Clinical decision-making for spinal manipulation for persistent spinal pain following lumbar surgery: a protocol for a systematic review and meta-analysis of individual participant data

Robert James Trager; Clinton J Daniels; Kevin W Meyer; Amber C Stout; Jeffery A Dusek

doi:10.1136/bmjopen-2021-054070

Clinical decision-making for spinal manipulation for persistent spinal pain following lumbar surgery: a protocol for a systematic review and meta-analysis of individual participant data

BMJ Open. 2021 Dec 23;11(12):e054070. doi: 10.1136/bmjopen-2021-054070.

Authors

Robert James Trager¹, Clinton J Daniels², Kevin W Meyer³, Amber C Stout⁴, Jeffery A Dusek⁵

Affiliations

¹ Connor Whole Health, University Hospitals of Cleveland, Cleveland, Ohio, USA Robert.Trager@UHhospitals.org.
² RCS, VA Puget Sound Health Care System, Seattle, Washington, USA.
³ Rehabilitation Care Services, VA Puget Sound Health Care System American Lake Campus, Tacoma, Washington, USA.
⁴ Lakeside Hospital Library, University Hospitals of Cleveland, Cleveland, Ohio, USA.
⁵ Connor Whole Health, University Hospitals of Cleveland, Cleveland, Ohio, USA.

Abstract

Introduction: There are limited available research and guidance regarding the use of spinal manipulative therapy (SMT) in patients with low back-related symptoms following lumbar spine surgery, a condition called persistent spinal pain syndrome type 2 (PSPS-2). This publication outlines a review protocol to identify and synthesise individual participant data (IPD) to examine associations between patient, clinical and surgical variables and SMT application in adults with PSPS-2.

Methods and analysis: PubMed, OVID, Web of Science, Scopus, PEDro, Index to Chiropractic Literature and KoreaMed will be searched from inception to 1 January 2022 without language restrictions. Case reports, series, observational studies and cases from grey literature of adults receiving SMT for PSPS-2 will be included. Two investigators will independently screen citations, abstracts and full-text articles. A risk-of-bias assessment will be performed in duplicate to rate cases according to exposure and outcome ascertainment and data completeness. Data extraction will be performed in duplicate and missing IPD will be requested from corresponding authors. Multiple binary logistic regression will be used to identify independent predictors of the use of lumbar-SMT, lumbar-manual-thrust SMT and SMT within 1-year postsurgery. Patient, clinical and surgical variables will be summarised using descriptive statistics, while SMT-related outcomes (lumbar-SMT, lumbar-manual-thrust SMT and 1-year surgery-to-SMT interval) will be described using adjusted ORs with 95% CIs.

Ethics and dissemination: This study was deemed not human subjects research by the University Hospitals' institutional review board. The results of this review will be disseminated at conferences and/or published in a peer-reviewed journal.

Prospero registration number: CRD42021250039.

Keywords: back pain; complementary medicine; rehabilitation medicine; spine; surgery.

Publication types

Clinical Trial Protocol

MeSH terms

Adult
Back Pain / etiology
Clinical Decision-Making
Humans
Manipulation, Spinal* / adverse effects
Meta-Analysis as Topic
Review Literature as Topic
Systematic Reviews as Topic