整骨疗法对患有非特异性慢性颈部疼痛的音乐家疼痛的影响：一项随机对照试验。
The effect of osteopathic medicine on pain in musicians with nonspecific chronic neck pain: a randomized controlled trial.
作者信息
Rotter Gabriele, Fernholz Isabel, Binting Sylvia, Keller Theresa, Roll Stephanie, Kass Benjamin, Reinhold Thomas, Willich Stefan N, Schmidt Alexander, Brinkhaus Benno
机构信息
Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Luisenstrasse 57, Berlin, 10117, Germany.
Kurt-Singer-Institute for Music Physiology and Musicians Health, Hanns Eisler School of Music Berlin, Germany.
出版信息
Ther Adv Musculoskelet Dis. 2020 Dec 10;12:1759720X20979853. doi: 10.1177/1759720X20979853. eCollection 2020.
BACKGROUND
Nonspecific chronic neck pain (cNP) is common in adult violinists and violists and is often treated with osteopathic medicine (OM), although the effectiveness of this treatment has not been determined to date. This study aimed to evaluate the effectiveness and safety of OM in adult violinists and violists with cNP.
METHODS
In a two-armed randomized controlled single-center open trial, adult violinists and violists, including music students, with cNP (⩾12 weeks) were randomized to either five individualized OM sessions (OM group) or to no intervention (control group, CG) in the outpatient clinic for integrative medicine, Charité - Universitätsmedizin Berlin, Germany. All patients received a musicians' medicine consultation and paracetamol on demand. The primary outcome parameter was the neck pain intensity on a visual analog scale (VAS, 0-100 mm, 0 = no pain, 100 = worst imaginable pain) after 12 weeks. Secondary outcomes included neck pain disability (Neck Disability Index, NDI, 0-100%) after 12 weeks. The last follow-up visit was after 52 weeks. Statistical analysis included analysis of covariance adjusted for respective baseline value.
RESULTS
Altogether, 62 outpatients were included [OM group ( = 28), CG ( = 34); 81% female; mean age, 41.6 ± 11.1 years; mean baseline neck pain, 55.9 ± 11.6 mm]. After 12 weeks, OM was associated with an improvement in the OM group the CG in neck pain on the VAS [14.6 mm (95% confidence interval 8.0; 21.2) 40.8 mm (34.7; 46.9), < 0.001, Cohen's = 1.4], and neck pain disability as determined by the NDI [8.8% (6.7; 10.8) 17.2% (15.3; 19.1), < 0.001]. Some improvements were maintained until 52 weeks of follow-up. No serious adverse events were observed.
CONCLUSIONS
The results of this study suggest that OM might be effective in reducing pain intensity in adult violinists and violists with nonspecific cNP. Further studies should investigate the efficacy of OM in comparison with a sham procedure and with other effective therapy methods in high-quality multicenter trials.
TRIAL REGISTRATION
WHO Trial Registration https://apps.who.int/trialsearch/NoAccess.aspx?aspxerrorpath=/trialsearch/Trial2.aspx by German Clinical Trials Register DRKS00009258, Universal Trial Number (UTN): U1111-1173-5943.
背景
非特异性慢性颈部疼痛（cNP）在成年小提琴家和中提琴家中很常见，通常采用整骨疗法（OM）进行治疗，尽管迄今为止这种治疗方法的有效性尚未确定。本研究旨在评估OM对患有cNP的成年小提琴家和中提琴家的有效性和安全性。
方法
在一项双臂随机对照单中心开放试验中，患有cNP（≥12周）的成年小提琴家和中提琴家，包括音乐专业学生，被随机分为接受五次个性化OM治疗（OM组）或不接受干预（对照组，CG），该试验在德国柏林夏里特大学医学中心综合医学门诊进行。所有患者都接受了音乐家医学咨询，并按需服用扑热息痛。主要结局参数是12周后视觉模拟量表（VAS，0 - 100mm，0 =无疼痛，100 =可想象的最严重疼痛）上的颈部疼痛强度。次要结局包括12周后的颈部疼痛残疾（颈部残疾指数，NDI，0 - 100%）。最后一次随访是在52周后。统计分析包括对各自基线值进行协方差调整的分析。
结果
总共纳入了62名门诊患者[OM组（n = 28），CG组（n = 34）；81%为女性；平均年龄41.6±11.1岁；平均基线颈部疼痛为55.9±11.6mm]。12周后，OM组与CG组相比，OM组在VAS上的颈部疼痛有所改善[14.6mm（95%置信区间8.0；21.2）对比40.8mm（34.7；46.9），P < 0.001，Cohen's d = 1.4]，并且由NDI确定的颈部疼痛残疾情况也有所改善[8.8%（6.7；10.8）对比17.2%（15.3；19.1），P < 0.001]。一些改善一直维持到52周的随访期。未观察到严重不良事件。
结论
本研究结果表明，OM可能对减轻患有非特异性cNP的成年小提琴家和中提琴家的疼痛强度有效。进一步的研究应在高质量多中心试验中，将OM与假手术以及其他有效治疗方法进行疗效对比研究。
试验注册
由德国临床试验注册中心DRKS00009258进行WHO试验注册https://apps.who.int/trialsearch/NoAccess.aspx?aspxerrorpath=/trialsearch/Trial2.aspx，通用试验编号（UTN）：U1111 - 1173 - 5943。
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