Table 5.

Summary of findings (GRADE).

Spinal manipulation compared to Control in influencing endocrine markers
Patient or population: Healthy or symptomatic participants Settings: Primary care, outpatient, communityIntervention: Spinal ManipulationComparison: Control
Quality assessment							№ of patients		Effect
№ of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	Spinal Manipulation	Control	Relative(95% CI)	Absolute(95% CI)		Quality
Cortisol, immediate changes (assessed with blood or saliva)
7	randomised trials	not serious	serious¹	not serious	Serious2	none	114	115	-	SMD 0.42 lower(-0.74 lower to -0.1 lower)		⊕⊕°°LOW
Cortisol, short-term changes (assessed with blood or saliva)
4	randomised trials	not serious	Serious3	not serious	Serious4	none	63	63	-	SMD 0.45 lower(-0.79 lower to 0.1 lower)		⊕⊕°°LOW
Testosterone (assessed with: saliva)
2	randomised trials	not serious	serious	not serious	very serious³	none	33	33	-	SMD -0.01 lower(-0.14 lower to 0.12 higher)	⊕°°°VERYLOW
Testosterone (assessed with: saliva)
2	randomised trials	not serious	serious	not serious	very serious³	none	33	33	-	SMD -0.04 lower(-0.06 lower to 0.14 higher)	⊕°°°VERYLOW

Note: CI: Confidence interval; SMD: Standardized mean difference.

¹Sample size < 100.

²Heterogeneity.

³Sample size < 50. Findings based on single study.