Clinical outcomes and satisfaction among low back pain patients following orthopedic manual therapy: systematic review

Vollständiger Abstract

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Abstract Background Low back pain (LBP) is one of the leading causes of disability worldwide, with significant socioeconomic and health system burdens. Orthopedic manual therapy (OMT), which comprises spinal manipulation, mobilization, and soft tissue techniques, is commonly employed in the management of LBP. Despite widespread use, evidence regarding its effectiveness in improving clinical outcomes and patient satisfaction remains varied, necessitating systematic evaluation. Objective This systematic review aimed to synthesize available evidence on the clinical outcomes and satisfaction among low back pain patients following orthopedic manual therapy compared to other interventions or standard care. Methods A comprehensive search was conducted across PubMed, Embase, CINAHL, Cochrane Library, Web of Science and Google Scholar and using Medical Subject Headings (MeSH) such as “Low Back Pain”, “Spinal manipulation”, “musculoskeletal mobilizations”, “Physical Therapy Modalities”, “Exercise Therapy”, “Patient Satisfaction”, and “Treatment Outcome(s)”. These studies were screened for relevance using topical scan and PICO framework, followed by critical appraisal using CASP tools. Only peer-reviewed articles published from 2010 to 2025 were included. Results Fifteen high-quality studies were included, comprising fourteen predominantly low-risk randomized controlled trials and one qualitative study. Across these studies, orthopedic manual therapy consistently reduced pain and improved function compared with usual care, exercise therapy, or sham treatments. Several trials demonstrated immediate benefits following manipulation or mobilization. The qualitative evidence showed noticeable patient satisfaction, primarily related to hands-on care and perceived symptom relief. However, heterogeneity in treatment protocols, outcome measures, follow-up periods and participants’ characteristics attributed to varied study findings. Overall, the evidence suggests that OMT is a safe intervention with minimal adverse effects.