Kent Peter, Marks Darryn, Pearson Warrick, Keating Jenny
School of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia.
J Manipulative Physiol Ther. 2005 Jun;28(5):312-22. doi: 10.1016/j.jmpt.2005.04.009.
The purpose of this study is to quantitatively compare outcomes for trials when treating clinicians did, or did not, have the discretion to decide on treatment technique.
CINAHL, EMBASE, MEDLINE, the Physiotherapy Evidence Database, the Cochrane Controlled Trials register, reference list searching, and citation tracking were investigated. Ten randomized controlled trials (RCTs) of mobilization and manipulation for nonspecific low back pain (NSLBP) met the inclusion criteria. The effectiveness of manual therapy with and without clinician technique choice was assessed using descriptive statistics and metaanalysis for the outcomes of pain and activity limitation.
In approximately two thirds of the included RCTs, clinicians had choice of treatment technique. There were no systematic differences favoring results for RCTs that did allow clinician choice of treatment technique.
Few quality studies are available, and conclusions on the basis of these data need to be interpreted with caution. However, allowing clinicians to choose from a number of treatment techniques does not appear to have improved the outcomes of these RCTs that have investigated the effect of manual therapy for NSLBP. If tailoring manual therapy treatment to NSLBP patients does positively impact on patient outcomes, this is not yet systematically apparent.
本研究旨在定量比较在治疗过程中临床医生有权或无权决定治疗技术的试验结果。
对护理学与健康领域数据库（CINAHL）、荷兰医学文摘数据库（EMBASE）、医学索引数据库（MEDLINE）、物理治疗证据数据库、考克兰对照试验注册库进行检索，并进行参考文献列表检索和引文跟踪。十项关于非特异性下腰痛（NSLBP）的松动术和整复术的随机对照试验（RCT）符合纳入标准。采用描述性统计和荟萃分析，评估有无临床医生技术选择的手法治疗对疼痛和活动受限结局的有效性。
在约三分之二纳入的随机对照试验中，临床医生可选择治疗技术。对于允许临床医生选择治疗技术的随机对照试验，其结果并无系统性优势。
现有高质量研究较少，基于这些数据得出的结论需谨慎解读。然而，允许临床医生从多种治疗技术中选择，似乎并未改善这些研究非特异性下腰痛手法治疗效果的随机对照试验的结果。如果针对非特异性下腰痛患者量身定制手法治疗确实对患者结局有积极影响，目前这一点尚未系统显现。
