Yuan Jing, Purepong Nithima, Kerr Daniel Paul, Park Jongbae, Bradbury Ian, McDonough Suzanne
School of Health Sciences, University of Ulster, Co Antrim, Northern Ireland.
Spine (Phila Pa 1976). 2008 Nov 1;33(23):E887-900. doi: 10.1097/BRS.0b013e318186b276.
A systematic review of randomized controlled trials (RCTs).
To explore the evidence for the effectiveness of acupuncture for nonspecific low back pain (LBP).
Since the most recent systematic reviews on RCTs on acupuncture for LBP, 6 RCTs have been published, which may impact on the previous conclusions.
Searches were completed for RCTs on all types of acupuncture for patients with nonspecific LBP published in English. Methodologic quality was scored using the Van Tulder scale. Trials were deemed to be high quality if they scored more than 6/11 on the Van Tulder scale, carried out appropriate statistical analysis, with at least 40 patients per group, and did not exceed 20% and 30% dropouts at short/intermediate and long-term follow-up, respectively. High quality trials were given more weight when conducting the best evidence synthesis. Studies were grouped according to the control interventions, i.e., no treatment, sham intervention, conventional therapy, acupuncture in addition to conventional therapy. Treatment effect size and clinical significance were also determined. The adequacy of acupuncture treatment was judged by comparison of recommendations made in textbooks, surveys, and reviews.
Twenty-three trials (n = 6359) were included and classified into 5 types of comparisons, 6 of which were of high quality. There is moderate evidence that acupuncture is more effective than no treatment, and strong evidence of no significant difference between acupuncture and sham acupuncture, for short-term pain relief. There is strong evidence that acupuncture can be a useful supplement to other forms of conventional therapy for nonspecific LBP, but the effectiveness of acupuncture compared with other forms of conventional therapies still requires further investigation.
Acupuncture versus no treatment, and as an adjunct to conventional care, should be advocated in the European Guidelines for the treatment of chronic LBP.
对随机对照试验（RCT）进行系统评价。
探讨针刺治疗非特异性下腰痛（LBP）有效性的证据。
自上次关于针刺治疗LBP的RCT系统评价以来，又发表了6项RCT，这可能会影响之前的结论。
检索以英文发表的关于各种针刺治疗非特异性LBP患者的RCT。使用范图尔德量表对方法学质量进行评分。如果试验在范图尔德量表上得分超过6/11、进行了适当的统计分析、每组至少有40名患者，并且在短期/中期和长期随访时脱落率分别不超过20%和30%，则认为该试验质量高。在进行最佳证据综合时，高质量试验的权重更大。研究根据对照干预措施进行分组，即不治疗、假干预、传统疗法、传统疗法加针刺。还确定了治疗效果大小和临床意义。通过比较教科书、调查和综述中的建议来判断针刺治疗的充分性。
纳入23项试验（n = 6359），分为5种比较类型，其中6项质量高。有中等证据表明针刺在短期疼痛缓解方面比不治疗更有效，有强有力的证据表明针刺与假针刺之间无显著差异。有强有力的证据表明针刺可作为非特异性LBP其他形式传统疗法的有用补充，但针刺与其他形式传统疗法相比的有效性仍需进一步研究。
在欧洲慢性LBP治疗指南中，应提倡针刺与不治疗相比，以及作为传统护理的辅助手段。
