Assendelft W J, Koes B W, van der Heijden G J, Bouter L M
Department of Epidemiology and Biostatistics, University of Limburg, Maastricht, The Netherlands.
J Manipulative Physiol Ther. 1992 Oct;15(8):487-94.
To assess the efficacy of chiropractic for patients with back pain.
Randomized clinical trials (RCTs) on spinal manipulation were identified with a Medline search (1966-1990), by citration tracking, and by manual examination of the relevant chiropractic reference systems [Chiropractic Research Archives Collection and Index to Chiropractic Literature]. [Indexing terms, Medline; backache, musculoskeletal diseases, manipulation, osteopathy or chiropractic in combination with evaluation studies, outcome and process assessment, prospective studies, comparative studies, clinical trials or double blind method. Indexing terms, Chiropractic Research Archives Collection: backache therapy-chiropractic clinical trials, cost benefit analysis, evaluation studies--chiropractic, manipulation--spinal, prospective studies, sciatica-therapy. Indexing terms, Index to Chiropractic Literature, backache therapy, clinical trials, cost benefit analysis, intervertebral disc displacement-therapy.]
All RCTs involving chiropractors as therapists. To find additional evidence from nonchiropractic RCTs, chiropractic standards similar to the type of treatment used in nonchiropractic trials were determined by a panel of blinded chiropractors.
Review by two blinded reviewers independently, using a list of methodological criteria, each of which was attached to a weight. The maximum was set at 100 points.
We identified five chiropractic RCTs. No similarity to chiropractic standards could be detected in any of the nonchiropractic RCTs. No chiropractic RCT had a methodological score of more than 50 points. The authors of four of the trials report favorable results for chiropractic, while one refrains from drawing conclusions. The results of the chiropractic RCTs differed on the timing of maximal effect as well as on the subgroups showing the best treatment results.
Although the small number of chiropractic RCTs and the poor general methodological quality precludes the drawing of strong conclusions, chiropractic seems to be an effective treatment of back pain. However, more studies with a better research methodology are clearly still needed.
评估脊椎按摩疗法对背痛患者的疗效。
通过医学索引数据库（Medline，1966 - 1990年）检索、文献追溯以及人工查阅相关脊椎按摩疗法参考系统[脊椎按摩疗法研究档案库及脊椎按摩疗法文献索引]来识别有关脊柱推拿的随机临床试验（RCT）。[医学索引数据库检索词：背痛、肌肉骨骼疾病、推拿、整骨疗法或脊椎按摩疗法与评估研究、结果与过程评估、前瞻性研究、对比研究、临床试验或双盲法相结合。脊椎按摩疗法研究档案库检索词：背痛治疗 - 脊椎按摩疗法临床试验、成本效益分析、评估研究 - 脊椎按摩疗法、推拿 - 脊柱、前瞻性研究、坐骨神经痛 - 治疗。脊椎按摩疗法文献索引检索词：背痛治疗、临床试验、成本效益分析、椎间盘移位 - 治疗。]
所有涉及脊椎按摩师作为治疗师的随机临床试验。为了从非脊椎按摩疗法的随机临床试验中找到更多证据，由一组不知情的脊椎按摩师确定与非脊椎按摩疗法试验中所用治疗类型相似的脊椎按摩疗法标准。
由两名不知情的评审员独立审查，使用一份方法学标准清单，每个标准都赋予一个权重。最高分为100分。
我们识别出五项脊椎按摩疗法的随机临床试验。在任何非脊椎按摩疗法的随机临床试验中均未发现与脊椎按摩疗法标准相似之处。没有一项脊椎按摩疗法的随机临床试验方法学得分超过50分。四项试验的作者报告脊椎按摩疗法有良好效果，而一项试验未得出结论。脊椎按摩疗法随机临床试验的结果在最大效果出现的时间以及显示最佳治疗效果的亚组方面存在差异。
尽管脊椎按摩疗法的随机临床试验数量较少且总体方法学质量较差，无法得出强有力的结论，但脊椎按摩疗法似乎是治疗背痛的一种有效方法。然而，显然仍需要更多采用更好研究方法的研究。
