Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Spine (Phila Pa 1976). 2011 Jun;36(13):E825-46. doi: 10.1097/BRS.0b013e3182197fe1.
Systematic review of interventions.
To assess the effects of spinal manipulative therapy (SMT) for chronic low-back pain.
SMT is one of the many therapies for the treatment of low-back pain, which is a worldwide, extensively practiced intervention.
Search methods. An experienced librarian searched for randomized controlled trials (RCTs) in multiple databases up to June 2009. Selection criteria. RCTs that examined manipulation or mobilization in adults with chronic low-back pain were included. The primary outcomes were pain, functional status, and perceived recovery. Secondary outcomes were return-to-work and quality of life. Data collection and analysis. Two authors independently conducted the study selection, risk of bias assessment, and data extraction. GRADE was used to assess the quality of the evidence.
We included 26 RCTs (total participants = 6070), 9 of which had a low risk of bias. Approximately two-thirds of the included studies (N = 18) were not evaluated in the previous review. There is a high-quality evidence that SMT has a small, significant, but not clinically relevant, short-term effect on pain relief (mean difference -4.16, 95% confidence interval -6.97 to -1.36) and functional status (standardized mean difference -0.22, 95% confidence interval -0.36 to -0.07) in comparison with other interventions. There is varying quality of evidence that SMT has a significant short-term effect on pain relief and functional status when added to another intervention. There is a very low-quality evidence that SMT is not more effective than inert interventions or sham SMT for short-term pain relief or functional status. Data were particularly sparse for recovery, return-to-work, quality of life, and costs of care. No serious complications were observed with SMT.
High-quality evidence suggests that there is no clinically relevant difference between SMT and other interventions for reducing pain and improving function in patients with chronic low-back pain. Determining cost-effectiveness of care has high priority.
系统评价干预措施。
评估脊柱手法治疗（SMT）治疗慢性下腰痛的效果。
SMT 是治疗下腰痛的众多疗法之一，下腰痛是一种全球性的、广泛应用的干预措施。
搜索方法。一位经验丰富的图书管理员在多个数据库中搜索了截止到 2009 年 6 月的随机对照试验（RCT）。选择标准。纳入了检查成年人慢性下腰痛时手法或松动的 RCT。主要结果是疼痛、功能状态和感知恢复。次要结果是重返工作和生活质量。数据收集和分析。两位作者独立进行了研究选择、偏倚风险评估和数据提取。GRADE 用于评估证据质量。
我们纳入了 26 项 RCT（总参与者=6070），其中 9 项的偏倚风险较低。大约三分之二的纳入研究（N=18）未在前一次综述中评估。有高质量证据表明，与其他干预措施相比，SMT 具有较小但有统计学意义但无临床相关的短期缓解疼痛（平均差异-4.16，95%置信区间-6.97 至-1.36）和功能状态（标准化均数差异-0.22，95%置信区间-0.36 至-0.07）的效果。有不同质量的证据表明，当 SMT 与另一种干预措施联合使用时，它具有显著的短期缓解疼痛和功能状态的效果。有极低质量的证据表明，SMT 在短期缓解疼痛或功能状态方面并不优于惰性干预或假 SMT。关于恢复、重返工作、生活质量和护理成本的数据特别稀疏。未观察到 SMT 有严重并发症。
高质量证据表明，在减轻慢性下腰痛患者的疼痛和改善功能方面，SMT 与其他干预措施之间没有临床相关差异。确定护理的成本效益具有很高的优先级。
