Bronfort Gert, Haas Mitch, Evans Roni, Leininger Brent, Triano Jay
Northwestern Health Sciences University, Bloomington, MN, USA.
Chiropr Osteopat. 2010 Feb 25;18:3. doi: 10.1186/1746-1340-18-3.
The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions.
The conclusions are based on the results of systematic reviews of randomized clinical trials (RCTs), widely accepted and primarily UK and United States evidence-based clinical guidelines, plus the results of all RCTs not yet included in the first three categories. The strength/quality of the evidence regarding effectiveness was based on an adapted version of the grading system developed by the US Preventive Services Task Force and a study risk of bias assessment tool for the recent RCTs.
By September 2009, 26 categories of conditions were located containing RCT evidence for the use of manual therapy: 13 musculoskeletal conditions, four types of chronic headache and nine non-musculoskeletal conditions. We identified 49 recent relevant systematic reviews and 16 evidence-based clinical guidelines plus an additional 46 RCTs not yet included in systematic reviews and guidelines.Additionally, brief references are made to other effective non-pharmacological, non-invasive physical treatments.
Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation.Massage is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. In children, the evidence is inconclusive for asthma and infantile colic.
本报告旨在对有关手法治疗在多种肌肉骨骼疾病和非肌肉骨骼疾病管理中的有效性的科学证据进行简洁而全面的总结。
结论基于随机临床试验（RCT）的系统评价结果、广泛接受的且主要是英国和美国的循证临床指南，以及前三类中尚未纳入的所有RCT的结果。关于有效性的证据强度/质量基于美国预防服务工作组开发的分级系统的改编版本以及近期RCT的研究偏倚风险评估工具。
到2009年9月，发现有26类疾病包含使用手法治疗的RCT证据：13种肌肉骨骼疾病、4种慢性头痛类型和9种非肌肉骨骼疾病。我们确定了49项近期相关的系统评价和16项循证临床指南，以及另外46项尚未纳入系统评价和指南的RCT。此外，还简要提及了其他有效的非药物、非侵入性物理治疗。
脊柱整复/松动术对成年人有效：用于急性、亚急性和慢性下腰痛；偏头痛和颈源性头痛；颈源性头晕；整复/松动术对几种四肢关节疾病有效；胸廓整复/松动术对急性/亚急性颈部疼痛有效。对于任何持续时间的颈部疼痛单独使用颈椎整复/松动术以及对于中背部疼痛、坐骨神经痛、紧张型头痛、尾骨痛、颞下颌关节紊乱、纤维肌痛、经前综合征和老年人肺炎使用整复/松动术，证据尚无定论。与假手法相比，脊柱整复术对哮喘和痛经无效，或与抗高血压饮食联合使用时对1期高血压无效。在儿童中，关于其对中耳炎和遗尿症有效性的证据尚无定论，与假手法相比，对婴儿腹绞痛和哮喘无效。按摩对成年人的慢性下腰痛和慢性颈部疼痛有效。对于膝骨关节炎、纤维肌痛、肌筋膜疼痛综合征、偏头痛和经前综合征，证据尚无定论。在儿童中，关于其对哮喘和婴儿腹绞痛有效性的证据尚无定论。
