Koes B W, Bouter L M, van Mameren H, Essers A H, Verstegen G J, Hofhuizen D M, Houben J P, Knipschild P G
Institute for Research in Extramural Medicine, Free University, Amsterdam, The Netherlands.
J Manipulative Physiol Ther. 1993 May;16(4):211-9.
To study the efficacy of manual therapy and physiotherapy in subgroups of patients with persistent back and neck complaints. The second objective was to determine the correlation between three important outcome measures used in this trial.
Randomized clinical trial (subgroup analysis).
Primary health care in the Netherlands.
Two hundred fifty-six patients with nonspecific back and neck complaints of at least 6 wk duration who had not received physiotherapy or manual therapy in the past 2 yr.
At the discretion of the manual therapists, physiotherapists and general practitioners. Physiotherapy consisted of exercises, massage and physical therapy (heat, electrotherapy, ultrasound, shortwave diathermy). Manual therapy consisted of manipulation and mobilization of the spine. Treatment by the general practitioner consisted of drugs (e.g., analgesics), advice about posture, home exercises and (bed)rest. Placebo treatment consisted of detuned shortwave diathermy (10 min) and detuned ultrasound (10 min).
Changes in severity of the main complaint and limitation of physical functioning measured on 10-point scales by a blinded research assistant and global perceived effect measured on a 6-point scale by the patients.
Improvement in the main complaint was larger with manual therapy (4.3) than with physiotherapy (2.5) for patients with chronic conditions (duration complaint of 1 yr or longer). Also, improvement in the main complaint was larger with manual therapy (5.5) than with physiotherapy (4.0) for patients younger than 40 yr (both were measured after 12-mo follow-up). Labeling of patients by the treating manual therapists as "suitable" or "not suitable" for treatment with manual therapy did not predict differences in outcomes. Generally, there was a moderate to strong correlation between the three outcome measures, although a considerable number of patients gave a relatively low score for perceived benefit, while the research assistant gave a high improvement score for the main complaint and physical functioning.
The subgroup analysis suggests better results of manual therapy compared to physiotherapy in chronic patients (duration of present complaints of 1 yr or longer) and in patients younger than 40 yr old). Differences for other subgroups were less clear. The explorative findings of these subgroup analyses have to be investigated in future research.
研究手法治疗和物理治疗对持续性颈背部疼痛患者亚组的疗效。第二个目的是确定本试验中使用的三项重要结局指标之间的相关性。
随机临床试验（亚组分析）。
荷兰的初级医疗保健机构。
256例非特异性颈背部疼痛患者，病程至少6周，且在过去2年未接受过物理治疗或手法治疗。
由手法治疗师、物理治疗师和全科医生自行决定。物理治疗包括运动疗法、按摩和物理治疗（热疗、电疗、超声、短波透热疗法）。手法治疗包括脊柱整复和松动术。全科医生的治疗包括药物治疗（如镇痛药）、姿势建议、家庭锻炼和（卧床）休息。安慰剂治疗包括失谐短波透热疗法（10分钟）和失谐超声（10分钟）。
由一名盲法研究助理用10分制量表测量主要症状严重程度和身体功能受限情况的变化，以及由患者用6分制量表测量整体感知效果。
对于慢性病患者（病程1年或更长），手法治疗（改善4.3）比物理治疗（改善2.5）对主要症状的改善更大。同样，对于40岁以下患者，手法治疗（改善5.5）比物理治疗（改善4.0）对主要症状的改善更大（均在12个月随访后测量）。手法治疗师将患者标记为“适合”或“不适合”手法治疗并不能预测结局差异。一般来说，三项结局指标之间存在中度至强相关性，尽管相当数量的患者对感知益处给出相对较低的评分，而研究助理对主要症状和身体功能给出较高的改善评分。
亚组分析表明，与物理治疗相比，手法治疗在慢性病患者（当前病程1年或更长）和40岁以下患者中效果更好。其他亚组的差异不太明显。这些亚组分析的探索性结果有待未来研究进一步调查。
