Li Tao, Li Xiaohui, Huang Fan, Tian Qiang, Fan Z Y, Wu S
The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China.
Massage Department, Guangdong Hospital of Traditional Chinese Medicine, Guangzhou 510405, Guangdong, China.
Evid Based Complement Alternat Med. 2021 Feb 24;2021:8862399. doi: 10.1155/2021/8862399. eCollection 2021.
To evaluate the effectiveness and safety of acupressure on low back pain (LBP).
We searched 7 electronic databases and 2 trial registries through December 28, 2020. Randomized controlled trials (RCTs) of acupressure on LBP were considered for meta-analysis with Revman 5.3 and Stata 15.0 software. Methodological quality was evaluated using the Cochrane Collaboration's tool. Trial sequential analysis (TSA) was used to quantify the statistical reliability. HETRED analysis and GRADE were used to determine the heterogeneity and quality of the results, respectively.
Twenty-three RCTs representing 2400 participants were included. Acupressure was superior to tuina massage on response rate (RR 1.25; 95% CI, 1.16 to 1.35; < 0.00001) and in the standardized mean difference (SMD) for pain reduction [SMD -1.92; 95% CI, -3.09 to -0.76; =0.001]. Likewise, acupressure was superior to physical therapy [SMD, -0.88; 95% CI, -1.10 to -0.65; < 0.00001] and to usual care [SMD, -0.32; 95% CI, -0.61 to -0.02; =0.04] in pain reduction. The Oswestry Disability Index was significantly improved by acupressure compared with usual care [SMD, -0.55; 95% CI, -0.84 to -0.25; =0.0003]. The combination of acupressure with either manual acupuncture or electro-acupuncture showed significant improvements over the adjuvant therapies alone in response rate [RR 1.19; 95% CI, 1.13 to 1.26; < 0.00001], pain reduction, and the Japanese Orthopedic Association score (JOA). However, each study displayed substantial heterogeneity. Through subgroup sensitivity analysis and -HETRED analysis, the heterogeneity of acupressure compared with manual acupuncture decreased while the results maintained significance with respect to pain reduction [SMD -0.9; 95% CI, -1.21 to -0.6; < 0.00001] and JOA [SMD, 0.66; 95% CI, 0.33 to 0.98; < 0.00001]. Similar results were obtained comparing acupressure with electro-acupuncture with respect to pain [SMD, -1.07; 95% CI, -1.33 to -0.81; < 0.00001] and JOA [SMD, 0.89; 95% CI, 0.51 to 1.27, < 0.00001]. TSA demonstrated the effectiveness of acupressure as a standalone or as a combinative treatment (with manual acupuncture or electro-acupuncture) for LBP.
Acupressure is an effective treatment for LBP. However, GRADE assessments downgraded the evidence in the trials, indicating that additional investigations are needed to confirm these observations.
评估指压疗法治疗下腰痛（LBP）的有效性和安全性。
截至2020年12月28日，我们检索了7个电子数据库和2个试验注册库。纳入指压疗法治疗LBP的随机对照试验（RCT），使用Revman 5.3和Stata 15.0软件进行荟萃分析。采用Cochrane协作网工具评估方法学质量。采用试验序贯分析（TSA）量化统计可靠性。分别采用异质性分析（HETRED）和推荐分级的评估、制定与评价（GRADE）来确定结果的异质性和质量。
纳入23项RCT，共2400名参与者。在缓解率方面（RR 1.25；95%CI，1.16至1.35；P<0.00001）以及疼痛减轻的标准化均数差（SMD）方面（SMD -1.92；95%CI，-3.09至-0.76；P=0.001），指压疗法优于推拿按摩。同样，在疼痛减轻方面，指压疗法优于物理治疗（SMD，-0.88；95%CI，-1.10至-0.65；P<0.00001）和常规护理（SMD，-0.32；95%CI，-0.61至-0.02；P=0.（此处原文有误，推测应为P=0.04）。与常规护理相比，指压疗法显著改善了Oswestry功能障碍指数（SMD，-0.55；95%CI，-0.84至-0.25；P=0.0003）。指压疗法与手针或电针联合应用在缓解率（RR 1.19；95%CI，1.13至1.26；P<0.00001）、疼痛减轻及日本矫形外科学会评分（JOA）方面均比单独辅助治疗有显著改善。然而，每项研究均显示出显著的异质性。通过亚组敏感性分析和异质性分析（HETRED），指压疗法与手针相比的异质性降低，而在疼痛减轻（SMD -0.9；95%CI，-1.21至-0.6；P<0.00001）和JOA（SMD，0.66；95%CI，0.33至0.98；P<0.00001）方面结果仍具有显著性。在疼痛（SMD，-1.07；95%CI，-1.33至-0.81；P<0.00001）和JOA（SMD，0.89；95%CI，0.51至1.27，P<0.00001）方面，指压疗法与电针相比也得到了类似结果。TSA证明指压疗法单独或与（手针或电针）联合治疗LBP是有效的。
指压疗法是治疗LBP的有效方法。然而，GRADE评估降低了试验证据的等级，表明需要进一步研究来证实这些观察结果。
