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Table 5 Results for within-group change and between-group differences in pressure pain threshold

From: Manipulation-induced hypoalgesia in musculoskeletal pain populations: a systematic critical review and meta-analysis

1st author, year Groups PPT testing site/s & follow-up time/s Within-group estimates; mean change from baseline in kg/cm2 (SD, % change) Significant within-group change (SMT groups only)?^ Difference in mean change in kg/cm2 [group 1 minus group 2] Significant between-group difference?^ Quality score
Casanova-Méndez, 2014 [28] Supine TSMT (TSMT 1), Toggle-recoil TSMT (TSMT 2) C4 SP, T4 SP, & upper trapezius,a immediately & 20 mins after intervention C4 SP   TSMT 1 vs TSMT 2   8
SMT 1 immed.: 0.21 (0.48, 10.4%) Yes C4 SP immed.: 0.00 No
SMT 1 20 min: 0.25 (0.59, 12.4%) Yes C4 SP 20 min: − 0.05 No
SMT 2 immed.: 0.21 (0.32, 10.7%) Yes T4 SP immed.: 0.03 No
SMT 2 20 min: 0.30 (0.42, 15.3%) Yes T4 SP 20 min: − 0.23 No
T4 SP   Trapezius immed.: − 0.19 No
TSMT 1 immed.: 0.40 (0.59, 10.8%) Yes Trapezius 20 min: − 0.11 No
TSMT 1 20 min: 0.47 (0.76, 12.7%) Yes   
TSMT 2 immed.: 0.37 (0.67, 11.0%) Yes   
TSMT 2 20 min: 0.70 (0.79, 20.9%) Yes   
Trapezius    
TSMT 1 immed.: 0.22 (0.60, 6.7%) Yesc   
TSMT 1 20 min: 0.32 (0.80, 9.7%) Yesc   
TSMT 2 immed.: 0.41 (0.51, 13.6%) Yesc   
TSMT 2 20 min: 0.43 (0.53, 14.2%) Yesc   
Coronado, 2015 [33] CSMT, Shoulder manipulation, Shoulder exercises Acromion & tibialis anterior, immediately after intervention Acromion   CSMT vs Shoulder manipulation   8
CSMT: 0.37 (0.68, 14.2%) Yesc Acromion: 0.18 No
Shoulder manipulation: 0.19 (0.70, 5.6%) - Tibialis anterior: 0.26 No
Exercise: 0.10 (0.69, 3.1%) - CSMT vs Exercise  
Tibialis anterior   Acromion: 0.27 No
CSMT: 0.35 (0.84, 7.4%) Yesc Tibialis anterior: 0.10 No
Shoulder manipulation: 0.09 (0.83, 1.7%) -   
Exercise: 0.25 (1.89, 4.5%) -   
Kardouni, 2015 [35] TSMT, Sham SMT Deltoida & lower trapezius,a immediately after intervention Deltoid   TSMT vs Sham   8
TSMT: 0.10 (1.65, 2.8%) No Deltoid: 0.11 No
Sham: − 0.01 (1.51, − 0.1%) - Trapezius: 0.11 No
Trapezius    
TSMT: 0.09 (1.70, 2.2%) No   
Sham: − 0.02 (1.49, − 0.3%) -   
Bautista-Aguirre, 2017 [27] CSMT, TSMT, Control Median nerve (wrist),a median nerve (elbow),a ulnar nerve,a & radial nerve,a immediately after intervention Median nerve (wrist)   CSMT vs control   7.5
CSMT: 0.24 (1.41, 3.4%) Noc Median nerve (wrist): 0.29 No
TSMT: 0.27 (1.38, 3.9%) Noc Median nerve (elbow): 0.14 No
Control: − 0.05 (3.52, − 0.8%) - Ulnar nerve: 0.26 No
Median nerve (elbow)   Radial nerve: 0.44 No
CSMT: 0.2 (0.72, 6.8%) Noc TSMT vs control  
TSMT: 0.2 (0.7, 6.8%) Noc Median nerve (wrist): 0.33 No
Control: 0.07 (0.91, 2.6%) - Median nerve (elbow): 0.14 No
Ulnar nerve   Ulnar nerve: 0.25 No
CSMT: 0.38 (1.01, 9.2%) Noc Radial nerve: 0.42 No
TSMT: 0.37 (0.99, 9.1%) Noc CSMT vs TSMT  
Control: 0.11 (0.7, 2.8%) - Median nerve (wrist): − 0.03 No
Radial nerve   Median nerve (elbow): 0.01 No
CSMT: 0.83 (1.25, 24.1%) Yesc Ulnar nerve: 0.01 No
TSMT: 0.81 (1.21, 23.6%) Yesc Radial nerve: 0.02 No
Control: 0.39 (0.82, 11.3%) -   
Martínez-Segura, 2012 [21] CSMT,b TSMT C5–6 facet,a lateral epicondyle,a & tibialis anterior,a 10 mins after intervention C5–6 facet   CSMT vs TSMT   7.5
CSMT: 0.40 (0.33, 29.1%) Yes C5–6 facet: 0.10 No
TSMT: 0.30 (0.32, 23.1%) Yes Lateral epicondyle: 0.05 No
Lateral epicondyle   Tibialis anterior: 0.07 No
CSMT: 0.45 (0.46, 31.6%) Yes   
TSMT: 0.40 (0.36, 28.6%) Yes   
Tibialis anterior    
CSMT: 0.82 (0.67, 38.8%) Yes   
TSMT: 0.75 (0.46, 36.6%) Yes   
De Oliveira, 2013 [32] “Non-region specific” TSMT, “Region-specific” LSMT Lumbar paraspinals & tibialis anterior, immediately after intervention Paraspinals   TSMT vs LSMT   7
TSMT: 0.37 (1.36, 7.5%) Yes Paraspinals: 0.18 No
LSMT: 0.19 (1.53, 3.8%) No Tibialis anterior: − 0.12 No
Tibialis anterior    
TSMT: 0.11 (1.26, 1.7%) No   
LSMT: 0.23 (1.12, 3.6%) No   
Maduro de Camargo, 2011 [30] CSMT, Control Upper trapezius,a deltoid,a & C5 SP, 5 mins after intervention Trapezius   CSMT vs Control   6.5
CSMT: 0.3 (0.41, 9.0%) Yesc Trapezius: 0.10 No
Control: 0.2 (0.69, 5.7%) - Deltoid: 0.45 Yes
Deltoid   C5 SP: 0.20 Yes
CSMT: 0.25 (0.49, 7.7%) Yesc   
Control: − 0.2 (0.58, − 6.3%) -   
C5 SP    
CSMT: 0.1 (0.19, 4.3%) Yesc   
Control: − 0.1 (0.53, − 4.3%) -   
Packer, 2014 [24] TSMT, Sham SMT TMJ,a masseter,a & temporalis,a immediately after intervention TMJ   TSMT vs Sham   6.5
TSMT: − 0.05 (NR, − 7.7%) No TMJ: − 0.05 No
Sham: 0.00 (NR, 0.0%) - Masseter: 0.05 No
Masseter   Temporalis: 0.00 No
TSMT: 0.05 (NR, 10.0%) No   
Sham: 0.00 (NR, 0.0%) -   
Temporalis    
TSMT: 0.00 (NR, 0.0%) No   
Sham: 0.00 (NR, 0.0%) -   
Salom-Moreno, 2014 [31] TSMT, Thoracic mob. C5–6 facet,a 2nd metacarpal,a & tibialis anterior,a 10 mins after intervention C5–6 facet   TSMT vs Mob.   6.5
TSMT: 0.37 (0.17, 27.2%) Yes C5–6 facet: 0.26 No
Mob.: 0.11 (0.20, 7.4%) - 2nd metacarpal: 0.03 No
2 nd metacarpal   Tibialis anterior: 0.00 No
TSMT: 0.20 (0.12, 7.4%) Yes   
Mob.: 0.16 (0.43, 6.4%) -   
Tibialis anterior    
TSMT: 0.09 (0.45, 2.1%) Yes   
Mob.: 0.09 (0.10, 2.2%) -   
Côté, 1994 [25] LSMT, Lumbar mob. L5 paraspinals, SIJs, & gluteal muscles, immediately, 15 mins & 30 mins after intervention L5 paraspinals   LSMT vs Mob.   5.5
LSMT immed.: 0.00 (NR, 0.0%) No L5 paraspinals immed.: 0.65 No
LSMT 15 min: − 0.11 (NR, − 2.1%) No L5 paraspinals 15 min: 0.65 No
LSMT 30 min: 0.20 (NR, 3.7%) No L5 paraspinals 30 min:1.07 No
Mob. immed.: − 0.65 (NR, − 11.0%) - SIJs immed.: 0.95 No
Mob. 15 min: − 0.77 (NR, − 12.9%) - SIJs 15 min: 0.45 No
Mob. 30 min: − 0.87 (NR, − 14.7%) - SIJs 30 min: 1.10 No
SIJs   Gluteals immed.: 0.32 No
LSMT immed.: 0.66 (NR, 12.9%) No Gluteals 15 min: 0.12 No
LSMT 15 min: 0.09 (NR, 1.7%) No Gluteals 30 min: 0.44 No
LSMT 30 min: 0.53 (NR, 10.4%) No   
Mob. immed.: − 0.29 (NR, − 4.7%) -   
Mob. 15 min: − 0.36 (NR, − 6.0%) -   
Mob. 30 min: − 0.57 (NR, − 9.4%) -   
Gluteals    
LSMT immed.: 0.31 (NR, 6.1%) No   
LSMT 15 min: 0.44 (NR, 8.9%) No   
LSMT 30 min: 0.59 (NR, 11.9%) No   
Mob. immed.: − 0.02 (NR, − 0.3%) -   
Mob. 15 min: 0.32 (NR, 6.4%) -   
Mob. 30 min: 0.16 (NR, 3.1%) -   
Lopez-Lopez, 2015 [29] CSMT, P-A cervical mob. (mob. 1), glide cervical mob. (mob. 2) C2 SP, 5 mins after intervention C2 SP   CSMT vs Mob. 1   5.5
CSMT: 0.08 (0.43, 4.6%) Yes C2 SP: −0.13 No
Mob. 1: 0.21 (0.40, 14.1%) - CSMT vs Mob. 2  
Mob. 2: 0.30 (0.41, 18.0%) - C2 SP: − 0.22 No
Mansilla Ferragut, 2009 [26] CSMT, Sham SMT Sphenoid bone, 5 mins after intervention Sphenoid bone   CSMT vs Sham   5
CSMT: 0.1 (0.20, 12.5%) Yesc Sphenoid bone: 0.20 Yes
Sham: − 0.1 (0.30, − 12.5%) -   
Fernández-Carnero, 2008 [34] CSMT, Sham SMT Lateral epicondyle,a 5 mins after intervention Lateral epicondyle   CSMT vs Sham   4.5
CSMT: 1.00 (0.68, 27.9%) Yes Lateral epicondyle: 0.90 Yes
Sham: 0.10 (0.45, 2.5%) -   
  1. Abbreviations: CSMT Cervical SMT, HVLA High-velocity low-amplitude, immed. Immediate, LSMT Lumbosacral SMT, mob. Mobilisation, NR Not reported (and unable to calculate), PPT Pressure pain threshold, SD Standard deviation, SIJ Sacroiliac joint, SP Spinous process, SMT Spinal manipulative therapy, TSMT Thoracic SMT, TMJ Temporomandibular joint
  2. ^ p < .05
  3. aRight and left side data combined by reviewers
  4. bRight and left cervical SMT groups’ data combined by reviewers
  5. cSignificance inferred from 95% confidence interval that does not cross zero