Hu Xiao-Yang, Chen Ni-Ni, Chai Qian-Yun, Yang Guo-Yan, Trevelyan Esmé, Lorenc Ava, Liu Jian-Ping, Robinson Nicola
School of Health and Social Care, London South Bank University, London, UK.
Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100700, China.
Chin J Integr Med. 2015 Oct 26. doi: 10.1007/s11655-015-2125-2.
Low back pain (LBP) is a common musculoskeletal condition often treated using integrative medicine (IM). Most reviews have focused on a single complementary and alternative medicine (CAM) therapy for LBP rather than evaluating wider integrative approaches. This exploratory systematic review aimed to identify randomized controlled trials (RCTs) and provide evidence on the effectiveness, cost effectiveness and adverse effects of integrative treatment for LBP.
A literature search was conducted in 12 English and Chinese databases. RCTs evaluating an integrative treatment for musculoskeletal related LBP were included. Reporting, methodological quality and relevant clinical characteristics were assessed and appraised. Metaanalyses were performed for outcomes where trials were sufficiently homogenous.
Fifty-six RCTs were identified evaluating integrative treatment for LBP. Although reporting and methodological qualities were poor, meta-analysis showed a favourable effect for integrative treatment over conventional and CAM treatment for back pain and function at 3 months or less follow-up. Two trials investigated costs, reporting £ 5332 per quality adjusted life years with 6 Alexander technique lessons plus exercise at 12 months follow-up; and an increased total costs of $244 when giving an additional up to 15 sessions of CAM package of care at 12 weeks. Sixteen trials mentioned safety; no severe adverse effects were reported.
Integrative treatment that combines CAM with conventional therapies appeared to have beneficial effects on pain and function. However, evidence is limited due to heterogeneity, the relatively small numbers available for subgroup analyses and the low methodological quality of the included trials. Identification of studies of true IM was not possible due to lack of reporting of the intervention details (registration No. CRD42013003916).
腰痛（LBP）是一种常见的肌肉骨骼疾病，通常采用综合医学（IM）进行治疗。大多数综述都集中在针对腰痛的单一补充和替代医学（CAM）疗法上，而不是评估更广泛的综合方法。这项探索性系统综述旨在识别随机对照试验（RCT），并提供关于腰痛综合治疗的有效性、成本效益和不良反应的证据。
在12个英文和中文数据库中进行文献检索。纳入评估肌肉骨骼相关腰痛综合治疗的随机对照试验。对报告、方法学质量和相关临床特征进行评估和评价。对试验充分同质的结果进行荟萃分析。
共识别出56项评估腰痛综合治疗的随机对照试验。尽管报告和方法学质量较差，但荟萃分析显示，在随访3个月或更短时间时，综合治疗在背痛和功能方面比传统治疗和CAM治疗具有更好的效果。两项试验调查了成本，一项试验报告在12个月随访时，6次亚历山大技术课程加运动，每质量调整生命年成本为5332英镑；另一项试验报告在12周时，额外提供多达15次CAM护理套餐会使总成本增加244美元。16项试验提到了安全性；未报告严重不良反应。
将CAM与传统疗法相结合的综合治疗似乎对疼痛和功能有有益影响。然而，由于异质性、可用于亚组分析的数量相对较少以及纳入试验的方法学质量较低，证据有限。由于缺乏干预细节的报告，无法识别真正的综合医学研究（注册号CRD42013003916）。
