干针疗法对腰痛有效吗？：一项系统评价和遵循PRISMA标准的Meta分析。
Is dry needling effective for low back pain?: A systematic review and PRISMA-compliant meta-analysis.
作者信息
Hu Han-Tong, Gao Hong, Ma Rui-Jie, Zhao Xiao-Feng, Tian Hong-Fang, Li Lu
机构信息
Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang Rehabilitation Medical Center, Hangzhou City, Zhejiang Province Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin City, China.
出版信息
Medicine (Baltimore). 2018 Jun;97(26):e11225. doi: 10.1097/MD.0000000000011225.
BACKGROUND
To evaluate the efficacy and safety of dry needling (DN) for treating low back pain (LBP).
METHODS
Nine databases were searched from inception to October 2017. Eligible randomized controlled trials (RCTs) involving DN for treating LBP were retrieved. Two reviewers independently screened the articles, extracted data, and evaluated the risk of bias among the included studies using the risk of bias assessment tool by Cochrane Collaboration.
RESULTS
Sixteen RCTs were included and the risk of bias assessment of them was "high" or "unclear" for most domains. Meta-analysis results suggested that DN was more effective than acupuncture in alleviating pain intensity and functional disability at postintervention, while its efficacy on pain and disability at follow-up was only equal to acupuncture. Besides, DN was superior to sham needling for alleviating pain intensity at postintervention/follow-up and functional disability at postintervention. Additionally, qualitative review revealed that DN combined with acupuncture had more significant effect on alleviating pain intensity at postintervention and achieved higher response rate than DN alone. However, compared with other treatments (laser, physical therapy, other combined treatments, etc.), it remained uncertain whether the efficacy of DN was superior or equal because the results of included studies were mixed.
CONCLUSIONS
Compared with acupuncture and sham needling, DN is more effective for alleviating pain and disability at postintervention in LBP, while its effectiveness on pain and disability at follow-up was equal to acupuncture. Besides, it remains uncertain whether the efficacy of DN is superior to other treatments. Nevertheless, considering the overall "high" or "unclear" risk of bias of studies, all current evidence is not robust to draw a firm conclusion regarding the efficacy and safety of DN for LBP. Future RCTs with rigorous methodologies are required to confirm our findings.
DETAILS OF ETHICS APPROVAL
No ethical approval was required for this systematic review and meta-analysis.
背景
评估干针疗法（DN）治疗腰痛（LBP）的疗效和安全性。
方法
检索了从起始到2017年10月的九个数据库。检索了涉及DN治疗LBP的合格随机对照试验（RCT）。两名评价者独立筛选文章、提取数据，并使用Cochrane协作网的偏倚风险评估工具评估纳入研究中的偏倚风险。
结果
纳入16项RCT，大多数领域的偏倚风险评估为“高”或“不清楚”。Meta分析结果表明，DN在干预后缓解疼痛强度和功能障碍方面比针灸更有效，而其在随访时对疼痛和功能障碍的疗效仅与针灸相当。此外，DN在干预后/随访时缓解疼痛强度以及干预后缓解功能障碍方面优于假针刺。此外，定性综述显示，DN联合针灸在干预后缓解疼痛强度方面效果更显著，且比单独使用DN的有效率更高。然而，与其他治疗方法（激光、物理治疗、其他联合治疗等）相比，由于纳入研究的结果不一，DN的疗效是否更优或相当仍不确定。
结论
与针灸和假针刺相比，DN在干预后缓解LBP的疼痛和功能障碍方面更有效，而其在随访时对疼痛和功能障碍的有效性与针灸相当。此外，DN的疗效是否优于其他治疗方法仍不确定。然而，考虑到研究总体偏倚风险为“高”或“不清楚”，目前所有证据都不足以就DN治疗LBP的疗效和安全性得出确凿结论。需要未来采用严谨方法的RCT来证实我们的发现。
伦理批准详情
本系统评价和Meta分析无需伦理批准。
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