The efficacy of physiotherapy for musculoskeletal disorders - Overview of the current state of knowledge

The clinical evidence for the efficacy of physiotherapy found in 180 randomized clinical trials (RCTs) in the literature was summarized. Bibliographic data bases, citation tracking, and correspondence with research in the field provided the material for our study. Focusing on disorders of the musculoskeletal system, a number of criterion-based meta-analyses were performed in order to summarize the available evidence. For each RCT a methodological score was calculated in each meta-analysis. A set of explicit criteria and weight factors were applied to the material by 2 or 3 independent reviewers who were blinded as to the outcome, the journal, and the authors of the publications at issue. In each meta-analysis, the RCTs were put into hierarchical order depending on the score they got for their methodological quality. Meta-analyses were performed for spinal manipulation, exercise therapy, traction, ultrasound, and laser therapy, and for disorders of the back, neck, shoulder and knee. In general, the methodological quality of the studies appears to be rather low, and the efficacy of physiotherapy is convincing for only a few indications and treatments. On the other hand, it is the prevalence of serious methodological flaws that does not allow us to draw the conclusion that physiotherapy has no effect.