Vanti Carla, Turone Luca, Panizzolo Alice, Guccione Andrew A, Bertozzi Lucia, Pillastrini Paolo
Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy.
Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA, 22030, USA.
Arch Physiother. 2021 Mar 15;11(1):7. doi: 10.1186/s40945-021-00102-5.
Only low-quality evidence is currently available to support the effectiveness of different traction modalities in the treatment of lumbar radiculopathy (LR). Yet, traction is still very commonly used in clinical practice. Some authors have suggested that the subgroup of patients presenting signs and symptoms of nerve root compression and unresponsive to movements centralizing symptoms may benefit from lumbar traction. The aim of this study is to conduct a systematic review of randomized controlled trials (RCTs) on the effects of vertical traction (VT) on pain and activity limitation in patients affected by LR.
We searched the Cochrane Controlled Trials Register, PubMed, CINAHL, Scopus, ISI Web of Science and PEDro from their inception to March 31, 2019 to retrieve RCTs on adults with LR using VT to reduce pain and activity limitation. We considered only trials reporting complete data on outcomes. Two reviewers selected the studies, extracted the results, and performed the quality assessment using the Risk of Bias and GRADE tools.
Three studies met the inclusion criteria. Meta-analysis was not possible due to the heterogeneity of the included studies. We found very low quality evidence for a large effect of VT added to bed rest when compared to bed rest alone (g = - 1.01; 95% CI = -2.00 to - 0.02). Similarly, VT added to medication may have a large effect on pain relief when compared to medication alone (g = - 1.13; 95% CI = -1.72 to - 0.54, low quality evidence). Effects of VT added to physical therapy on pain relief were very small when compared to physical therapy without VT (g = - 0.14; 95% CI = -1.03 to 0.76, low quality evidence). All reported effects concerned short-term effect up to 3 months post-intervention.
With respect to short-term effects, VT may have a positive effect on pain relief if added to medication or bed rest. Long-term effects of VT are currently unknown. Future higher quality research is very likely to have an important impact on our confidence in the estimate of effect and may change these conclusions.
目前仅有低质量证据支持不同牵引方式治疗腰椎神经根病（LR）的有效性。然而，牵引在临床实践中仍被广泛使用。一些作者认为，出现神经根受压体征和症状且症状未因运动而集中缓解的患者亚组可能从腰椎牵引中获益。本研究的目的是对随机对照试验（RCT）进行系统评价，以探讨垂直牵引（VT）对LR患者疼痛和活动受限的影响。
我们检索了Cochrane对照试验注册库、PubMed、CINAHL、Scopus、ISI科学网和PEDro，检索时间从各数据库建库至2019年3月31日，以获取关于使用VT减轻疼痛和活动受限的LR成年患者的RCT。我们仅纳入报告了完整结局数据的试验。两名研究者筛选研究、提取结果，并使用偏倚风险和GRADE工具进行质量评估。
三项研究符合纳入标准。由于纳入研究的异质性，无法进行荟萃分析。我们发现，与单纯卧床休息相比，VT联合卧床休息对疼痛有显著减轻作用的证据质量极低（g = -1.01；95%CI = -2.00至-0.02）。同样，与单纯药物治疗相比，VT联合药物治疗对疼痛缓解可能有显著效果（g = -1.13；95%CI = -1.72至-0.54，证据质量低）。与不使用VT的物理治疗相比，VT联合物理治疗对疼痛缓解的效果非常小（g = -0.14；95%CI = -1.03至0.76，证据质量低）。所有报告的效果均涉及干预后3个月内的短期效果。
就短期效果而言，VT联合药物治疗或卧床休息可能对疼痛缓解有积极作用。VT的长期效果目前尚不清楚。未来更高质量的研究很可能对我们对疗效估计的信心产生重要影响，并可能改变这些结论。
