González-Gómez Luis, Moral-Munoz Jose A, Rosales-Tristancho Abel, Cuevas-Moreno Alejandro, Cardellat-González Melania, Rodríguez-Domínguez Álvaro-José
Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain.
Biomedical Research and Innovation Institute of Cadiz (INiBICA), University of Cadiz, Cádiz, Spain.
Eur J Pain. 2025 Sep;29(8):e70090. doi: 10.1002/ejp.70090.
Guidelines recommend combining physical and psychological programmes for chronic low back pain (CLBP); however, exercise therapy (ET) and manual therapy (MT) are often delivered separately. This systematic review with meta-analysis and meta-regression of randomised controlled trials (RCTs) aimed to compare the efficacy of ET with MT in terms of pain intensity, disability and physical function in people with CLBP.
MEDLINE, Web of Science, PEDro, Cochrane Library and Scopus were searched July-August 2024 for RCTs comparing ET with MT in participants aged 18-54 years. Outcomes were extracted for the short-, medium- and long-term follow-up periods. Risk of bias (RoB 2.0 Cochrane Tool) and certainty of evidence (GRADE) were appraised.
Six RCTs (743 patients) were included. Meta-analyses showed, albeit non-clinically relevant, a significant difference for long-term in favour of ET for disability (SMD = -0.25, 95% CI [-0.43, -0.07], p = 0.007). Meta-regression showed that the female-male ratio, treatment duration and mean age explain variability in pain intensity and disability.
ET had a small beneficial effect on long-term disability in people with CLBP. Nevertheless, evidence does not provide conclusive differences between both the treatments overall, influenced by heterogeneity and the number of studies included. Biopsychosocial factors may moderate the differences in outcomes. The GRADE assessment revealed very low certainty across all outcomes, highlighting the lack of high-quality research.
ET may offer small long-term benefits over MT for disability in people with CLBP. Differences seem to be influenced by sex, age and treatment duration. The choice of ET over MT, or vice versa, as a stand-alone treatment does not appear to be supported by current evidence.
CRD42024569120.
指南建议将物理治疗和心理治疗方案相结合用于慢性下腰痛（CLBP）；然而，运动疗法（ET）和手法治疗（MT）往往是分开进行的。这项对随机对照试验（RCT）进行的系统评价、荟萃分析和元回归分析旨在比较ET与MT在CLBP患者的疼痛强度、功能障碍和身体功能方面的疗效。
于2024年7月至8月在MEDLINE、科学网、PEDro、考科蓝图书馆和Scopus中检索比较18至54岁参与者的ET与MT的RCT。提取短期、中期和长期随访期的结果。评估偏倚风险（RoB 2.0考科蓝工具）和证据确定性（GRADE）。
纳入了6项RCT（743例患者）。荟萃分析显示，尽管在临床上无显著差异，但在长期功能障碍方面ET有显著优势（标准化均数差[SMD]= -0.25，95%置信区间[-0.43，-0.07]，p = 0.007）。元回归分析表明，男女比例、治疗持续时间和平均年龄可解释疼痛强度和功能障碍的变异性。
ET对CLBP患者的长期功能障碍有微小的有益影响。然而，受异质性和纳入研究数量的影响，总体证据并未提供两种治疗方法之间的确切差异。生物心理社会因素可能会缓和结果的差异。GRADE评估显示所有结果的确定性都非常低，突出了高质量研究的缺乏。
对于CLBP患者的功能障碍，ET可能比MT有微小的长期益处。差异似乎受性别、年龄和治疗持续时间的影响。目前的证据似乎不支持单独选择ET而非MT，反之亦然。
PROSPERO注册号：CRD42024569120。
