCLUSION CRITERIA |N included trials: 16 |RESULTS |

| |Study design: RCTs |Study quality: level I – grade A (7 trials),|Corticosteroid injections more beneficial versus PT (elbow manipulation and exercise) |

|Focus: effectiveness of |Participants: adults with LE |level II – grade B (9 trials) |or Cyriax physiotherapy (6 months or less) (Grade-A recommendation); no difference |

|various physical therapy (PT) |Interventions: Cyriax physiotherapy, wrist |Study characteristics: randomised studies in|between PT (elbow manipulation and exercise) versus corticosteroid injections or no |

|treatments for LE in adults |manipulation, standard physical therapy, ultrasound,|LE adults reporting effectiveness of |treatment (6 months or longer) (Grade-A recommendation); radial head mobilisation |

| |bracing, shockwave therapy |physical therapy interventions such as |better than standard treatment (ultrasound, massage, stretching, exercise for wrist) in|

|Quality: medium |Outcomes: global improvement, pain, grip strength, |Cyriax physiotherapy, wrist manipulation, |a short-term follow-up (15 weeks); PT protocol (pulsed ultrasound, friction massage, |

| |pressure pain threshold, range of motion, pain-free |standard physical therapy, ultrasound, |and stretching, exercise for wrist) better than a brace with/without pulsed ultrasound |

| |grip, quality of life , self-reported progression of|bracing, shockwave therapy |(Grade-A recommendation); Cyriax PT better than light therapy, but worse than |

| |the condition | |supervised exercise of wrist extensors; wrist manipulation better than a combination of|

| | |Excluded studies eligible for current |ultrasound, friction massage, and muscle strengthening (Grade-B recommendation) |

| |METHODOLOGY |review: none | |

| |Data analysis: four relevant databases searched from| |CONCLUSIONS |

| |1994 to 2006; narrative synthesis, tables; | |no single treatment technique shown to be the most effective in treatment of LE |

| |methodological quality assessment using Megens and | | |

| |Harris criteria and Sackett’s hierarchical levels | | |

| |(I-V) and three grades of recommendation (A, B, and | | |

| |C) | | |

| |Subgroups / sensitivity analyses: not reported | | |

|Nimgade 2005 |INCLUSION CRITERIA |N included trials: 30 |RESULTS |

| |Study design: RCTs and non-RCTs |Study quality: study quality score ranged |At 6 weeks, steroid injections and multimodal physiotherapy (arm stretching, |

|Focus: the effectiveness of |Participants: adults with LE |from 2 to 9 (out of 11) |strengthening, ultrasound, and massage) were more effective than relative rest. |

|physiotherapy, steroid |Interventions: physiotherapy, steroid injections, |Study characteristics: randomised and | |

|injections, and relative rest |and relative rest |non-randomised studies in LE adults (males |After 3 months, the multimodal physiotherapy was better than steroid injections, but as|

|for the treatment of adult LE |Outcomes: pain, strength, and function |and females) reporting effectiveness of |effective as relative rest |

| | |physiotherapy, steroid injections, and | |

|Quality: medium |METHODOLOGY |relative rest |CONCLUSIONS |

| |Searched 3 databases (for the period of 1966-2004) | |The active interventions such as steroid injections and multimodal physiotherapy may |

| |and bibliographic citations of relevant studies |Excluded studies eligible for current |improve symptoms of LE in adults but this needs to be confirmed in future large and |

| |Data analysis: narrative synthesis, tables; |review: none |high quality studies |

| |methodological quality assessment using the Cochrane| | |

| |Collaboration guidelines for grading controlled | | |

| |trials (internal validity: 11 items, external | | |

| |validity: 6 items, and statistical criteria: 2 | | |

| |items) | | |

| |Subgroups / sensitivity analyses: not reported | | |

|Trudel 2004 |INCLUSION CRITERIA |N included trials: 31 |RESULTS |

| |Study design: randomised/non-randomised controlled |Study quality: level 2b studies |Mobilisation/manipulation was more effective in improving symptoms of LE compared to |

|Focus: the effectiveness of |clinical trials |Study characteristics: randomised and |placebo or standard physiotherapy. At one year of follow-up, there was no difference |

|conservative treatments for LE|Participants: adults with LE |non-randomised studies in LE adults (males |between corticosteroid injections and manipulation/mobilisation (Cyriax group) |

|in adults |Interventions: conservative treatments (e.g., |and females) reporting effectiveness of | |

| |ultrasound, acupuncture, rebox, exercise, wait and |conservative treatment (physiotherapy, |CONCLUSIONS |

|Quality: medium |see, mobilisation, and/or manipulation, laser) |manipulation/mobilisation) |The authors concluded that level 2b (Sackett’s evidence rating) evidence indicates |

| |Outcomes: pain, grip strength, pressure pain | |benefits of mobilisation/manipulation in treating LE |

| |threshold, range of motion, pain-free grip, muscle |Excluded studies eligible for current | |

| |function, endurance for activity |review: none | |

| | | | |

| |METHODOLOGY | | |

| |Searched 4 databases (for the period of 1983 to | | |

| |2003) and bibliographic citations of relevant | | |

| |studies | | |

| |Data analysis: narrative synthesis, tables; | | |

| |methodological quality assessment using 23 criteria | | |

| |by MacDermid; the evidence was rated using Sackett’s| | |

| |levels of evidence | | |

| |Subgroups / sensitivity analyses: not reported | | |

|Shoulder conditions | | | |

|Brantingham 2011 |INCLUSION CRITERIA |N included trials: 23 RCTs, 5 CCTs, 7 before|RESULTS / CONCLUSIONS |

| |Study design: systematic reviews or primary studies |and after studies, case reports and case |Rotator cuff disorders: fair evidence for manual and manipulative therapy of the |

|Focus: effectiveness of |Participants: patients with a shoulder peripheral |series |shoulder, shoulder girdle and/or full kinetic chain combined with multimodal or |

|manipulative therapy for |diagnosis |Study quality: rotator cuff disorders: 7 |exercise therapy |

|shoulder pain and disorders |Interventions: manipulative therapy with or without |high or very high quality studies, 3 medium,|Shoulder complaints, dysfunctions, disorders or pain: fair evidence for manual and |

| |multimodal or adjunctive therapy |1 low; shoulder complaints / disorders: 6 |manipulative therapy of the shoulder/shoulder girdle and full kinetic chain combined |

|Quality: medium |Outcomes: as reported |high or very high, 1 medium; frozen |with exercise or a multimodal treatment approach |

| | |shoulder: 3 high or very high, 3 medium; |Frozen shoulder (adhesive capsulitis): fair evidence for manual and manipulative |

| |METHODOLOGY |shoulder soft tissue disorders: 2 high, 1 |therapy of the shoulder, shoulder girdle and/or full kinetic chain combined with |

| |5 relevant databases searched from 1983, English |medium; neurogenic shoulder pain: 2 high; |multimodal or exercise therapy (manual therapy included high velocity low amplitude |

| |language; no details on study selection, independent|shoulder osteoarthritis: no specific RCTs |manipulation, mid- or end-range mobilisation, mobilisation with movement) |

| |data extraction by three authors; quality assessment|Study characteristics: n=1 to 172; |Shoulder soft tissue disorders: fair evidence for using soft tissue or myofascial |

| |using PEDro and whole systems research scores; |interventions: mobilisation, manipulation |treatments (ischaemic compression, deep friction massage, therapeutic stretch) |

| |details on individual studies; excluded studies not |with and without exercise, combined in some |Neurogenic shoulder pain: limed evidence for cervical lateral glide mobilisation and / |

| |listed. |studies with soft tissue treatment, |or high velocity low amplitude manipulation with soft tissue release and exercise in |

| |Data analysis: text and tables |mobilisation with movement, myofascial |the treatment of minor neurogenic shoulder pain |

| |Subgroups / sensitivity analyses: different shoulder|treatments, cervical lateral glide |Osteoarthritis of the shoulder: insufficient evidence (no trials in this patient group)|

| |disorders |mobilisation | |

| | | | |

| | |Excluded studies eligible for current | |

| | |review: not reported | |

|Braun 2009 |INCLUSION CRITERIA |N included trials: 8 systematic reviews, 6 |RESULTS |

| |Study design: systematic reviews, RCTs, quasi-RCTs |RCTs |5 reviews: evidence to favour manual therapy plus exercise over exercise alone |

|Focus: effectiveness of manual|Participants: patients with pain arising locally in |Study quality: both systematic reviews and |Evidence of three relevant additional trials inconclusive (with a tendency towards |

|therapy for |a shoulder with grossly abnormal mobility; diagnosed|RCTs had a range of quality deficits |improved outcomes with manual therapy and exercise) |

|impingement-related shoulder |'shoulder impingement' disorders; shoulder bursitis;|Study characteristics: n=30 to 112, 3 RCTs |No evidence found for the effectiveness of mobilisation alone |

|pain |tendinitis, tendinopathy and degenerative changes of|included exercise only, 3 included exercise |None of the systematic reviews and only one of the RCTs included a specific statement |

| |any rotator cuff muscle; positive findings for |and manual therapy (mobilisation) |on adverse events; in the one RCT no adverse events were reported |

|Quality: medium |'painful arc'; impingement signs or tests; pain in | | |

| |the shoulder with emphasis on provocation through |Excluded studies eligible for current |CONCLUSIONS |

| |elevation or lowering of the arm; impaired rotator |review: no |There is limited evidence to support the effectiveness of manual therapy and exercise |

| |cuff function or integrity | |interventions for impingement-related shoulder pain; this primarily relates to subacute|

| |Interventions: manual or exercise therapy compared | |and chronic complaints and short and medium term effectiveness; the conclusions are |

| |to any conservative or surgical or no treatment | |based on research of varying methodological quality, with varying risk of bias, and are|

| |Outcomes: pain, function, disability, symptoms, | |affected by weaknesses in the reporting quality; cautious interpretation is warranted |

| |quality of life, range of motion, strength, work | |due to heterogeneity of populations, interventions and outcomes |

| |absenteeism, costs, adverse events | | |

| | | | |

| |METHODOLOGY | | |

| |6 relevant databases searched, primary studies post | | |

| |cut-off dates of reviews (Jan 2005) to Oct 2008, | | |

| |English or German; duplicate selection or data | | |

| |extraction not mentioned; quality assessment using | | |

| |AMSTAR and PEDro scale; details on quality | | |

| |assessment and individual studies; excluded studies | | |

| |listed. | | |

| |Data analysis: text and tables | | |

| |Subgroups / sensitivity analyses: none | | |

|Camarinos 2009 |INCLUSION CRITERIA |N included trials: 7 RCTs |RESULTS |

| |Study design: RCTs |Study quality: average PEDro score 7.86, |Mobilisation with movement (n=3): significant improvement in range of motion in two of |

|Focus: effectiveness of manual|Participants: adults 18 to 80 years with shoulder |range 6 to 9 |three studies, highest percentage change in range of motion in third study; significant|

|physical therapy for painful |Interventions: physical therapy for conservative |Study characteristics: participants: n=14 to|improvement in pain in one of two studies; significant functional improvement in one |

|shoulder conditions |management of shoulder pain, treatment by physical |100, interventions: mobilisation with |study and highest percentage change in function in second study |

| |therapists; the interventions of interest were |movement, Cyriax approach, static |Cyriax manual therapy (n=1): significant improvement in range of motion compared to |

|Quality: medium |manual therapy interventions including low and high |mobilisation performed at end-range or |control |

| |velocity mobilisations directed to the glenohumeral |mid-ranges of motion |Mobilisations at end-range of motion (n=3): improvement in range of motion and |

| |joint without additional mobilisation of adjacent | |end-range mobilisation reported in all studies; two studies reported no significant |

| |structures |Excluded studies eligible for current |difference in pain measures, two of three studies reported significantly improved |

| |Outcomes: active or passive range of motion, a |review: none |function compared to control |

| |functional outcome measure specific to the shoulder,| |Mid-range mobilisation (n=4): no effect on range of motion, only one reported a |

| |quality of life measure, pain measure | |significant improvement in pain and none reported a significant difference in function |

| | | | |

| |METHODOLOGY | |CONCLUSIONS |

| |4 relevant databases searched, English language, | |The included studies demonstrated a benefit of manual therapy for improvements in |

| |published between 1996 and 2009; reference lists, | |mobility and a trend in improving pain measures, while increases in function and |

| |hand searching of a couple of relevant journals; | |quality of life were questionable |

| |study selection, data extraction and quality | | |

| |assessment by more than one author; details on | | |

| |quality assessment (PEDro scores) and individual | | |

| |studies; excluded studies not listed. | | |

| |Data analysis: text and tables | | |

| |Subgroups / sensitivity analyses: none | | |

|Pribicevic 2010 |INCLUSION CRITERIA |N included trials: 22 case reports, 4 case |RESULTS |

| |Study design: case reports, case series, RCTs |series, 4 RCTs |Munday 2007: manipulation superior to placebo in the short term treatment of shoulder |

|Focus: effectiveness of |Participants: patients with shoulder pain or related|Study quality: RCTs scored 5 to 8 out of 10 |impingement syndrome |

|manipulative therapy for the |specific clinical diagnosis; adhesive capsulitis |Study characteristics: case reports and case|Winters 1997: manipulation significantly better than classic physiotherapy in reducing |

|treatment of shoulder pain |excluded |series all of chiropractic treatment; RCTs: |pain and recurrence (general shoulder complaints) |

| |Interventions: treatment by registered practitioner |n=15 to 172, interventions: 1 RCT with |Bergman 2004: after 12 weeks significantly more patients in the manipulation than usual|

|Quality: medium |of chiropractic, physiotherapy or medicine; |chiropractic manipulations, 3 with |care group reported full recovery or very large improvement; no difference at 12 months|

| |treatment typical of the profession and included |physiotherapeutic manipulations |(shoulder dysfunctions) |

| |manipulative thrust technique | |Savolainen 2004: at 12 months, VAS pain was reduced in favour of the thoracic |

| |Outcomes: any outcomes |Excluded studies eligible for current |manipulation group (neck and shoulder pain in occupational health) |

| | |review: not reported | |

| |METHODOLOGY | |CONCLUSIONS |

| |5 relevant databases searched, from 1985, English | |Evidence is limited, only two RCTs of reasonably sound methodology; need for |

| |language; bibliographies searched; methods of study | |well-designed trials investigating multi-modal chiropractic treatment |

| |selection and data extraction unclear; quality | | |

| |assessment using PEDro scale; details on quality | | |

| |assessment and individual studies; excluded studies | | |

| |not listed. | | |

| |Data analysis: text and tables | | |

| |Subgroups / sensitivity analyses: none | | |

|Cervicogenic headache | | | |

|Posadzki 2011 |INCLUSION CRITERIA |N included studies: 9 RCTs |RESULTS |

| |Study design: RCTs |Study quality: Cochrane Risk of Bias tool |6 trials, which were conducted by chiropractors, suggested the benefit of SMT in |

|Focus: effectiveness/safety of|Participants: adults with CGH |and Jadad score; most trials had major |treating the headaches over physical therapy, light massage, drug therapy, or no |

|spinal manipulation therapy |Interventions: manipulative procedures |methodological flaws; two trials (Borusiak |intervention. The remaining 3 trials, which were conducted by non-chiropractors, showed|

|(SMT) in cervicogenic headache|(chiropractic, osteopathy) |2010 and Jull 2002) had low risk of bias |no significant difference in headache intensity, duration, or frequency between SMT and|

|(CGH) |Outcomes: headache intensity, duration, frequency |with Jadad score of 4 and three trials |placebo, physical therapy, massage, or wait list controls |

| | |(Bitterli 1977, Howe 1983, Li 2007) had high| |

|Quality: high |METHODOLOGY |risk of bias with Jadad score of 0-1 |CONCLUSIONS |

| |7 relevant databases searched; no language limit; |Study characteristics: populations across |Given the clinical heterogeneity, inconsistency in results, and low methodological |

| |some details on study selection; quality assessment |studies were relatively homogenous, but |quality of the reviewed studies, the evidence regarding the effectiveness of SMT for |

| |of studies presented; studies not presenting |control interventions were different ranging|CGH is rendered inconclusive |

| |original data, abstracts, conference proceedings, |from sham manipulation, light massage, | |

| |outcomes of interest not reported were excluded; |drugs, physical therapy to no intervention | |

| |excluded studies not listed | | |

| |Data analysis: text and tables |Excluded studies eligible for current | |

| |Subgroups / sensitivity analyses: not reported |review: not reported | |

|Miscellaneous headaches | | | |

|Bryans 2011 |INCLUSION CRITERIA |N included studies: 11 RCTs, 5 controlled |RESULTS |

| |Study design: systematic reviews, RCTs, CCTs |trials, and 5 systematic reviews |Spinal manipulation was shown beneficial for adults with episodic/chronic migraine and |

|Focus: effectiveness/safety of|Participants: adults with miscellaneous headaches |Study quality: the Cochrane Collaboration |cervicogenic headache, but not for those with episodic tension-type headache |

|spinal manipulation therapy |(migraine, tension-type headache, cervicogenic |Back Review Group (controlled studies; score|Craniocervical mobilisation and joint mobilisation were effective for episodic/chronic |

|(SMT), mobilisation, or manual|headache) |range: 3-9) and Oxman and Guyatt (systematic|tension-type headaches and cervicogenic headache, respectively |

|traction in adults with |Interventions: spinal manipulation therapy (SMT), |reviews; score range: 6-9) |It is not clear if spinal manipulation, manual traction, connective tissue |

|miscellaneous headaches |mobilisation, or manual traction |Study characteristics: studies differed in |manipulation, Cyriax’ mobilisation or exercise are effective for tension-type headaches|

|(migraine, tension-type |Outcomes: headache intensity, duration, frequency, |inclusion criteria and included adults with | |

|headache, cervicogenic |quality of life, disability, medicine use |miscellaneous headaches (migraine, |Risks of harms reported in 6 trials were low |

|headache) | |tension-type headache, or cervicogenic | |

| |METHODOLOGY |headache). Most studies reported pain |CONCLUSIONS |

|Quality: high |8 relevant databases searched; English publications;|relief, pain duration, frequency, pain |The guideline panel recommend the use of spinal manipulation for the management of |

| |hand search of reference lists; details on study |medication use, and quality of life |adults with episodic/chronic migraine (moderate evidence level) and cervicogenic |

| |selection; quality assessment of studies presented; | |headache (moderate evidence level) |

| |excluded studies and reasons for exclusions are |Excluded studies eligible for current |The guideline panel cannot recommend the use of spinal manipulation for the management |

| |listed; assessed strength of evidence using |review: not reported |of episodic tension-type headache (moderate evidence level) |

| |pre-defined rules and recommendations for practice | |The guideline panel recommend the use of craniocervical mobilisation and joint |

| |are developed | |mobilisation for episodic/chronic tension-type headaches and cervicogenic headache, |

| |Data analysis: text and tables | |respectively |

| |Subgroups / sensitivity analyses: not reported | |No recommendation on spinal manipulation, manual traction, connective tissue |

| | | |manipulation, Cyriax’ mobilisation or exercise for chronic tension-type headache |

|Fibromyalgia | | | |

|Terhorst 2011 |INCLUSION CRITERIA |N included studies: 3 small RCTs on |RESULTS |

| |Study design: RCTs |manipulative therapy |The two chiropractic studies had significant effects in favour of the intervention |

|Focus: effectiveness of |Participants: adults diagnosed with fibromyalgia |Study quality: manipulative therapy: 2 low | |

|complementary and alternative |according to the American College of Rheumatology, |and 1 moderate quality |CONCLUSIONS |

|medicine in the treatment of |Yunus, or Smythe criteria |Study characteristics: 1 trial of |No overall conclusions can be drawn, as there was only a very limited number of very |

|pain in fibromyalgia |Interventions: a complementary or alternative |chiropractic versus waiting list (n=19), 1 |small studies on manipulative therapy |

|Quality: medium |therapy compared to control |trial of osteopathy versus treatment as | |

| |Outcomes: pain |usual (n=12), 1 trial of chiropractic plus |Research recommendations |

| | |resistance training versus resistance |Patients with fibromyalgia should be subdivided into subgroups based on baseline |

| |METHODOLOGY |training (n=21) |characteristics; studies with larger sample sizes are needed |

| |11 relevant databases searched; hand search of | | |

| |reference lists; details on study selection; quality|Excluded studies eligible for current | |

| |assessment of studies presented; study details shown|review: not reported | |

| | | | |

| |Data analysis: text and tables | | |

| |Subgroups / sensitivity analyses: not reported, | | |

| |analysis by type of therapy | | |

|Asthma | | | |

|Kaminskyj 2010 |INCLUSION CRITERIA |N included trials: 8 (3 RCTs, 1 CCT, 1 case |RESULTS |

| |Study design: prospective and retrospective studies |study, 1 case series, 2 surveys) |in comparative studies, no significant differences between comparison groups in |

|Focus: effectiveness of |including RCTs, controlled |N participants: 275 plus 5607 from one |respiratory parameters, symptoms or subjective measures |

|chiropractic treatment for |clinical/quasi-experimental trials; cohort, |survey |in uncontrolled studies, improvements were generally seen in subjective measures |

|asthma |case-control, case series and survey designs |Trial quality: four studies 18 years, with a diagnosed |bias, 1 with high risk of bias |to control (effect size -3.38 (95% CI: -5.46, -1.31, p=0.001) overall, effect size |

|treatment on female lower |female urination disorder; exclusions: neurologic |Study characteristics: studies addressed |-6.34 (95% CI: -10.85, -1.84, p=0.008) when compared to no treatment) |

|urinary tract disorders |disorders, tumours, urinary tract infections, |voiding dysfunction, urinary incontinence, |There was no significant difference when comparing osteopathic treatment with pelvic |

|Quality: high |pregnancy |urge and stress incontinence; number of |floor muscle training |

| |Interventions: osteopathic treatments |participants: 47 to 90; interventions: | |

| |Outcomes: urologic symptoms |osteopathic manual therapy compared to no |CONCLUSIONS |

| | |treatment or pelvic floor muscle training; |The studies point to an improvement of the symptoms associated with female lower |

| |METHODOLOGY |duration: 4 to 12 weeks |urinary tract disorders with osteopathic treatment |

| |7 relevant databases searched, ongoing trials | | |

| |searched, keywords shown, citation tracking, |Excluded studies eligible for current | |

| |bibliographies searched; studies selected |review: not reported | |

| |independently by 2 authors; data extraction and | | |

| |quality assessment conducted independently by 2 | | |

| |reviewers; quality assessment using the Cochrane | | |

| |Risk of Bias Tool; systematic tabulation of studies.| | |

| |Data analysis: meta-analysis; text and tables | | |

| |Subgroups / sensitivity analyses: none | | |

|Loving 2012 |INCLUSION CRITERIA |N included trials: 6 RCTs, 1 cohort study, 3|RESULTS |

| |Study design: prospective quantitative study design |case-series; 3 RCTs relevant to manual |There was level 1d evidence (high risk of bias) that physiotherapeutic distension of |

|Focus: effects of |Participants: women, >19 years, with chronic pelvic |therapy |painful pelvic structures combined with pain counselling improves pain experience |

|physiotherapy in the |pain (pelvic adhesion, pelvic congestion syndrome, |Study quality: 3 RCTs with low risk of bias |compared to treatment as usual |

|management of adult female |bladder pain syndrome, urethral pain syndrome and |and 3 RCTs with high risk of bias |No evidence was found for myofascial therapy or chiropractic treatment |

|chronic pelvic pain |irritable bowel syndrome); exclusions: malignancy, |Study characteristics: sample sizes 21 to | |

|Quality: high |primary dysmenorrhoea, endometriosis, pregnancy, |370; mean ages 30.5 to 43 years; 6 studies | |

| |infections, active chronic pelvic inflammatory |minimum duration 6 months of chronic pelvic |CONCLUSIONS |

| |disease and vulvodynia/vulvar pain syndrome; |pain symptoms; manual therapy interventions |The authors did not find any convincing evidence for the use of manual therapy in |

| |exclusions: neurologic disorders, tumours, urinary |of 3 relevant RCTs: myofascial therapy, |female chronic pelvic pain; they concluded that there was some evidence to support the |

| |tract infections, pregnancy |chiropractic techniques and manual trigger |use of multidisciplinary intervention approaches |

| |Interventions: physiotherapeutic intervention alone |point therapy, distension of pelvic floor | |

| |or in combination with other medical or | | |

| |psychological therapies |Excluded studies eligible for current | |

| |Outcomes: pain, quality of life, physical activity |review: not reported | |

| | | | |

| |METHODOLOGY | | |

| |8 relevant databases searched, keywords listed, | | |

| |bibliographies searched, authors contacted; | | |

| |obviously irrelevant studies removed by one author, | | |

| |remainder independently selected by 2 authors; data | | |

| |extracted by one author and checked by a second; | | |

| |quality assessment using the Cochrane Risk of Bias | | |

| |Tool; systematic tabulation of studies. | | |

| |Data analysis: text and tables | | |

| |Subgroups / sensitivity analyses: none | | |

|Gastrointestinal disorders | | | |

|Ernst 2011 |INCLUSION CRITERIA |N included trials: 2 controlled trials: 1 |RESULTS |

| |Study design: controlled studies |RCT and 1 non-RCT |No significant differences in outcome measures (symptom severity score, clinical |

|Focus: effectiveness of spinal|Participants: studies concerning any |Study quality: Jadad score (0-1); Hains 2007|parameters) between the manual therapy and control groups |

|manipulation in patients with |gastrointestinal disorders |low quality (Jadad score 1), Pikalov 1994 | |

|gastrointestinal disorders |Interventions: manual procedures |low quality (Jadad score 0) |CONCLUSIONS |

|Quality: medium |Outcomes: pain relief, symptom severity, clinical |Study characteristics: Hains 2007: 62 adults|Evidence is inconclusive based on two low quality studies; it cannot be established |

| |remission |with gastro-oesophageal reflux disease |whether manual therapy is more effective than ischaemic compression or conventional |

| | |treated with spinal manipulation versus |treatment in patients with gastrointestinal disorders |

| |METHODOLOGY |ischaemic compression for 7 weeks (20 | |

| |6 relevant databases searched; no language limit; |sessions); Pikalov 1994: 35 adults with | |

| |some details on study selection and data extraction;|duodenal ulcer treated with spinal | |

| |studies of infant colic were excluded; excluded |manipulation (3-14 sessions; duration: not | |

| |studies not listed |reported) plus conventional treatment versus| |

| |Data analysis: text and tables |conventional treatment only | |

| |Subgroups / sensitivity analyses: none | | |

| | |Excluded studies eligible for current | |

| | |review: not reported | |

|Hypertension | | | |

|Mangum 2012 |INCLUSION CRITERIA |N included trials: 10 studies, but only |RESULTS |

| |Study design: observational or therapy trial |results for 5 studies with low or unclear |Goertz 2002, low risk of bias, 12 sessions of “diversified adjustments” plus diet |

|Focus: effects of spinal |Participants : patients with hypertension |risk of bias reported (5 RCTs, 2 |versus diet only |

|manipulative therapy for |Interventions: spinal manipulative therapy |non-randomised CCTs, 3 case reports) |Plaugher 2002, low risk of bias, Gonstead chiropractic adjusting (up to 20 treatments),|

|hypertension |Outcomes: blood pressure |Study quality: of RCTs, 2 low risk of bias, |versus brief massage or control |

|Quality: medium | |3 unclear risk of bias |Bakris 2007, unclear risk of bias, SMT NUCCA technique weekly for 8 weeks (but 85% had |

| |METHODOLOGY |Study characteristics: 21 to 128 patients |only one adjustment) |

| |5 relevant databases searched, non-English studies |included; spinal manipulative treatment |Abram 1988, unclear risk of bias, single Activator SMT versus placebo and no treatment |

| |and abstracts excluded; studies selected by three |(SMT) single session to up to 20 treatments |Morgan 1985, unclear risk of bias, cross-over, 6 weeks osteopathic manipulative therapy|

| |authors; quality rated by all authors, data |over 2 months; types of SMT: Gonstead |versus sham massage |

| |extraction unclear; quality assessment using the |chiropractic adjusting, NUCCA technique, |Study |

| |Cochrane Risk of Bias tool; excluded studies not |“diversified adjustments”, Activator |Intervention BP, study end (mmHg, 95% CI) |

| |listed; systematic tabulation of studies. |instrument, osteopathic manipulative therapy|Control BP, study end |

| |Data analysis: text and tables | |(mmHg, 95% CI) |

| |Subgroups / sensitivity analyses: none |Excluded studies eligible for current |p |

| | |review: not reported | |

| | | |Goertz 2002 |

| | | |SP -3.5 (-5.7 to -1.3) |

| | | |DP -4.0 (-5.3 to -2.7) |

| | | |SP -4.9 (-6.7 to -3.1) |

| | | |DP -5.6 (-6.8 to -4.4) |

| | | |NS |

| | | | |

| | | |Plaugher 2002 |

| | | |SP -2.3 (-6.4 to +1.8) |

| | | |DP -4.8 (-12.6 to +3.0) |

| | | |No treatment |

| | | |SP -7.7 (-14.5 to -0.9) |

| | | |DP -9.0 (-16.8 to -1.2) |

| | | |Brief massage |

| | | |SP -1.3 (-9.4 to +11.9) |

| | | |DP -1.7 (-6.2 to +2.9) |

| | | |NS |

| | | | |

| | | |Bakris 2007 |

| | | |SP -17.2 (-20.7 to -13.7) |

| | | |DP -10.3 (-14.6 to -6.0) |

| | | |SP -3.2 (-7.5 to +1.1) |

| | | |DP -1.8 (-4.5 to +0.9) |

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