A prospective, cohort study by Flynn et al was carried out with the objective of developing a clinical prediction rule (CPR) to identify patients with non-specific LBP who would improve with spinal manipulation. The CPR includes five variables (see Table 3); when four of these five variables were present, patients were very likely to improve (positive likelihood ratio, 24), increasing the probability of success with manipulation from 45–95%, and the presence of two or fewer variables was almost always associated with a failure to improve (negative likelihood ratio, 0.09). This CPR has been validated by a randomized controlled trial.22
There is strong evidence that once a worker has been out of work for four to 12 weeks, they have a 10–40% risk (depending on the setting) of remaining off work at least one year. After one to two years’ absence, it is unlikely they will return to any form of work, irrespective of further treatment.
Many commentators continue to believe that there is a lack of evidence supporting the efficacy of manual treatment (spinal manipulation/mobilization) on LBP.23 However, most studies have not used homogenous samples, and thus, patients who may indeed benefit by spinal manipulation/mobilization are grouped with others who likely would not benefit. Researchers are now challenging this myth with subgrouping methods to maximize treatment outcomes.