Table 226, Manual therapy (manipulation) + self-management (advice) + pharmacological therapy (NSAIDs) compared to usual care for acute low back pain with or without sciatica (mixed population) - Low Back Pain and Sciatica in Over 16s: Assessment and Management

Outcomes	No of Participants (studies) Follow up	Quality of the evidence (GRADE)	Anticipated absolute effects
Function (RMDQ change score, 0-24) < 4 months	72 (1 study) 16 weeks	MODERATE^a due to imprecision	The mean function (RMDQ, 0-24 change score) < 4 months in the control groups was 0.04	The mean function (RMDQ, 0-24 change score) < 4 months in the intervention groups was 2.54 lower (4.37 to 0.71 lower)
Function (RMDQ change score, 0-24) > 4 months	71 (1 study) 24 weeks	MODERATE^a due to imprecision	The mean function (RMDQ, 0-24 change score) > 4 months in the control groups was 0.06	The mean function (RMDQ, 0-24 change score) > 4 months in the intervention groups was 2.58 lower (4.41 to 0.75 lower)
Quality of life (SF-36 Bodily Pain change score, 0-100) < 4 months	72 (1 study) 16 weeks	LOW^a due to imprecision	The mean quality of life (SF-36 bodily pain change score) < 4 months in the control groups was 6.55	The mean quality of life (SF-36 bodily pain change score) < 4 months in the intervention groups was 1.83 higher (3.54 lower to 7.2 higher)
Quality of life (SF-36 Physical Function change score, 0-100) < 4 months	72 (1 study) 16 weeks	MODERATE^a due to imprecision	The mean quality of life (SF-36 Physical Function change score, 0-100)< 4 months in the control groups was 7.41	The mean quality of life (SF-36 Physical Function change score, 0-100)< 4 months in the intervention groups was 4.77 higher (1.96 lower to 11.5 higher)
Quality of life (SF-36 Bodily Pain change score, 0-100) > 4 months	71 (1 study) 24 weeks	MODERATE^a due to imprecision	The mean Quality of life (SF-36 Bodily Pain change score, 0-100) > 4 months in the control groups was 4.71	The mean Quality of life (SF-36 Bodily Pain change score, 0-100) > 4 months in the intervention groups was 3.38 higher (1.99 lower to 8.75 higher)
Quality of life (SF-36 Physical Function change score, 0-100) > 4 months	71 (1 study) 24 weeks	LOW^a due to imprecision	The mean Quality of life (SF-36 Physical Function change score, 0-100) > 4 months in the control groups was 11.67	The mean Quality of life (SF-36 Physical Function change score, 0-100) > 4 months in the intervention groups was 3 lower (9.73 lower to 3.73 higher)

Outcomes

No of Participants
(studies)
Follow up

Quality of the evidence
(GRADE)

Anticipated absolute effects

Risk with Usual care

Risk difference with Manipulation + self-management + NSAIDS (95% CI)

Function (RMDQ change score, 0-24) < 4 months

72
(1 study)
16 weeks

MODERATE^a
due to imprecision

The mean function (RMDQ, 0-24 change score) < 4 months in the control groups was
0.04

The mean function (RMDQ, 0-24 change score) < 4 months in the intervention groups was
2.54 lower
(4.37 to 0.71 lower)

Function (RMDQ change score, 0-24) > 4 months

71
(1 study)
24 weeks

MODERATE^a
due to imprecision

The mean function (RMDQ, 0-24 change score) > 4 months in the control groups was
0.06

The mean function (RMDQ, 0-24 change score) > 4 months in the intervention groups was
2.58 lower
(4.41 to 0.75 lower)

Quality of life (SF-36 Bodily Pain change score, 0-100) < 4 months

72
(1 study)
16 weeks

LOW^a
due to imprecision

The mean quality of life (SF-36 bodily pain change score) < 4 months in the control groups was
6.55

The mean quality of life (SF-36 bodily pain change score) < 4 months in the intervention groups was
1.83 higher
(3.54 lower to 7.2 higher)

Quality of life (SF-36 Physical Function change score, 0-100) < 4 months

72
(1 study)
16 weeks

MODERATE^a
due to imprecision

The mean quality of life (SF-36 Physical Function change score, 0-100)< 4 months in the control groups was
7.41

The mean quality of life (SF-36 Physical Function change score, 0-100)< 4 months in the intervention groups was
4.77 higher
(1.96 lower to 11.5 higher)

Quality of life (SF-36 Bodily Pain change score, 0-100) > 4 months

71
(1 study)
24 weeks

MODERATE^a
due to imprecision

The mean Quality of life (SF-36 Bodily Pain change score, 0-100) > 4 months in the control groups was
4.71

The mean Quality of life (SF-36 Bodily Pain change score, 0-100) > 4 months in the intervention groups was
3.38 higher
(1.99 lower to 8.75 higher)

Quality of life (SF-36 Physical Function change score, 0-100) > 4 months

71
(1 study)
24 weeks

LOW^a
due to imprecision

The mean Quality of life (SF-36 Physical Function change score, 0-100) > 4 months in the control groups was
11.67

The mean Quality of life (SF-36 Physical Function change score, 0-100) > 4 months in the intervention groups was
3 lower
(9.73 lower to 3.73 higher)

From: 12, Manual therapies

Low Back Pain and Sciatica in Over 16s: Assessment and Management.

NICE Guideline, No. 59.

National Guideline Centre (UK).

London: National Institute for Health and Care Excellence (NICE); 2016 Nov.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Table 226Manual therapy (manipulation) + self-management (advice) + pharmacological therapy (NSAIDs) compared to usual care for acute low back pain with or without sciatica (mixed population)