推拿疗法与手法物理治疗对膝骨关节炎的比较疗效：一项随机对照试验
Comparative effectiveness of Tuina therapy versus manual physical therapy for knee osteoarthritis: a randomized controlled trial.
作者信息
Ma Peihong, Liu Luping, Li Sina, Cai Meiling, Han Siyu, Weng Zhiwen, Chen Qianji, Gao Yixuan, Zhang Lingyun, Wu Guiyun, Yang Xiaoming, Zhang Yang, Li Duoduo, Liu Changxin, Sun Ya'nan, Yan Shiyan, Wang Xiyou, Yu Changhe
机构信息
Acupuncture and Moxibustion Department, Beijing University of Chinese Medicine, Beijing, China.
School of Medical Technology, Tianjin University of Traditional Chinese Medicine, Beijing, China.
出版信息
BMC Complement Med Ther. 2025 Apr 8;25(1):128. doi: 10.1186/s12906-025-04850-w.
BACKGROUND
Tuina therapy (Tuina) is commonly utilized for managing knee osteoarthritis (KOA), yet the available evidence is limited. This study aimed to evaluate the effectiveness of Tuina compared to widely accepted manual physical therapy (mPT) for patients with KOA.
METHODS
Between Oct 2019 and Oct 2021, patients with KOA (Kellgren-Lawrence score II or III) were randomly assigned in a 1:1 ratio to receive Tuina or mPT, with eight 20-min sessions over 3 weeks. Assessments were performed at baseline, week 4, 8, and 16. The primary outcome was the change of total Western Ontario and McMaster University Osteoarthritis Index (WOMAC) from baseline to week 4. Secondary outcomes included WOMAC subscales, knee pain measures, performance-based tests, quality-of-life measures, and safety assessments. Patients, evaluators, and statisticians were blinded to treatment group assignment. All main analyses were by intention-to-treat.
RESULTS
Of the 140 patients allocated to Tuina or mPT, 127 completed the treatment. There was significant intervention × time interaction observed in the WOMAC-total (F(2, 266) = 3.87, P = 0.02), there was no statistically significant between groups at week 4 (between-group difference: -1.00, 95%CI: -5.33 to 3.33, P = 0.79, Bonferroni correction). By week 8, Tuina showed significantly consistent improvement compared to mPT (between-group difference: -4.33, 95%CI: -8.34 to -0.31, P = 0.03, Bonferroni correction), whereas there were no statistically significant differences between groups at week 16 (between-group difference: 0.74, 95%CI: -3.67 to 5.15, P = 0.37, Bonferroni correction). Most secondary outcomes showed no significant between-group differences, except for the Timed Up and Go Test Time favoring mPT (0.94, 95%CI: 0.03 to 1.85, P = 0.04). No serious adverse events occurred. One patient in the mPT group took the medication and no patients received other therapies for KOA.
CONCLUSIONS
Tuina produced beneficial effectiveness similar to mPT in treating KOA.
TRIAL REGISTRATION
NCT03966248, Registered on 29/05/2019, ClinicalTrials.gov.
背景
推拿疗法常用于治疗膝关节骨关节炎（KOA），但其现有证据有限。本研究旨在评估推拿疗法与广泛接受的手法物理治疗（mPT）相比，对KOA患者的有效性。
方法
在2019年10月至2021年10月期间，将KOA患者（Kellgren-Lawrence评分II或III级）按1:1比例随机分配接受推拿疗法或mPT，在3周内进行8次，每次20分钟的治疗。在基线、第4周、第8周和第16周进行评估。主要结局是从基线到第4周，西安大略和麦克马斯特大学骨关节炎指数（WOMAC）总分的变化。次要结局包括WOMAC分量表、膝关节疼痛测量、基于表现的测试、生活质量测量和安全性评估。患者、评估者和统计人员对治疗组分配情况不知情。所有主要分析均采用意向性分析。
结果
在分配接受推拿疗法或mPT的140例患者中，127例完成了治疗。在WOMAC总分中观察到显著的干预×时间交互作用（F(2, 266) = 3.87，P = 0.02），在第4周时两组之间无统计学显著差异（组间差异：-1.00，95%CI：-5.33至3.33，P = 0.79，Bonferroni校正）。到第8周时，与mPT相比，推拿疗法显示出显著持续的改善（组间差异：-4.33，95%CI：-8.34至-0.31，P = 0.03，Bonferroni校正），而在第16周时两组之间无统计学显著差异（组间差异：0.74，95%CI：-3.67至5.15，P = 0.37，Bonferroni校正）。除了“从座椅起身行走测试”时间有利于mPT外（0.94，95%CI：0.03至1.85，P = 0.04），大多数次要结局显示两组之间无显著差异。未发生严重不良事件。mPT组有1例患者服用了药物，没有患者接受其他KOA治疗。
结论
推拿疗法在治疗KOA方面产生了与mPT相似的有益效果。
试验注册
NCT03966248，于2019年5月29日注册，ClinicalTrials.gov。
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