Gross A R, Aker P D, Goldsmith C H, Peloso P
Chedoke-McMaster Hospitals & Schools of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
Online J Curr Clin Trials. 1996 Jul 30;Doc No 200-201:[34457 words; 185 paragraphs].
This overview reports the efficacy of conservative treatments (drug therapy, manual therapy, patient education, physical medicine modalities) in reducing pain in adults with mechanical neck disorders.
Computerized bibliographic database searches from 1985 to December 1993, information requests from authors, and bibliography screenings were used to identify published and unpublished research. Applying strict criteria, two investigators independently reviewed the blinded articles. Each selected trial was evaluated independently for methodologic quality.
Twenty-four randomized controlled trials (RCTs) and eight before-after studies met our selection criteria. Twenty RCTs rated moderately strong or better in terms of methodologic quality. Five trials using manual therapy in combination with other treatments were clinically similar, were statistically not heterogeneous (p = 0.98), and were combined to yield an effect size of -0.6 (95% CI: -0.9, -0.4), equivalent to a 16 point improvement on a 100 point pain scale. Four RCTs using physical medicine modalities were combined using the inverse chi-square method: two using electromagnetic therapy produced a significant reduction in pain (p < 0.01); and two using laser therapy did not differ significantly from a placebo (p = 0.63). Little or no scientific evidence exists for other therapies, including such commonly used treatments as medication, rest and exercise.
Within the limits of methodologic quality, the best available evidence supports the use of manual therapies in combination with other treatments for short-term relief of neck pain. There is some support for the use of electromagnetic therapy and against the use of laser therapy. In general, other interventions have not been studied in enough detail adequately to assess efficacy or effectiveness. This overview provides the foundation for an evidence-based approach to practice. More robust design and methodology should be used in future research, in particular, the use of valid and reliable outcomes measures.
本综述报告保守治疗（药物治疗、手法治疗、患者教育、物理医学方法）在减轻成人机械性颈部疾病疼痛方面的疗效。
通过1985年至1993年12月的计算机化书目数据库检索、向作者索取信息以及文献筛选来识别已发表和未发表的研究。两名研究人员按照严格标准独立审阅双盲文章。对每项入选试验的方法学质量进行独立评估。
24项随机对照试验（RCT）和8项前后对照研究符合我们的入选标准。20项RCT在方法学质量方面被评为中等强度或更高。5项将手法治疗与其他治疗相结合的试验在临床上相似，在统计学上无异质性（p = 0.98），合并后效应量为-0.6（95%CI：-0.9，-0.4），相当于在100分疼痛量表上提高16分。4项使用物理医学方法的RCT采用反向卡方方法合并：两项使用电磁疗法的试验使疼痛显著减轻（p < 0.01）；两项使用激光疗法的试验与安慰剂无显著差异（p = 0.63）。对于其他疗法，包括药物、休息和锻炼等常用治疗方法，几乎没有科学证据。
在方法学质量的限制范围内，现有最佳证据支持手法治疗与其他治疗联合使用以短期缓解颈部疼痛。有一些证据支持使用电磁疗法，而反对使用激光疗法。总体而言，其他干预措施尚未得到足够详细的研究以充分评估其疗效或效果。本综述为基于证据的实践方法提供了基础。未来研究应采用更稳健的设计和方法，特别是使用有效且可靠的结局指标。
