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No trial scored 60 or more points(maximum score 100)suggesting that most were of poor quality.Eighteen studies(51%)showed favourable results for manipulation.In addition,five studies(14%)reported positive results in one or more subgroups.Of the four studies with 50-60 points,one reported that manipulation was better,two reported that manipulation was better in only a subgroup,and one reported that manipulation was no better or worse than reference treatment.Eight trials attempted to compare manipulation with some placebo,with inconsistent results.Although some results are promising,the efficacy of manipulation has not been convincingly shown. Further trials are needed,but much more attention should be paid to the methods of study. |
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