The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.
Department of Anatomy and Histology & Embryology, Faculty of Basic Medical Science, Kunming Medical University, 1168 West Chunrong Road, Kunming, 650500, Yunnan, China.
Complement Ther Clin Pract. 2022 Nov;49:101627. doi: 10.1016/j.ctcp.2022.101627. Epub 2022 Jul 5.
To directly or indirectly compare the effectiveness and pain relief of TN combined with different treatments for lumbar disc herniation (LDH).
The Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI), Wanfang data, Chinese Biomedical Literature database (CBM), Chinese Scientific Journal Database (VIP), PubMed, Embase, Cochrane library, and Web of Science were searched from inception to July 2020. Only full texts of randomized controlled trials (RCTs) that make comparisons between Tuina and Tuina combined with other methods were included. We extracted trial data and assessed the risk of bias by two reviewers independently. We pooled continuous data in standard mean differences (SMDs) and binary data in risk ratios (RRs), and provided 95% confidence intervals. The primary outcomes were the effectiveness rate. The secondary outcome was pain measurements including visual analog scale (VAS) scores.
Forty-four trials which included 4741 participants and 16 kinds of interventions were selected in our study. Tuina combined with Acupuncture was the most frequently investigated intervention. Five (31%) kindnesces (SMDs) and binary data in risk ratios (RRs), and provided 95% confidence intervals. The primary outcomes were the effectiveness rate. The secondary outcome was pain measurements including visual analog scale (VAS) scores.
Forty-four trials of treatments among 15 increased the healing rate more significantly compared with Tuina(TN), including Tuian combined with Traction and formula(TN + TRA + FM), Tuina combined with formula(TN + FM), Tuina combined with Traction and Acupuncture(ACU + TN + TRA), Tuian combined with Traction(TN + TRA), Tuina combined with Electroacupuncture(EA + TN), Tuina combined with the warm needle(TN + WN), Tuina combined with Acupuncture(ACU + TN). Seven treatments including Tuina combined with Electroacupuncture(EA + TN), Tuian combined with Traction and formula(TN + TRA + FM), Tuina combined with Acupuncture(ACU + TN), Tuina combined with formula(TN + FM), Acupuncture(ACU), Tuian combined with Traction(TN + TRA), Tuina combined with the warm needle(TN + WN) had better effects in reducing pain intensity compared with Tuina, range from 0.01 (95%Crl 0-0.08) for EA + TN to 0.30 (95%Crl 0.20-0.45) for TN + WN.
According to the comprehensive review, Tuina combined with Traction and formula(TN + TRA + FM) seemed to be the most recommendable treatment which is more affordable and effective. However, all the available evidence was of low quality, so more high-quality studies are expected to confirm the effectiveness.
PROSPERO CRD42020193068.
直接或间接比较推拿联合不同治疗方法治疗腰椎间盘突出症（LDH）的有效性和止痛效果。
检索 Cochrane 对照试验中心注册库、中国知网（CNKI）、万方数据、中国生物医学文献数据库（CBM）、中国科学引文数据库（VIP）、PubMed、Embase、Cochrane 图书馆和 Web of Science，检索时间截至 2020 年 7 月。仅纳入推拿与推拿联合其他方法比较的随机对照试验（RCT）的全文。我们由两位评审员独立提取试验数据并评估偏倚风险。我们采用标准化均数差（SMD）汇总连续数据，采用风险比（RR）汇总二分类数据，并提供 95%置信区间。主要结局为有效率。次要结局为疼痛测量，包括视觉模拟量表（VAS）评分。
本研究共纳入 44 项试验，包含 4741 名参与者和 16 种干预措施。推拿联合针刺是最常研究的干预措施。5 种干预措施（SMD）和二分类数据（RR），并提供 95%置信区间。主要结局为有效率。次要结局为疼痛测量，包括视觉模拟量表（VAS）评分。
推拿联合牵引和配方（TN+TRA+FM）、推拿联合配方（TN+FM）、推拿联合牵引和针刺（ACU+TN+TRA）、推拿联合牵引（TN+TRA）、推拿联合电针（EA+TN）、推拿联合温针（TN+WN）、推拿联合针刺（ACU+TN）等 15 种治疗方法中的 44 种治疗方法提高了愈合率，与推拿（TN）相比更显著。推拿联合电针（EA+TN）、推拿联合牵引和配方（TN+TRA+FM）、推拿联合针刺（ACU+TN）、推拿联合配方（TN+FM）、针刺（ACU）、推拿联合牵引（TN+TRA）、推拿联合温针（TN+WN）等 7 种治疗方法在降低疼痛强度方面优于推拿，范围从 EA+TN 的 0.01（95%CI 0-0.08）到 TN+WN 的 0.30（95%CI 0.20-0.45）。
根据综合评价，推拿联合牵引和配方（TN+TRA+FM）似乎是最值得推荐的治疗方法，因为它更实惠且有效。然而，所有可用的证据质量都较低，因此需要更多高质量的研究来证实其有效性。
PROSPERO CRD42020193068。
