Department of Epidemiology and Biostatistics and EMGO Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
Eur Spine J. 2010 Aug;19(8):1213-28. doi: 10.1007/s00586-010-1356-3. Epub 2010 Mar 14.
The purpose of this systematic review was to assess the effects of spinal manipulative therapy (SMT), acupuncture and herbal medicine for chronic non-specific LBP. A comprehensive search was conducted by an experienced librarian from the Cochrane Back Review Group (CBRG) in multiple databases up to December 22, 2008. Randomised controlled trials (RCTs) of adults with chronic non-specific LBP, which evaluated at least one clinically relevant, patient-centred outcome measure were included. Two authors working independently from one another assessed the risk of bias using the criteria recommended by the CBRG and extracted the data. The data were pooled when clinically homogeneous and statistically possible or were otherwise qualitatively described. GRADE was used to determine the quality of the evidence. In total, 35 RCTs (8 SMT, 20 acupuncture, 7 herbal medicine), which examined 8,298 patients, fulfilled the inclusion criteria. Approximately half of these (2 SMT, 8 acupuncture, 7 herbal medicine) were thought to have a low risk of bias. In general, the pooled effects for the studied interventions demonstrated short-term relief or improvement only. The lack of studies with a low-risk of bias, especially in regard to SMT precludes any strong conclusions; however, the principal findings, which are based upon low- to very-low-quality evidence, suggest that SMT does not provide a more clinically beneficial effect compared with sham, passive modalities or any other intervention for treatment of chronic low-back pain. There is evidence, however, that acupuncture provides a short-term clinically relevant effect when compared with a waiting list control or when acupuncture is added to another intervention. Although there are some good results for individual herbal medicines in short-term individual trials, the lack of homogeneity across studies did not allow for a pooled estimate of the effect. In general, these results are in agreement with other recent systematic reviews on SMT, but in contrast with others. These results are also in agreement with recent reviews on acupuncture and herbal medicine. Randomized trials with a low risk of bias and adequate sample sizes are directly needed.
本次系统评价的目的是评估脊柱推拿疗法（SMT）、针灸和草药治疗慢性非特异性下腰痛的效果。由 Cochrane 腰痛评价组（CBRG）的一位经验丰富的图书管理员在多个数据库中进行了全面检索，检索截至 2008 年 12 月 22 日。纳入了评估至少一项临床相关、以患者为中心的结局指标的成人慢性非特异性下腰痛的随机对照试验（RCT）。两名作者独立地根据 CBRG 推荐的标准评估偏倚风险并提取数据。如果临床同质且统计学可行，将对数据进行合并；否则将进行定性描述。采用 GRADE 评估证据质量。共有 35 项 RCT（8 项 SMT、20 项针灸、7 项草药），共纳入 8298 例患者，符合纳入标准。这些 RCT 中有大约一半（2 项 SMT、8 项针灸、7 项草药）被认为存在低偏倚风险。总体而言，所研究干预措施的合并效应仅显示短期缓解或改善。由于缺乏低偏倚风险的研究，特别是在 SMT 方面，无法得出任何有力的结论；然而，基于低至极低质量证据的主要发现表明，与假对照、被动治疗或任何其他干预措施相比，SMT 并不能提供更有益的临床效果。但是，与等待对照或与其他干预措施联合应用时，针灸有短期临床相关效果的证据。尽管个别草药在短期个别试验中取得了一些较好的结果，但由于研究之间缺乏同质性，无法对其效应进行合并估计。总的来说，这些结果与其他最近关于 SMT 的系统评价一致，但与其他系统评价相反。这些结果也与最近关于针灸和草药的系统评价一致。需要直接进行低偏倚风险和足够样本量的随机试验。
