Department of Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
Parker Research Center, Parker University, Dallas, Texas.
J Manipulative Physiol Ther. 2020 Sep;43(7):714-731. doi: 10.1016/j.jmpt.2020.05.005. Epub 2020 Sep 6.
The purpose of this study was to conduct a systematic review (SR) of the literature to assess the effectiveness of chiropractic care options commonly used for pregnancy-related low back pain (LBP), pelvic girdle pain (PGP), or combination pain for both experienced practitioners and students of chiropractic.
We included procedures that were commonly used by chiropractors and not requiring additional certifications. Outcomes were self-reported changes in pain or disability. We used the Scottish Intercollegiate Guideline Network checklists to assess outcomes. For strength of evidence, we used the adapted version of the US Preventive Services Task Force criteria as described in the UK report.
Fifty articles were included from 18 SRs, 30 randomized controlled trials (RCTs), and 2 cohort studies. Pregnancy LBP (7 SRs and 12 RCTs): moderate, favorable evidence for electrotherapy and osteopathic manipulative therapy; inconclusive, favorable strength for chiropractic care, exercise, and support devices; and inconclusive, unclear strength for spinal manipulative therapy. Pregnancy PGP (4 SRs and 4 RCTs): inconclusive, favorable strength for exercise; and inconclusive, unclear evidence for patient education, information, and support devices. Pregnancy LBP or PGP (13 SRs and 12 RCTs): moderate, unclear evidence for complementary and alternative medicine; moderate, unclear evidence for exercise; inconclusive, favorable evidence for multimodal care, patient education, and physiotherapy; and inconclusive, unclear strength for spinal manipulative therapy, osteopathic manipulative therapy, and support devices.
Although there is a lack of conclusive evidence, many of the interventions have moderate or unclear but favorable evidence.
本研究旨在进行系统评价（SR），评估常见的用于妊娠相关下腰痛（LBP）、骨盆带疼痛（PGP）或两者组合的脊骨疗法选择的有效性，针对有经验的从业者和脊骨疗法学生。
我们纳入了脊骨治疗师常用且不需要额外认证的程序。结局是自我报告的疼痛或残疾变化。我们使用苏格兰校际指南网络清单来评估结局。对于证据强度，我们使用了 UK 报告中描述的美国预防服务工作组标准的改编版本。
从 18 项 SR、30 项随机对照试验（RCT）和 2 项队列研究中纳入了 50 篇文章。妊娠 LBP（7 项 SR 和 12 项 RCT）：电疗和整骨手法治疗的中等、有利证据；脊骨疗法、运动和支撑设备的有利但证据不确定；脊柱手法治疗的有利但证据不确定、不清楚。妊娠 PGP（4 项 SR 和 4 项 RCT）：运动的有利但证据不确定；患者教育、信息和支撑设备的有利但证据不确定。妊娠 LBP 或 PGP（13 项 SR 和 12 项 RCT）：补充和替代医学的中等、不清楚证据；运动的中等、不清楚证据；多模式护理、患者教育和物理治疗的有利但证据不确定；脊柱手法治疗、整骨手法治疗和支撑设备的有利但证据不确定、不清楚。
尽管缺乏结论性证据，但许多干预措施具有中等或不清楚但有利的证据。
