Koes B W, Assendelft W J, van der Heijden G J, Bouter L M, Knipschild P G
Department of Epidemiology and Biostatistics, University of Limburg, Maastricht, The Netherlands.
BMJ. 1991 Nov 23;303(6813):1298-303. doi: 10.1136/bmj.303.6813.1298.
To assess the efficacy of spinal manipulation for patients with back or neck pain.
Computer aided search for published papers and blinded assessment of the methods of the studies.
35 randomised clinical trials comparing spinal manipulation with other treatments.
Score for quality of methods (based on four main categories: study population, interventions, measurement of effect, and data presentation and analysis) and main conclusion of author(s) with regard to spinal manipulation.
No trial scored 60 or more points (maximum score 100) suggesting that most were of poor quality. Eighteen studies (51%) showed favourable results for manipulation. In addition, five studies (14%) reported positive results in one or more subgroups. Of the four studies with 50-60 points, one reported that manipulation was better, two reported that manipulation was better in only a subgroup, and one reported that manipulation was no better or worse than reference treatment. Eight trials attempted to compare manipulation with some placebo, with inconsistent results.
Although some results are promising, the efficacy of manipulation has not been convincingly shown. Further trials are needed, but much more attention should be paid to the methods of study.
评估脊柱推拿对背痛或颈痛患者的疗效。
计算机辅助检索已发表的论文，并对研究方法进行盲法评估。
35项比较脊柱推拿与其他治疗方法的随机临床试验。
方法质量评分（基于四个主要类别：研究人群、干预措施、疗效测量以及数据呈现与分析）以及作者关于脊柱推拿的主要结论。
没有试验得分达到60分或更高（满分100分），这表明大多数试验质量较差。18项研究（51%）显示推拿效果良好。此外，5项研究（14%）在一个或多个亚组中报告了阳性结果。在4项得分为50 - 60分的研究中，1项报告推拿效果更好，2项报告仅在亚组中推拿效果更好，1项报告推拿与对照治疗效果相当。8项试验试图将推拿与某种安慰剂进行比较，结果不一致。
尽管一些结果很有前景，但推拿的疗效尚未得到令人信服的证明。需要进一步的试验，但应更加关注研究方法。
