Department of Clinical Neuroscience, Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
Department of Health Promotion Sciences, Sophiahemmet University, Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
J Manipulative Physiol Ther. 2023 Jun-Dec;46(5-9):315-326. doi: 10.1016/j.jmpt.2024.03.002. Epub 2024 Sep 19.
The purpose of this study was to identify, critically assess, and summarize evidence of the effectiveness of primary care treatments for adults with non-specific chronic low back pain (NSCLBP).
We conducted an umbrella review of systematic reviews focusing on primary care treatments for NSCLBP. We searched the PubMed and Cochrane library databases for systematic reviews of randomized controlled trials (RCTs) evaluating primary care treatments for adults with NSCLBP published between January 2007 and March 2021. Two reviewers independently assessed the quality of these systematic reviews using the AMSTAR checklist. We selected systematic reviews with a low or moderate risk of bias and graded the evidence based on Grading of GRADE criteria.
Among the initial 66 systematic reviews meeting our inclusion criteria, 19 systematic reviews with low or moderate bias risk were selected for analysis. These reviews included a total of 365 studies involving 62 832 participants. The evidence suggested moderate to high support for the effectiveness of certain primary care treatments in improving pain and function in NSCLBP patients. These treatments included NSAIDs and opioids compared to placebos, spinal manipulation versus exercise/physical therapy, and MBR versus exercise/education/advice/no treatment.
Recommendations for specific primary care treatments for NSCLBP in adults remain inconclusive. Further high-quality systematic reviews and RCTs are needed to better understand the effectiveness of these treatments. Future RCTs should prioritize the assessment of NSAIDs, opioids, spinal manipulation, and MBR, as they appear promising for improving NSCLBP outcomes in certain comparisons.
本研究旨在确定、批判性评估和总结针对非特异性慢性下腰痛（NSCLBP）成人的初级保健治疗的有效性证据。
我们对侧重于 NSCLBP 初级保健治疗的系统评价进行了伞式审查。我们在 PubMed 和 Cochrane 图书馆数据库中搜索了 2007 年 1 月至 2021 年 3 月期间发表的评估成人 NSCLBP 初级保健治疗的随机对照试验（RCT）的系统评价。两名审查员使用 AMSTAR 清单独立评估这些系统评价的质量。我们选择了偏倚风险低或中低的系统评价，并根据 GRADE 标准对证据进行分级。
在符合纳入标准的最初 66 项系统评价中，有 19 项低或中偏倚风险的系统评价被选入分析。这些综述共纳入了 365 项研究，涉及 62832 名参与者。证据表明，某些初级保健治疗在改善 NSCLBP 患者的疼痛和功能方面具有中度至高度的有效性。这些治疗包括与安慰剂相比 NSAIDs 和阿片类药物、脊柱手法治疗与运动/物理疗法以及 MBR 与运动/教育/建议/无治疗。
对于成人 NSCLBP 的具体初级保健治疗的建议仍然不确定。需要进一步开展高质量的系统评价和 RCT，以更好地了解这些治疗方法的有效性。未来的 RCT 应优先评估 NSAIDs、阿片类药物、脊柱手法治疗和 MBR，因为它们在某些比较中似乎对改善 NSCLBP 结果有希望。
