Di Fabio R P
Department of Rehabilitation Medicine, University of Minnesota, Minneapolis 55455.
Phys Ther. 1992 Dec;72(12):853-64. doi: 10.1093/ptj/72.12.853.
The use of manual therapy to treat somatic pain syndromes and associated disabilities is widespread. Yet, the efficacy of manual therapy has not been previously established because equivocal findings in the literature prevent definitive conclusions. The purposes of this article are (1) to establish objective criteria for judging the validity of manual therapy research, (2) to identify and discuss the results of those trials that were determined to be valid demonstrations of treatment efficacy or valid demonstrations of nonuseful therapy, and (3) to determine whether patients who benefit from manual therapy have common characteristics. The abstracts or full reports of 146 titles with appropriate key words were reviewed. Of these, 105 studies were not primary studies of manual therapy and were thus eliminated from review. In the 41 remaining studies, 18 did not utilize statistical comparisons or report blinded assessment of outcome measures. Nine controlled studies yielded negative results, but the statistical power or minimum sample size required to detect potential differences between manual therapy and control groups was not described. The 14 studies that met the efficacy criteria were categorized by the following factors: (1) the anatomical region of intervention, (2) pragmatic versus explanatory goals, and (3) primary intervention (manipulation, mobilization, combination). There was a paucity of valid explanatory research in all areas and a particular absence of controlled trials involving manual therapy applied to the peripheral joints. Manual therapy for low back pain, however, was studied extensively. The analysis of valid trials provided clear evidence that manual therapy, particularly manipulation, can be an effective modality when used to treat patients who have low back pain. A preliminary "profile" of the patient with low back pain who would likely benefit from manual therapy included acute symptom onset with less than a 1-month duration of symptoms, central or paravertebral pain distribution, no previous exposure to spinal manipulation, and no pending litigation or workers' compensation. Suggestions for future manual therapy research are discussed.
手法治疗用于治疗躯体疼痛综合征及相关功能障碍的情况很普遍。然而，由于文献中的结果模棱两可，无法得出明确结论，手法治疗的疗效此前尚未得到证实。本文的目的是：（1）建立判断手法治疗研究有效性的客观标准；（2）识别并讨论那些被确定为有效证明治疗效果或有效证明无效治疗的试验结果；（3）确定从手法治疗中获益的患者是否具有共同特征。对146篇带有适当关键词的文献摘要或完整报告进行了回顾。其中，105项研究并非手法治疗的原发性研究，因此被排除在回顾范围之外。在其余41项研究中，18项未进行统计比较，也未报告对结果指标的盲法评估。9项对照研究得出了阴性结果，但未描述检测手法治疗组与对照组之间潜在差异所需的统计效力或最小样本量。符合疗效标准的14项研究按以下因素进行了分类：（1）干预的解剖区域；（2）务实目标与解释性目标；（3）主要干预措施（整复、松动、联合）。所有领域中有效的解释性研究都很匮乏，尤其缺乏涉及应用于外周关节的手法治疗的对照试验。然而，针对腰痛的手法治疗进行了广泛研究。对有效试验的分析提供了明确证据，表明手法治疗，尤其是整复，用于治疗腰痛患者时可能是一种有效的治疗方式。可能从手法治疗中获益的腰痛患者的初步“特征”包括症状急性发作且症状持续时间少于1个月、疼痛分布于中央或椎旁、既往未接受过脊柱整复、且无未决诉讼或工伤赔偿。文中讨论了对手法治疗未来研究的建议。
