Introduction: The use of spinal manipulation is still under debate. The number of review articles on the effectiveness of spinal manipulative therapy (SMT) for back pain (N > 50) by far exceeds the number of original RCTs (N = 30). The conclusions of the available review articles seem to vary substantially.

Objective: 1. To assess the relation between characteristics of review articles (especially their methodological quality) and the conclusion regarding effectiveness of SMT for back pain as drawn in the reviews. 2. To study the feasibility of methodological quality assessment of review articles using an extensive criteria list.

Methods: Reviews were identified by searching Index Medicus and Science Citation Index, by article citation tracking, library search and correspondence with experts. Reviews were selected if: 1. dealing with the effectiveness of SMT for low back pain (not necessarily exclusively), 2. at least 2 RCTs were included in the assessment of effectiveness, 3. language was English, German or Dutch, 4. publication year was up to 1993. Two reviewers assessed study quality using a standardized list of methodological criteria. To each criterium a weight was attached, providing a hierarchical listing of the reviews. In addition, other potentially relevant characteristics were extracted: type of review (narrative or criteria-based), publication year, proportion of available RCTs included, profession of the reviewer, book or (indexed) journal, indexed in Index Medicus. The overall conclusion on effectiveness of SMT reached by the authors of a review article will be related to methodological quality of the review and other publication characteristics.

Results/Discussion: Not available yet. Will be presented at the conference.