Evaluating Manual Therapy in Musculoskeletal Pain: Why Certain Trial Designs May Overestimate Effectiveness—A Scoping Review

This scoping review summarizes studies using an 'A vs. A+B design', where manual therapy is added to usual care, with or without a sham control. The review identifies a lack of medium- or long-term effectiveness and highlights a methodological bias toward generating positive short- or immediate-term results of questionable clinical relevance. Based on these findings, we provide several recommendations to improve future research and to support clinicians in interpreting the current evidence base.