Psychological response in spinal manipulation (PRISM): A systematic review of psychological outcomes in randomised controlled trials

Department of General Practice, Cardiff University, Centre for Health Services Research/North Wales Clinical School, Gwenfro Building, Wrecsam Technology Park, Wrecsam LL13 7YP, United Kingdom.
Complementary Therapies in Medicine (Impact Factor: 1.55). 01/2008; 15(4):271-83. DOI: 10.1016/j.ctim.2007.01.008
Source: PubMed


The most important risk factors for back and neck pain are psychosocial. Nevertheless, systematic reviews of spinal manipulation have concentrated on pain and spine related disability, and ignored psychological outcomes.
To assess whether spinal manipulation was effective in improving psychological outcome.
Systematic review of randomised controlled trials (RCTs).
RCTs were identified by searching Medline, CINAHL, Embase, CENTRAL, AMED, PsycINFO until November 2005. Trials reporting psychological outcomes including the mental health components of generic outcomes were extracted, and combined where appropriate in meta-analyses.
One hundred and twenty nine RCTs of spinal manipulation were identified; 12 had adequately reported psychological outcomes. Six trials with a verbal intervention comparator were combined in a meta-analysis, and found a mean benefit from spinal manipulation equivalent to 0.34 of the population standard deviation (S.D.) [95% confidence interval (CI) 0.23-0.45] at 1-5 months; 0.27 of the S.D. [95% CI 0.14-0.40] at 6-12 months. Eight trials with a physical treatment comparator were combined in a meta-analysis and found a mean benefit of 0.13 of the S.D. [95% CI 0.01-0.24] in favour of manipulation at 1-5 months; 0.11 of the S.D. [95% CI -0.02 to 0.25] at 6-12 months.
There was some evidence that spinal manipulation improved psychological outcomes compared with verbal interventions.

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Available from: Nefyn H Williams, Oct 05, 2015
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    • "Alternatively a reduction in levels of adverse psychological variables may have occurred during care, therefore reducing their effect on treatment response. In support of this, a systematic review of psychological outcomes from studies involving manipulation describes significantly greater reduction in adverse scores on psychological questionnaires in populations having manipulation when compared to groups receiving verbal interventions (advice, education or handout) or other physical treatments (exercise, electrotherapy, sham manipulation or acupuncture) [38]. In addition to this, a small study found that a statistically significant reduction in fear avoidance beliefs and catastrophisation as well as improvement in self-efficacy occurred shortly after an initial visit with a chiropractor. "
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    • "In comparison, many definitions in a therapeutic context describe a proposed mechanical effect (or response) within the recipient, which is caused by the action. This mechanical response may be associated with distinct physiological, neurological or psychological responses (Evans, 2002; Cramer et al., 2006; Bolton and Budgell, 2006; Williams et al., 2007). However, rather than including these secondary responses, which have yet to be clearly delineated, we shall follow the convention of prior definitions and limit our discussion to the action of the practitioner and the passive mechanical response within the recipient. "
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