Griswold D, Wilhelm M, Donaldson M, Learman K, Cleland J
a Department of Physical Therapy , Youngstown State University , Youngstown , OH , USA.
b Department of Physical Therapy , Walsh University , North Canton , OH , USA.
J Man Manip Ther. 2019 Jul;27(3):128-140. doi: 10.1080/10669817.2019.1589030. Epub 2019 Mar 19.
: The purpose of this systematic review was to evaluate the effects of deep versus superficial dry needling or acupuncture on pain and disability for spine-related painful conditions. A secondary purpose was to account for the differences of needling location in relation to the painful area. : This PROSPERO (#CRD42018106237) registered review found 691 titles through a multi-database search. Following a comprehensive search, 12 manuscripts were included in the systematic review and 10 in the meta-analysis. Standardized mean differences (SMD) with 95% confidence intervals were calculated for pain and disability. : The included studies demonstrated an unclear to high risk of bias recommending a cautious interpretation of the results. A consistent effect supporting deep needling over superficial with an SMD of 0.585 [0.335, 0.835], < 0.001 from 10 articles for pain but a non-significant effect of 0.197 [-0.066, 0.461], = 0.14 from 2 studies for disability. A temporal examination was similar for effects on pain with an SMD of 0.450 [0.104, 0.796] immediately, 0.711 [0.375, 1.048] short-term (1 to 11 weeks), and 0.470 [0.135, 0.805] for time-points ≥12 weeks. Regionally, there was a greater effect needling the area of pain locally (SMD = 0.754) compared to remotely (SMD = 0.501). : Statistically significant between-group differences were observed favoring deep needling over superficial. Both superficial and deep needling resulted in clinically meaningful changes in pain scores over time. However, differences between groups may not be clinically meaningful. More high-quality trials are needed to better estimate the effect size of deep versus superficial needling while controlling for location and depth of the lesion. Level of evidence: 1a.
本系统评价的目的是评估深层与浅层干针疗法或针刺疗法对脊柱相关疼痛性疾病的疼痛和功能障碍的影响。次要目的是说明针刺部位与疼痛区域的差异。：这项在PROSPERO（#CRD42018106237）注册的评价通过多数据库检索找到691篇标题。经过全面检索，12篇手稿被纳入系统评价，10篇被纳入荟萃分析。计算了疼痛和功能障碍的标准化均数差（SMD）及95%置信区间。：纳入的研究显示偏倚风险不明确至高，建议对结果进行谨慎解读。有一致的效应支持深层针刺优于浅层针刺，疼痛方面10篇文章的SMD为0.585[0.335,0.835]，P<0.001，但功能障碍方面2项研究的效应不显著，SMD为0.197[-0.066,0.461]，P = 0.14。对疼痛影响的时间分析结果类似，即时SMD为0.450[0.104,0.796]，短期（1至11周）为0.711[0.375,1.048]，≥12周时间点为0.470[0.135,0.805]。在区域方面，与远程针刺（SMD = 0.501）相比，在疼痛局部区域针刺的效果更大（SMD = 0.754）。：观察到组间存在统计学显著差异，支持深层针刺优于浅层针刺。随着时间推移，浅层和深层针刺均导致疼痛评分出现具有临床意义的变化。然而，组间差异可能不具有临床意义。需要更多高质量试验，以在控制病变位置和深度的同时，更好地估计深层与浅层针刺的效应大小。证据级别：1a。
