Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-17177, Stockholm, Sweden.
BMC Musculoskelet Disord. 2010 Feb 5;11:26. doi: 10.1186/1471-2474-11-26.
Back and neck pain are very common, disabling and recurrent disorders in the general population and the knowledge of long-term effect of treatments are sparse. The aim of this study was to compare the long-term effects (up to one year) of naprapathic manual therapy and evidence-based advice on staying active regarding non-specific back and/or neck pain. Naprapathy, a health profession mainly practiced in Sweden, Finland, Norway and in the USA, is characterized by a combination of manual musculoskeletal manipulations, aiming to decrease pain and disability in the neuromusculoskeletal system.
Subjects with non-specific pain/disability in the back and/or neck lasting for at least two weeks (n = 409), recruited at public companies in Sweden, were included in this pragmatic randomized controlled trial. The two interventions compared were naprapathic manual therapy such as spinal manipulation/mobilization, massage and stretching, (Index Group), and advice to stay active and on how to cope with pain, provided by a physician (Control Group). Pain intensity, disability and health status were measured by questionnaires.
89% completed the 26-week follow-up and 85% the 52-week follow-up. A higher proportion in the Index Group had a clinically important decrease in pain (risk difference (RD) = 21%, 95% CI: 10-30) and disability (RD = 11%, 95% CI: 4-22) at 26-week, as well as at 52-week follow-ups (pain: RD = 17%, 95% CI: 7-27 and disability: RD = 17%, 95% CI: 5-28). The differences between the groups in pain and disability considered over one year were statistically significant favoring naprapathy (p < or = 0.005). There were also significant differences in improvement in bodily pain and social function (subscales of SF-36 health status) favoring the Index Group.
Combined manual therapy, like naprapathy, is effective in the short and in the long term, and might be considered for patients with non-specific back and/or neck pain.
Current Controlled Trials ISRCTN56954776.
背痛和颈痛在普通人群中非常普遍，是使人丧失能力和容易复发的疾病，而对治疗的长期效果的了解却很少。本研究的目的是比较整脊手法治疗和基于证据的积极活动建议对非特异性背痛和/或颈痛的长期效果（长达一年）。整脊疗法是一种主要在瑞典、芬兰、挪威和美国开展的健康职业，其特点是结合了针对肌肉骨骼系统的手动操作，旨在减轻疼痛和功能障碍。
在瑞典的一家公共公司招募了背痛和/或颈痛持续至少两周（n = 409）的非特异性疼痛/功能障碍患者，将其纳入这项实用的随机对照试验中。比较的两种干预措施是整脊手法治疗，如脊柱推拿/松动、按摩和伸展（索引组），以及由医生提供的积极活动和疼痛处理建议（对照组）。通过问卷调查评估疼痛强度、残疾和健康状况。
89%的患者完成了 26 周的随访，85%的患者完成了 52 周的随访。索引组在 26 周和 52 周的随访时，疼痛（风险差异（RD）= 21%，95%CI：10-30）和残疾（RD = 11%，95%CI：4-22）有更大比例出现临床显著下降，在一年的随访中差异具有统计学意义（疼痛：RD = 17%，95%CI：7-27，残疾：RD = 17%，95%CI：5-28）。在疼痛和残疾方面，两组之间的差异在一年以上具有统计学意义，有利于整脊疗法（p<0.005）。索引组在身体疼痛和社会功能（SF-36 健康状况量表的子量表）方面的改善也有显著差异。
联合手动疗法，如整脊疗法，在短期和长期内都有效，可考虑用于治疗非特异性背痛和/或颈痛患者。
当前对照试验 ISRCTN56954776。
