The George Institute for International Health, PO Box M201 Missenden Rd Sydney, NSW 2050, Australia.
BMC Med. 2010 Jan 26;8:10. doi: 10.1186/1741-7015-8-10.
Low back pain is a highly prevalent and disabling condition worldwide. Clinical guidelines for the management of patients with acute low back pain recommend first-line treatment consisting of advice, reassurance and simple analgesics. Exercise is also commonly prescribed to these patients. The primary aim of this study was to evaluate the short-term effect of adding the McKenzie method to the first-line care of patients with acute low back pain.
A multi-centre randomized controlled trial with a 3-month follow-up was conducted between September 2005 and June 2008. Patients seeking care for acute non-specific low back pain from primary care medical practices were screened. Eligible participants were assigned to receive a treatment programme based on the McKenzie method and first-line care (advice, reassurance and time-contingent acetaminophen) or first-line care alone, for 3 weeks. Primary outcome measures included pain (0-10 Numeric Rating Scale) over the first seven days, pain at 1 week, pain at 3 weeks and global perceived effect (-5 to 5 scale) at 3 weeks. Treatment effects were estimated using linear mixed models.
One hundred and forty-eight participants were randomized into study groups, of whom 138 (93%) completed the last follow-up. The addition of the McKenzie method to first-line care produced statistically significant but small reductions in pain when compared to first-line care alone: mean of -0.4 points (95% confidence interval, -0.8 to -0.1) at 1 week, -0.7 points (95% confidence interval, -1.2 to -0.1) at 3 weeks, and -0.3 points (95% confidence interval, -0.5 to -0.0) over the first 7 days. Patients receiving the McKenzie method did not show additional effects on global perceived effect, disability, function or on the risk of persistent symptoms. These patients sought less additional health care than those receiving only first-line care (P = 0.002).
When added to the currently recommended first-line care of acute low back pain, a treatment programme based on the McKenzie method does not produce appreciable additional short-term improvements in pain, disability, function or global perceived effect. However, the McKenzie method seems to reduce health utilization although it does not reduce patient's risk of developing persistent symptoms.
Australian New Zealand Clinical Trials Registry: ACTRN12605000032651.
腰痛是一种在全球范围内高发且致残的疾病。针对急性腰痛患者的临床管理指南建议一线治疗采用包括建议、安慰和简单的镇痛药。运动也常被开给这些患者。本研究的主要目的是评估在急性腰痛患者的一线治疗中加入麦肯基疗法的短期效果。
这是一项在 2005 年 9 月至 2008 年 6 月进行的多中心随机对照试验，随访时间为 3 个月。从初级保健医疗诊所就诊的急性非特异性腰痛患者中进行筛选。符合条件的参与者被分配接受基于麦肯基疗法和一线治疗（建议、安慰和时间依赖性扑热息痛）的治疗方案，或仅接受一线治疗，为期 3 周。主要观察指标包括第 1 周的前 7 天的疼痛（0-10 数字评分量表）、第 1 周的疼痛、第 3 周的疼痛和第 3 周的总体感知效果（-5 到 5 分量表）。使用线性混合模型估计治疗效果。
148 名参与者被随机分配到研究组，其中 138 名（93%）完成了最后一次随访。与仅接受一线治疗相比，在一线治疗中加入麦肯基方法可使疼痛明显减轻，但程度较小：第 1 周时为-0.4 分（95%置信区间，-0.8 至-0.1），第 3 周时为-0.7 分（95%置信区间，-1.2 至-0.1），第 1 周时为-0.3 分（95%置信区间，-0.5 至-0.0）。接受麦肯基方法的患者在总体感知效果、残疾、功能或持续症状风险方面没有显示出额外的效果。与仅接受一线治疗的患者相比，这些患者寻求额外的医疗保健较少（P=0.002）。
当加入到急性腰痛的目前推荐的一线治疗中时，基于麦肯基方法的治疗方案并不能在疼痛、残疾、功能或总体感知效果方面产生明显的短期改善。然而，麦肯基方法似乎减少了卫生资源的利用，尽管它并没有降低患者发展为持续症状的风险。
澳大利亚和新西兰临床试验注册中心：ACTRN12605000032651。
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