{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T19:02:19Z","timestamp":1789758139170,"version":"4.0.1"},"reference-count":48,"publisher":"Journal of Orthopaedic & Sports Physical Therapy (JOSPT)","issue":"9","content-domain":{"domain":["www.jospt.org"],"crossmark-restriction":true},"short-container-title":["Journal of Orthopaedic &amp; Sports Physical Therapy"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:p> OBJECTIVE: We aimed to examine whether targeting spinal manipulative therapy (SMT), by applying the intervention to a specific vertebral level, produces superior clinical outcomes than a nontargeted approach in patients with nonspecific low back pain. <\/jats:p><jats:p> DESIGN: Systematic review with meta-analysis. <\/jats:p><jats:p> LITERATURE SEARCH: MEDLINE, Embase, CENTRAL, CINAHL, Scopus, PEDro, and Index to Chiropractic Literature were searched up to May 31, 2023. <\/jats:p><jats:p> STUDY SELECTION CRITERIA: Randomized controlled trials comparing targeted SMT (mobilization or manipulation) to a nontargeted approach in patients with nonspecific low back pain, and measuring the effects on pain intensity and patient-reported disability. <\/jats:p><jats:p> DATA SYNTHESIS: Data extraction, risk of bias, and evaluation of the overall certainty of evidence using the GRADE approach were performed by 2 authors independently. Meta-analyses were performed using the restricted maximum likelihood method. <\/jats:p><jats:p> RESULTS: Ten randomized controlled trials (n = 931 patients) were included. There was moderate-certainty evidence of no difference between targeted SMT and a nontargeted approach for pain intensity at postintervention (weighted mean difference = \u22120.20 [95% CI: \u22120.51, 0.10]) and at follow-up (weighted mean difference = 0.05 [95% CI: \u22120.26, 0.36]). For patient-reported disability, there was moderate-certainty evidence of no difference at postintervention (standardized mean difference = \u22120.04 [95% CI: \u22120.36, 0.29]) and at follow-up (standardized mean difference = \u22120.05 [95% CI: \u22120.24, 0.13]). Adverse events were reported in 4 trials, and were minor and evenly distributed between groups. <\/jats:p><jats:p> CONCLUSION: Targeting a specific vertebral level when administering SMT for patients with nonspecific low back pain did not result in improved outcomes on pain intensity and patient-reported disability compared to a nontargeted approach. J Orthop Sports Phys Ther 2023;53(9):529-539. 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