手法治疗与运动疗法对不同阶段非特异性下腰痛的疗效：系统评价的更新
The efficacy of manual therapy and exercise for different stages of non-specific low back pain: an update of systematic reviews.
作者信息
Hidalgo Benjamin, Detrembleur Christine, Hall Toby, Mahaudens Philippe, Nielens Henri
机构信息
Institute of Neuroscience, Faculty of Motor Sciences, University of Louvain, Brussels, Belgium.
School of Physiotherapy, Curtin Innovation Health Research Institute, Curtin University of Technology, Perth, WA, Australia.
出版信息
J Man Manip Ther. 2014 May;22(2):59-74. doi: 10.1179/2042618613Y.0000000041.
OBJECTIVE
to review and update the evidence for different forms of manual therapy (MT) for patients with different stages of non-specific low back pain (LBP).
DATA SOURCES
MEDLINE, Cochrane-Register-of-Controlled-Trials, PEDro, EMBASE.
METHOD
A systematic review of MT with a literature search covering the period of January 2000 to April 2013 was conducted by two independent reviewers according to Cochrane and PRISMA guidelines. A total of 360 studies were evaluated using qualitative criteria. Two stages of LBP were categorized; combined acute-subacute and chronic. Further sub-classification was made according to MT intervention: MT1 (manipulation); MT2 (mobilization and soft-tissue-techniques); and MT3 (MT1 combined with MT2). In each sub-category, MT could be combined or not with exercise or usual medical care (UMC). Consequently, quantitative evaluation criteria were applied to 56 eligible randomized controlled trials (RCTs), and hence 23 low-risk of bias RCTs were identified for review. Only studies providing new updated information (11/23 RCTs) are presented here.
RESULTS
Acute-subacute LBP: STRONG-evidence in favour of MT1 when compared to sham for pain, function and health improvements in the short-term (1-3 months). MODERATE-evidence to support MT1 and MT3 combined with UMC in comparison to UMC alone for pain, function and health improvements in the short-term. Chronic LBP: MODERATE to STRONG-evidence in favour of MT1 in comparison to sham for pain, function and overall-health in the short-term. MODERATE-evidence in favour of MT3 combined with exercise or UMC in comparison to exercise and back-school was established for pain, function and quality-of-life in the short and long-term. LIMITED-evidence in favour of MT2 combined with exercise and UMC in comparison to UMC alone for pain and function from short to long-term. LIMITED-evidence of no effect for MT1 with extension-exercise compared to extension-exercise alone for pain in the short to long-term.
CONCLUSION
This systematic review updates the evidence for MT with exercise or UMC for different stages of LBP and provides recommendations for future studies.
目的
回顾并更新针对不同阶段非特异性下背痛（LBP）患者的不同形式手法治疗（MT）的证据。
数据来源
MEDLINE、Cochrane对照试验注册库、PEDro、EMBASE。
方法
两名独立评审员根据Cochrane和PRISMA指南，对2000年1月至2013年4月期间的MT进行了系统综述，并进行文献检索。共使用定性标准评估了360项研究。LBP分为两个阶段；急性 - 亚急性和慢性合并阶段。根据MT干预进一步细分：MT1（整复）；MT2（松动术和软组织技术）；以及MT3（MT1与MT2联合）。在每个子类别中，MT可与运动或常规医疗护理（UMC）联合或不联合使用。因此，对56项符合条件的随机对照试验（RCT）应用了定量评估标准，从而确定了23项低偏倚风险的RCT进行综述。这里仅展示提供新的更新信息的研究（11/23项RCT）。
结果
急性 - 亚急性LBP：与假治疗相比，MT1在短期（1 - 3个月）内改善疼痛、功能和健康方面有强有力的证据支持。与单独使用UMC相比，MT1和MT3联合UMC在短期改善疼痛、功能和健康方面有中等强度的证据支持。慢性LBP：与假治疗相比，MT1在短期改善疼痛、功能和整体健康方面有中等至强有力的证据支持。与运动和返校治疗相比，MT3联合运动或UMC在短期和长期改善疼痛、功能和生活质量方面有中等强度的证据支持。与单独使用UMC相比，MT2联合运动和UMC在短期至长期改善疼痛和功能方面有有限的证据支持。与单独进行伸展运动相比，MT1联合伸展运动在短期至长期改善疼痛方面没有效果的证据有限。
结论
本系统综述更新了MT联合运动或UMC治疗不同阶段LBP的证据，并为未来研究提供了建议。
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