Skillgate Eva, Vingård Eva, Alfredsson Lars
Institute of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
Clin J Pain. 2007 Jun;23(5):431-9. doi: 10.1097/AJP.0b013e31805593d8.
To compare naprapathic manual therapy with evidence-based care for back or neck pain regarding pain, disability, and perceived recovery. Naprapathy that is common in the Nordic countries and in some states in the United States is characterized by manual manipulations with a focus on soft and connective tissues, aiming to decrease pain and disability in the musculoskeletal system.
Four hundred and nine patients with pain and disability in the back or neck lasting for at least 2 weeks, recruited at 2 large public companies in Sweden in 2005, were included in this randomized controlled trial. The 2 interventions were naprapathy, including spinal manipulation/mobilization, massage, and stretching (Index Group) and support and advice to stay active and how to cope with pain, according to the best scientific evidence available, provided by a physician (Control Group). Pain, disability, and perceived recovery were measured by questionnaires at baseline and after 3, 7, and 12 weeks.
At 7-week and 12-week follow-ups, statistically significant differences between the groups were found in all outcomes favoring the Index Group. At 12-week follow-up, a higher proportion in the naprapathy group had improved regarding pain [risk difference (RD)=27%, 95% confidence interval (CI): 17-37], disability (RD=18%, 95% CI: 7-28), and perceived recovery (RD=44%, 95% CI: 35-53). Separate analysis of neck pain and back pain patients showed similar results.
This trial suggests that combined manual therapy, like naprapathy, might be an alternative to consider for back and neck pain patients.
比较整骨推拿疗法与循证护理在治疗背部或颈部疼痛方面对疼痛、功能障碍及康复感知的影响。整骨推拿疗法在北欧国家及美国部分州较为常见，其特点是侧重于软组织和结缔组织的手法操作，旨在减轻肌肉骨骼系统的疼痛和功能障碍。
2005年在瑞典两家大型上市公司招募了409名背部或颈部疼痛且功能障碍持续至少2周的患者，纳入这项随机对照试验。两种干预措施分别为整骨推拿疗法，包括脊柱调整/松动、按摩和拉伸（试验组），以及由医生根据现有最佳科学证据提供的保持活动及应对疼痛的支持和建议（对照组）。在基线、3周、7周和12周时通过问卷调查测量疼痛、功能障碍及康复感知情况。
在7周和12周的随访中，两组在所有结局指标上均存在统计学显著差异，试验组更具优势。在12周随访时，整骨推拿疗法组在疼痛改善方面的比例更高[风险差(RD)=27%，95%置信区间(CI)：17 - 37]，功能障碍方面(RD=18%，95% CI：7 - 28)，以及康复感知方面(RD=44%，95% CI：35 - 53)。对颈部疼痛和背部疼痛患者的单独分析显示了类似结果。
该试验表明，像整骨推拿疗法这样的联合手法治疗可能是背部和颈部疼痛患者可考虑的一种替代疗法。
