Reliable reporting and publication practices are essential for trustworthy evidence synthesis and clinical decision-making. This analysis aimed to identify latent classes of randomized controlled trials (RCTs) evaluating spinal manipulative therapy (SMT) based on trial reporting and publication practices, and to examine whether these classes influenced treatment effects.
Trials were evaluated on whether they met criteria for trial reporting and publication practices across six domains. Latent class analysis was used to identify trial subgroups. Random-effects meta-regression models assessed whether class membership predicted pooled estimates of treatment effects for pain and disability.
The international team included 239 RCTs and identified four classes: Dated (23 %), older trials (mostly pre-2010) with consistently low proportions of criteria met; Non-contributing (30 %), newer trials that inconsistently met the criteria, had small samples, and short follow-ups; SMT-focused (15 %), which reported SMT details and fidelity more consistently but otherwise resembled the Non-contributing class; and Pragmatic (33 %), consisting of larger trials, meeting most criteria, but often underreported SMT-specific and fidelity details. Reporting practices had larger impact on class membership than publication practices. Despite differences class membership was not associated with treatment effect estimates and explained minimal outcome variability (R2 ∼1 %).
The authors concluded that, although trial reporting and publication practices varied substantially across SMT trials, these differences were not associated with differences in treatment effects. The widespread failure to meet key criteria raises concerns about the interpretability and credibility of the SMT evidence base. To strengthen transparency and scientific value, future trials should adhere more rigorously to reporting guidelines.
What does this mean?
The authors state that editors and peer reviewers should more rigorously enforce established reporting standards, including CONSORT (with its Harms extension), TIDieR, and the CIRCLe SMT checklist.
Undoubtedly, this is true.
But what does it mean for patients?
In my view, it is a reminder for all of us to be skeptical about the claims made by chiropractors, osteopaths and other providers of SMT – even if they claim to be based on evidence.
One Response to The credibility of trials of spinal manipulative therapy is questionable
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The majority of individuals I know who contracted COVID-19, myself included, and subsequently experienced lower back pain, were referred to chiropractors or physical therapists. Efforts to present PCPs with evidence indicating the ineffectiveness of these interventions were largely disregarded (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2778522). Meanwhile, chiropractors and physical therapists appeared to benefit financially from a sustained influx of patients suffering from persistent, and in many cases, treatment-resistant symptoms.