OBJECTIVE: To examine whether targeting spinal manipulative therapy (SMT), by applying the intervention to a specific vertebral level, produces superior clinical outcomes than a non-targeted approach in patients with non-specific low back pain. DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: MEDLINE, EMBASE, CENTRAL, CINAHL, Scopus, PEDro, and Index to Chiropractic Literature were searched up to May 31, 2023. STUDY SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing targeted SMT (mobilization or manipulation) to a non-targeted approach in patients with non-specific low back pain, and measuring the effects on pain intensity and patient-reported disability. DATA SYNTHESIS: Data extraction, risk of bias, and evaluation of the overall certainty of evidence using the GRADE approach were performed by two authors independently. Meta-analyses were performed using the Restricted Maximum Likelihood Method. RESULTS: Ten RCTs (n = 931 patients) were included. There was moderate certainty evidence of no difference between targeted SMT and a non-targeted approach for pain intensity at post-intervention: weighted mean difference (WMD) -0.20 (95% CI -0.51 to 0.10) and at follow-up: WMD 0.05 (95% CI -0.26 to 0.36). For patient-reported disability, there was moderate certainty evidence of no difference at post-intervention: standardized mean difference (SMD) -0.04 (95% CI -0.36 to 0.29) and at follow-up: SMD -0.05 (95% CI -0.24 to 0.13). Adverse events were reported in four trials, and were minor and evenly distributed between groups. CONCLUSION: Targeting a specific vertebral level when administering SMT for patients with non-specific low back pain did not result in improved outcomes on pain intensity and patient-reported disability compared to a non-targeted approach.

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