Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Spine (Phila Pa 1976). 2013 Feb 1;38(3):E158-77. doi: 10.1097/BRS.0b013e31827dd89d.
Systematic review of interventions.
To assess the effects of spinal manipulative therapy (SMT) for acute low back pain.
SMT is one of many therapies for the treatment of low back pain, which is a worldwide, extensively practiced intervention.
An experienced librarian searched for randomized controlled trials (RCTs) in multiple databases up to March 13, 2011. RCTs that examined manipulation or mobilization in adults with acute low back pain (<6-week duration) were included. The primary outcomes were pain, functional status and perceived recovery. Secondary outcomes were return-to-work and quality of life. Two authors independently conducted the study selection, risk of bias assessment and data extraction. GRADE (grading of recommendations assessment, development, and evaluation) was used to assess the quality of the evidence. The effects were examined for SMT versus (1) inert interventions, (2) sham SMT, (3) other interventions, and (4) SMT as adjunct therapy.
We identified 20 RCTs (total participants = 2674), 12 (60%) of which were not included in the previous review. In total, 6 trials (30% of all included studies) had a low risk of bias. In general, for the outcomes of pain and functional status, there is low- to very low-quality evidence suggesting no difference in effect for SMT when compared with inert interventions, sham SMT or as adjunct therapy. There was varying quality of evidence (from very low to moderate) suggesting no difference in effect for SMT when compared with other interventions. Data were particularly sparse for recovery, return-to-work, quality of life, and costs of care. No serious complications were observed with SMT.
SMT is no more effective for acute low back pain than inert interventions, sham SMT or as adjunct therapy. SMT also seems to be no better than other recommended therapies. Our evaluation is limited by the few numbers of studies; therefore, future research is likely to have an important impact on these estimates. Future RCTs should examine specific subgroups and include an economic evaluation.
系统评价干预措施。
评估脊柱手法治疗（SMT）对急性腰痛的疗效。
SMT 是治疗腰痛的多种疗法之一，腰痛是一种全球性的、广泛应用的干预手段。
一位经验丰富的图书管理员在多个数据库中搜索了截至 2011 年 3 月 13 日的随机对照试验（RCT）。纳入了评估成年人急性腰痛（<6 周）中手法或松动术的 RCT。主要结局指标是疼痛、功能状态和感知恢复。次要结局指标是重返工作岗位和生活质量。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（推荐评估、制定和评价分级）用于评估证据质量。评估了 SMT 与（1）惰性干预、（2）假 SMT、（3）其他干预以及（4）SMT 辅助治疗的效果。
我们确定了 20 项 RCT（总参与者=2674 人），其中 12 项（60%）未包含在前一次综述中。总共，有 6 项试验（所有纳入研究的 30%）具有低偏倚风险。总体而言，对于疼痛和功能状态的结局，有低至极低质量的证据表明，SMT 与惰性干预、假 SMT 或辅助治疗相比，效果无差异。有不同质量的证据（从极低到中等）表明，SMT 与其他干预相比，效果无差异。关于恢复、重返工作岗位、生活质量和医疗费用的数据特别稀疏。未观察到 SMT 出现严重并发症。
SMT 对急性腰痛的疗效并不优于惰性干预、假 SMT 或辅助治疗。SMT 似乎也不比其他推荐的疗法更好。我们的评估受到研究数量较少的限制，因此未来的研究很可能对这些估计产生重要影响。未来的 RCT 应检查特定亚组并进行经济评估。
