Pach Daniel, Piper Mike, Lotz Fabian, Reinhold Thomas, Dombrowski Mirja, Chang Yinghui, Liu Bin, Blödt Susanne, Rotter Gabriele, Icke Katja, Witt Claudia M
1 Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin , and Berlin Institute of Health , Institute for Social Medicine, Epidemiology and Health Economics, Berlin, Germany .
2 First Teaching Hospital of Tianjin University of Traditional Chinese Medicine , Tianjin, China .
J Altern Complement Med. 2018 Mar;24(3):231-237. doi: 10.1089/acm.2017.0209. Epub 2017 Oct 26.
To evaluate whether tuina is more effective and cost-effective in reducing pain compared to no intervention in patients with chronic neck pain.
Single-center randomized two-armed controlled trial.
University outpatient clinic specialized in Integrative Medicine.
Outpatients with chronic neck pain were randomly allocated to tuina or no intervention.
Six tuina treatments within 3 weeks.
The primary outcome was the mean neck pain intensity during the previous 7 days on a visual analogue scale after 4 weeks (VAS, 0-100 mm, 0 = no pain, 100 = worst imaginable pain). Secondary outcomes included Neck Pain and Disability Scale (NPDS), Neck Disability Index (NDI), health-related quality of life (12-item quality-of-life questionnaire [SF-12]), medication intake, and cost-effectiveness after 4 and 12 weeks. Statistical analysis included analysis of covariance adjusted for baseline values and a full economic analysis from a societal perspective.
Altogether, 92 outpatients were included (46 in both groups, 87% female, mean age 45.4 [standard deviation ±9.7], and mean VAS 57.7 ± 11.5). Tuina treatment led to a clinically meaningful reduction in neck pain intensity (group differences, 4 weeks: -22.8 mm [95% confidence interval, -31.7 to -13.8]; p < 0.001 and 12 weeks: -17.9 mm [-27.1 to -8.8], p < 0.001). No serious adverse events were observed. Total costs as well as quality-adjusted life years (QALYs) did not differ significantly between the groups. When taking group differences into account independently from their statistical significance, costs per QALY gained (incremental cost-effectiveness ratio) would range within a cost-effective area from €7,566 (for costs €10.28 per session) to €39,414 (cost €35 per session).
An additional treatment with six tuina sessions over 3 weeks was effective, safe and relatively cost-effective for patients with chronic neck pain. A future trial should compare tuina to other best care options.
评估与不干预相比，推拿治疗对慢性颈痛患者减轻疼痛是否更有效且更具成本效益。
单中心随机双臂对照试验。
大学综合医学门诊。
慢性颈痛门诊患者被随机分配至推拿组或不干预组。
3周内进行6次推拿治疗。
主要观察指标为4周后采用视觉模拟量表（VAS，0 - 100mm，0 = 无疼痛，100 = 可想象的最严重疼痛）评估的过去7天颈部疼痛强度均值。次要观察指标包括颈部疼痛与功能障碍量表（NPDS）、颈部功能障碍指数（NDI）、健康相关生活质量（12项生活质量问卷[SF - 12]）、药物摄入量以及4周和12周后的成本效益。统计分析包括对基线值进行协方差分析以及从社会角度进行全面经济分析。
共纳入92例门诊患者（两组各46例，87%为女性，平均年龄45.4岁[标准差±9.7]，平均VAS为57.7±11.5）。推拿治疗使颈部疼痛强度有临床意义的降低（组间差异，4周时：-22.8mm[95%置信区间，-31.7至-13.8]；p < 0.001；12周时：-17.9mm[-27.1至-8.8]，p < 0.001）。未观察到严重不良事件。两组的总成本以及质量调整生命年（QALY）无显著差异。若独立考虑组间差异而不考虑其统计学意义，每获得一个QALY的成本（增量成本效益比）在具有成本效益的范围内，从7566欧元（每次治疗成本10.28欧元）到39414欧元（每次治疗成本35欧元）。
对慢性颈痛患者而言，在3周内额外进行6次推拿治疗是有效、安全且相对具有成本效益的。未来的试验应将推拿与其他最佳治疗方案进行比较。
