脊柱推拿手法与常规医疗护理治疗急慢性下腰痛的比较：一项随机临床试验。
Comparison of spinal manipulation methods and usual medical care for acute and subacute low back pain: a randomized clinical trial.
作者信息
Schneider Michael, Haas Mitchell, Glick Ronald, Stevans Joel, Landsittel Doug
机构信息
*School of Health and Rehabilitation Sciences, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA †Center for Outcomes Studies, University of Western States, Portland, OR ‡Department of Psychiatry and Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Center for Integrative Medicine at UPMC Shadyside, Pittsburgh, PA §School of Health and Rehabilitation Sciences University of Pittsburgh, Pittsburgh, PA; and ¶Department of Medicine and Department of Biostatistics, Clinical & Translational Science Institute, Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, PA.
出版信息
Spine (Phila Pa 1976). 2015 Feb 15;40(4):209-17. doi: 10.1097/BRS.0000000000000724.
STUDY DESIGN
Randomized controlled trial with follow-up to 6 months.
OBJECTIVE
This was a comparative effectiveness trial of manual-thrust manipulation (MTM) versus mechanical-assisted manipulation (MAM); and manipulation versus usual medical care (UMC).
SUMMARY OF BACKGROUND DATA
Low back pain (LBP) is one of the most common conditions seen in primary care and physical medicine practice. MTM is a common treatment for LBP. Claims that MAM is an effective alternative to MTM have yet to be substantiated. There is also question about the effectiveness of manipulation in acute and subacute LBP compared with UMC.
METHODS
A total of 107 adults with onset of LBP within the past 12 weeks were randomized to 1 of 3 treatment groups: MTM, MAM, or UMC. Outcome measures included the Oswestry LBP Disability Index (0-100 scale) and numeric pain rating (0-10 scale). Participants in the manipulation groups were treated twice weekly during 4 weeks; subjects in UMC were seen for 3 visits during this time. Outcome measures were captured at baseline, 4 weeks, 3 months, and 6 months.
RESULTS
Linear regression showed a statistically significant advantage of MTM at 4 weeks compared with MAM (disability = -8.1, P = 0.009; pain = -1.4, P = 0.002) and UMC (disability = -6.5, P = 0.032; pain = -1.7, P < 0.001). Responder analysis, defined as 30% and 50% reductions in Oswestry LBP Disability Index scores revealed a significantly greater proportion of responders at 4 weeks in MTM (76%; 50%) compared with MAM (50%; 16%) and UMC (48%; 39%). Similar between-group results were found for pain: MTM (94%; 76%); MAM (69%; 47%); and UMC (56%; 41%). No statistically significant group differences were found between MAM and UMC, and for any comparison at 3 or 6 months.
CONCLUSION
MTM provides greater short-term reductions in self-reported disability and pain scores compared with UMC or MAM.
LEVEL OF EVIDENCE
研究设计
随访6个月的随机对照试验。
目的
这是一项关于手法推按整复（MTM）与机械辅助整复（MAM）对比；以及整复与常规医疗护理（UMC）对比的相对疗效试验。
背景数据总结
腰痛（LBP）是初级保健和物理医学实践中最常见的病症之一。MTM是治疗LBP的常用方法。声称MAM是MTM有效替代方法的说法尚未得到证实。与UMC相比，整复在急性和亚急性LBP中的有效性也存在疑问。
方法
共有107名在过去12周内出现LBP的成年人被随机分为3个治疗组之一：MTM、MAM或UMC。结局指标包括Oswestry腰痛残疾指数（0 - 100分）和数字疼痛评分（0 - 10分）。整复组的参与者在4周内每周接受两次治疗；UMC组的受试者在此期间接受3次就诊。在基线、4周、3个月和6个月时收集结局指标。
结果
线性回归显示，与MAM（残疾 = -8.1，P = 0.009；疼痛 = -1.4，P = 0.002）和UMC（残疾 = -6.5，P = 0.032；疼痛 = -1.7，P < 0.001）相比，MTM在4周时有统计学显著优势。应答者分析定义为Oswestry腰痛残疾指数评分降低30%和50%，结果显示与MAM（50%；16%）和UMC（48%；39%）相比MTM在4周时应答者比例显著更高（76%；5&）。在疼痛方面也发现了类似的组间结果：MTM（94%；76%）；MAM（69%；47%）；UMC（56%；41%）。在MAM和UMC之间以及在3个月或6个月时的任何比较中均未发现统计学显著的组间差异。
结论
与UMC或MAM相比，MTM能在短期内更大程度降低自我报告残疾和疼痛评分。
证据级别
2级。
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