Yu Hainan, Wang Dan, Verville Leslie, Southerst Danielle, Bussières André, Gross Douglas P, Pereira Paulo, Mior Silvano, Tricco Andrea C, Cedraschi Christine, Brunton Ginny, Nordin Margareta, Shearer Heather M, Wong Jessica J, Connell Gaelan, Myrtos Danny, da Silva-Oolup Sophia, Young James J, Funabashi Martha, Romanelli Andrew, Lee Joyce G B, Stuber Kent, Guist Brett, Muñoz Laguna Javier, Hofstetter Léonie, Murnaghan Kent, Hincapié Cesar A, Cancelliere Carol
Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada.
Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.
J Occup Rehabil. 2023 Dec;33(4):661-672. doi: 10.1007/s10926-023-10125-3. Epub 2023 Nov 22.
Evaluate benefits and harms of needling therapies (NT) for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline.
Electronic databases were searched for randomized controlled trials (RCTs) assessing NT compared with placebo/sham, usual care, or no intervention (comparing interventions where the attributable effect could be isolated). We conducted meta-analyses where indicated and graded the certainty of evidence.
We screened 1831 citations and 109 full text RCTs, yeilding 37 RCTs. The certainty of evidence was low or very low across all included outcomes. There was little or no difference between NT and comparisons across most outcomes; there may be some benefits for certain outcomes. Compared with sham, NT improved health-related quality of life (HRQoL) (physical) (2 RCTs; SMD = 0.20, 95%CI 0.07; 0.32) at 6 months. Compared with no intervention, NT reduced pain at 2 weeks (21 RCTs; MD = - 1.21, 95%CI - 1.50; - 0.92) and 3 months (9 RCTs; MD = - 1.56, 95%CI - 2.80; - 0.95); and reduced functional limitations at 2 weeks (19 RCTs; SMD = - 1.39, 95%CI - 2.00; - 0.77) and 3 months (8 RCTs; SMD = - 0.57, 95%CI - 0.92; - 0.22). In older adults, NT reduced functional limitations at 2 weeks (SMD = - 1.10, 95%CI - 1.71; - 0.48) and 3 months (SMD = - 1.04, 95%CI - 1.66; - 0.43). Compared with usual care, NT reduced pain (MD = - 1.35, 95%CI - 1.86; - 0.84) and functional limitations (MD = - 2.55, 95%CI - 3.70; - 1.40) at 3 months.
Based on low to very low certainty evidence, adults with CPLBP experienced some benefits in pain, functioning, or HRQoL with NT; however, evidence showed little to no differences for other outcomes.
评估针刺疗法（NT）对成人慢性原发性下腰痛（CPLBP）的益处和危害，以为世界卫生组织（WHO）制定标准临床指南提供依据。
检索电子数据库，查找评估NT与安慰剂/假治疗、常规护理或无干预措施（比较可分离归因效应的干预措施）的随机对照试验（RCT）。在有指征的情况下进行荟萃分析，并对证据的确定性进行分级。
我们筛选了1831篇引文和109篇全文RCT，最终得到37项RCT。所有纳入结局的证据确定性均为低或极低。在大多数结局方面，NT与对照之间几乎没有差异；某些结局可能存在一些益处。与假治疗相比，NT在6个月时改善了健康相关生活质量（HRQoL）（身体方面）（2项RCT；标准化均数差（SMD）=0.20，95%置信区间（CI）0.07；0.32）。与无干预措施相比，NT在2周（21项RCT；平均差（MD）=-1.21，95%CI -1.50；-0.92）和3个月（9项RCT；MD=-1.56，95%CI -2.80；-0.95）时减轻了疼痛；在2周（19项RCT；SMD=-1.39，95%CI -2.00；-0.77）和3个月（8项RCT；SMD=-0.57，95%CI -0.92；-0.22）时减少了功能受限。在老年人中，NT在2周（SMD=-1.10，95%CI -1.71；-0.48）和3个月（SMD=-1.04，95%CI -1.66；-0.43）时减少了功能受限。与常规护理相比，NT在3个月时减轻了疼痛（MD=-1.35，95%CI -1.86；-0.84）和功能受限（MD=-2.55，95%CI -3.70；-1.40）。
基于低至极低确定性的证据，患有CPLBP的成年人通过NT在疼痛、功能或HRQoL方面有一些益处；然而，证据显示在其他结局方面几乎没有差异。
