Barbier Gaetan, Picchiottino Mathieu, Delafontaine Arnaud, Goncalves Guillaume, Bussières André, Cottin François, Lardon Arnaud
CIAMS, Université Paris-Saclay, 91405, Orsay Cedex, France.
CIAMS, Université d'Orléans, 45067, Orléans, France.
BMC Complement Med Ther. 2025 Sep 18;25(1):330. doi: 10.1186/s12906-025-04975-y.
Primary care providers consider the identification of patient subgroups as a high research priority. Unfortunately, evidence to support the benefit of treatments targeting subgroups of patients with NSLBP remains inconsistent. Specifically, little is known about baseline individual patient characteristics associated with optimal clinical improvement from manual therapy. This systematic review aims to identify baseline individual factors (BIFs), including patient characteristics, self-reported questionnaires, clinical examination, and ancillary test factors associated with clinical improvement (or lack of) among adult patients with Non-Specific Low Back Pain (NSLBP) following manual therapy.
A systematic review of published evidence in Medline, Embase, Cochrane, Index To Chiropractic Literature, and CINAHL was conducted until April 2024. Studies included participants aged 18 years and over with NSLBP and without radiculopathy. Participants received manual therapies, including musculoskeletal manipulation/mobilization (spinal and extremities) and soft tissue therapy. We excluded mechanically assisted manipulations and interventions mainly involving exercise, education, and/or advice. Two independent assessors screened studies for inclusion, extracted data, and assessed risks of bias using the Quality In Prognosis Studies (QUIPS) Tools. A qualitative synthesis of findings was undertaken. BIFs were synthesized according to patient-reported outcomes measure domains: 1) pain intensity measures, 2) disability measures, 3) global perceived effect, and 4) other factors (e.g., satisfaction with care, total number of visits).
Data from 19 studies (reported in 21 articles) involving 4,689 participants were analyzed. Twelve studies reported pain intensity, 18 reported disability outcomes, and 4 reported patient's global perceived effect. Over 70% of the included studies had a high risk of confounding bias. Included studies explored the potential association between clinical outcomes and 172 BIFs. BIFs were categorized into patient characteristics (n = 40), self-reported questionnaire (n = 31), clinical examination (n = 82), and ancillary tests (n = 20). Fourteen multivariate models explored the association with clinical improvement, and four others investigated the association with non-improvement. Findings were inconsistent across studies.
Using BIFs in clinical practice to predict clinical outcomes following manual therapy treatment appears to be premature. Future studies should aim to replicate the results and differentiate prognostic factors from treatment effect modifiers.
CRD42019131416.
基层医疗服务提供者将识别患者亚组视为一项重要的研究重点。不幸的是，支持针对非特异性下腰痛（NSLBP）患者亚组进行治疗的益处的证据仍然不一致。具体而言，关于与手法治疗后最佳临床改善相关的个体患者基线特征知之甚少。本系统评价旨在确定基线个体因素（BIFs），包括患者特征、自我报告问卷、临床检查以及与非特异性下腰痛（NSLBP）成年患者手法治疗后临床改善（或未改善）相关的辅助检查因素。
对截至2024年4月发表在Medline、Embase、Cochrane、脊椎按摩文献索引和护理学与健康领域数据库（CINAHL）中的证据进行系统评价。纳入的研究参与者年龄在18岁及以上，患有NSLBP且无神经根病。参与者接受手法治疗，包括肌肉骨骼整复/松动术（脊柱和四肢）以及软组织治疗。我们排除了机械辅助整复和主要涉及运动、教育和/或建议的干预措施。两名独立评估员筛选纳入研究、提取数据，并使用预后研究质量（QUIPS）工具评估偏倚风险。对研究结果进行定性综合分析。根据患者报告的结局测量领域对BIFs进行综合分析：1）疼痛强度测量；2）残疾测量；3）整体感知效果；4）其他因素（如对护理的满意度、就诊总次数）。
分析了来自19项研究（发表在21篇文章中）的4689名参与者的数据。12项研究报告了疼痛强度，18项报告了残疾结局，4项报告了患者的整体感知效果。超过70%的纳入研究存在较高的混杂偏倚风险。纳入研究探讨了临床结局与172个BIFs之间的潜在关联。BIFs分为患者特征（n = 40）、自我报告问卷（n = 31）、临床检查（n = 82）和辅助检查（n = 20）。14个多变量模型探讨了与临床改善的关联，另外4个模型研究了与未改善的关联。各研究结果不一致。
在临床实践中使用BIFs来预测手法治疗后的临床结局似乎为时过早。未来的研究应旨在重复这些结果，并区分预后因素和治疗效果修饰因素。
CRD42019131416。
