A systematic review and meta-analysis on effect of spinal mobilization and manipulation on cardiovascular responses.
Charu Gera, Manoj Malik, Jaspreet Kaur and 1 others
PMID 33005072WHAT IT FOUND
Spinal manipulation and mobilization slightly lowered systolic blood pressure in the main analysis, but the result was borderline and varied greatly between studies.
Diastolic pressure and heart rate showed no significant change. This is not yet reliable evidence for treating hypertension.
Key findings
01The primary analysis found a statistically significant reduction in systolic blood pressure (MD = -4.56, p = 0.05), but with moderate heterogeneity (I2 = 75%).
02There was no significant change in diastolic blood pressure or heart rate in the primary analysis.
03Sensitivity analysis excluding short-duration studies showed a significant reduction in diastolic blood pressure, suggesting treatment duration may influence outcomes.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Seven of the eighteen included studies were excluded from the meta-analysis because required data could not be retrieved, reducing the sample size. Only two databases were searched, which may have missed relevant studies. The primary outcome for systolic blood pressure had moderate heterogeneity, meaning the studies varied significantly in their results. Diastolic blood pressure results showed substantial heterogeneity in the primary analysis. The analysis grouped together different techniques (mobilization vs. manipulation) and different spinal regions, which may have different physiological effects. The significance level for the primary systolic blood pressure finding was exactly p = 0.05, which is borderline.
Declared interests
The authors report no conflict of interest and no funding source for this paper.
The easy way to misread this
Do not conclude that spinal manipulation is an effective treatment for hypertension based on this paper. The primary finding for systolic blood pressure was borderline (p = 0.05) with high variability between studies, and diastolic blood pressure and heart rate showed no significant change in the main analysis. The positive findings in sensitivity analyses were secondary explorations, not the primary proof.