Integrative Health & Wellbeing Research Program, Earl E. Bakken Center for Spirituality and Healing, University of Minnesota, Minneapolis, MN, USA.
Pain. 2018 Jul;159(7):1297-1307. doi: 10.1097/j.pain.0000000000001211.
Low back pain (LBP) is common in adolescence, but there is a paucity of high-quality research to inform care. We conducted a multicenter randomized trial comparing 12 weeks of spinal manipulative therapy (SMT) combined with exercise therapy (ET) to ET alone. Participants were 185 adolescents aged 12 to 18 years with chronic LBP. The primary outcome was LBP severity at 12, 26, and 52 weeks. Secondary outcomes included disability, quality of life, medication use, patient- and caregiver-rated improvement, and satisfaction. Outcomes were analyzed using longitudinal linear mixed effect models. An omnibus test assessing differences in individual outcomes over the entire year controlled for multiplicity. Of the 185 enrolled patients, 179 (97%) provided data at 12 weeks and 174 (94%) at 26 and 52 weeks. Adding SMT to ET resulted in a larger reduction in LBP severity over the course of 1 year (P = 0.007). The group difference in LBP severity (0-10 scale) was small at the end of treatment (mean difference = 0.5; P = 0.08) but was larger at weeks 26 (mean difference = 1.1; P = 0.001) and 52 (mean difference = 0.8; P = 0.009). At 26 weeks, SMT with ET performed better than ET alone for disability (P = 0.04) and improvement (P = 0.02). The SMT with ET group reported significantly greater satisfaction with care at all time points (P ≤ 0.02). There were no serious treatment-related adverse events. For adolescents with chronic LBP, spinal manipulation combined with exercise was more effective than exercise alone over a 1-year period, with the largest differences occurring at 6 months. These findings warrant replication and evaluation of cost effectiveness.
下背痛（LBP）在青少年中很常见，但高质量的研究很少，无法为治疗提供依据。我们进行了一项多中心随机试验，比较了 12 周的脊柱手法治疗（SMT）联合运动疗法（ET）与单独 ET。参与者为 185 名年龄在 12 至 18 岁之间患有慢性 LBP 的青少年。主要结局是 12、26 和 52 周时的 LBP 严重程度。次要结局包括残疾、生活质量、药物使用、患者和照顾者评估的改善以及满意度。使用纵向线性混合效应模型分析结果。一项评估整个一年中个体结果差异的综合测试控制了多重性。在纳入的 185 名患者中，179 名（97%）在 12 周时提供了数据，174 名（94%）在 26 周和 52 周时提供了数据。在 ET 中加入 SMT 可在 1 年内更大程度地减轻 LBP 严重程度（P=0.007）。治疗结束时，LBP 严重程度的组间差异较小（0-10 量表，平均差异=0.5；P=0.08），但在 26 周（平均差异=1.1；P=0.001）和 52 周（平均差异=0.8；P=0.009）时较大。在 26 周时，SMT 联合 ET 治疗在残疾（P=0.04）和改善（P=0.02）方面优于 ET 单独治疗。在所有时间点，SMT 联合 ET 组对护理的满意度都显著更高（P≤0.02）。没有严重的与治疗相关的不良事件。对于患有慢性 LBP 的青少年，在 1 年期间，脊柱推拿联合运动疗法比单独运动疗法更有效，最大差异发生在 6 个月时。这些发现值得进一步复制和评估成本效益。
