Intervention Review

Spinal manipulative therapy for low-back pain

  1. Willem JJ Assendelft1,*,
  2. Sally C Morton2,
  3. Emily I Yu3,
  4. Marika J Suttorp4,
  5. Paul G Shekelle5

Editorial Group: Cochrane Back Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 30 JAN 2000

DOI: 10.1002/14651858.CD000447.pub2

Database Title

Additional Information

How to Cite

Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD000447. DOI: 10.1002/14651858.CD000447.pub2.

Author Information

  1. 1

    Leiden University Medical Centre, Department of Public Health and Primary Care, Leiden, Netherlands

  2. 2

    RTI International, Research Triangle Park, NC, USA

  3. 3

    San Francisco, California, USA

  4. 4

    RAND, Statistics Group, Santa Monica, CA, USA

  5. 5

    RAND Corporation, Santa Monica, California, USA

*Willem JJ Assendelft, Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, Postzone V 06-P, Leiden, 2300 RC, Netherlands. w.j.j.assendelft@lumc.nl.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 OCT 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Low-back pain is a costly illness for which spinal manipulative therapy is commonly recommended. Previous systematic reviews and practice guidelines have reached discordant results on the effectiveness of this therapy for low-back pain.

Objectives

To resolve the discrepancies related to the use of spinal manipulative therapy and to update previous estimates of effectiveness, by comparing spinal manipulative therapy with other therapies and then incorporating data from recent high-quality randomized, controlled trials (RCTs) into the analysis.

Search methods

The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL were electronically searched from their respective beginning to January 2000, using the Back Group search strategy; references from previous systematic reviews were also screened.

Selection criteria

Randomized, controlled trials (RCT) that evaluated spinal manipulative therapy for patients with low-back pain, with at least one day of follow-up, and at least one clinically-relevant outcome measure.

Data collection and analysis

Two authors, who served as the authors for all stages of the meta-analysis, independently extracted data from unmasked articles. Comparison treatments were classified into the following seven categories: sham, conventional general practitioner care, analgesics, physical therapy, exercises, back school, or a collection of therapies judged to be ineffective or even harmful (traction, corset, bed rest, home care, topical gel, no treatment, diathermy, and minimal massage).

Main results

Thirty-nine RCTs were identified. Meta-regression models were developed for acute or chronic pain and short-term and long-term pain and function. For patients with acute low-back pain, spinal manipulative therapy was superior only to sham therapy (10-mm difference [95% CI, 2 to 17 mm] on a 100-mm visual analogue scale) or therapies judged to be ineffective or even harmful. Spinal manipulative therapy had no statistically or clinically significant advantage over general practitioner care, analgesics, physical therapy, exercises, or back school. Results for patients with chronic low-back pain were similar. Radiation of pain, study quality, profession of manipulator, and use of manipulation alone or in combination with other therapies did not affect these results.

Authors' conclusions

There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low-back pain.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Spinal manipulative therapy for low-back pain

There was little or no difference in pain reduction or the ability to perform everyday activities between people with low-back pain who received spinal manipulation and those who received other advocated therapies.

This review of 39 trials found that spinal manipulation was more effective in reducing pain and improving the ability to perform everyday activities than sham (fake) therapy and therapies already known to be unhelpful. However, it was no more or less effective than medication for pain, physical therapy, exercises, back school or the care given by a general practitioner.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

脊椎推拿對於下背痛的治療

下背痛是一項需付出大量代價的疾病，而脊椎推拿治療是常見的建議。然而,這種治療方式的效用在從前的系統性回溯資料和實行指導方針兩方面看法並不一致

目標

為了解決使用脊椎推拿治療的差異性，並更新先前估計的有效性,我們藉由比較脊椎推拿治療與其他治療方式,並將數據從近期的高品質的隨機對照試驗(highquality randomized, controlled trials;RCTs)進行分析。

搜尋策略

我們分別搜尋了Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE和CINAHL從2000年1月開始的資料,利用返回集團搜索策略;以前系統性回顧的文獻也加以篩選。

選擇標準

利用隨機對照試驗去評估脊椎推拿治療下背痛,包含至少一天的後續追蹤及至少一項與臨床相關的結果。

資料收集與分析

兩位作者，誰擔任所有階段的metaanalysis，獨立的從揭露的文章提取數據。治療比較分為以下七類：假性治療，傳統一般醫者的照護，止痛藥，物理治療，運動，背痛教室，或某些被判定無效甚至有害的療法(牽引，緊身衣，臥床休息，家庭護理，局部凝膠，不治療，電療，輕微按摩)。

主要結論

總共39個隨機對照試驗被確認。Metaregression模型被設計用於急性或慢性疼痛,及短期和長期疼痛和功能。對於急性下背痛病人，脊椎推拿治療僅優於假性治療(在100毫米視覺的類似語等級法上有10毫米差異[95% CI, 2 to 17 mm])甚至被認為是無效治療或有害的。脊椎推拿治療在統計學或臨床上並未優於全科醫師的照護，止痛藥，物理治療，運動，或背痛教室。關於慢性下背痛結果也是類似。輻射痛，研究的質量，操作者的專業的度，單獨推拿或結合其它療法並未影響這些結果。

作者結論

沒有任何證據顯示脊椎推拿對於急性或慢性下背痛的治療優於其他標準療法

翻譯人

本摘要由臺灣大學附設醫院曾渥然翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

對於下背痛的患者,在減輕疼痛或執行日常生活能力方面,脊椎推拿與其他被提到的治療方式幾乎沒有或根本沒有差別。本次審查的39個試驗發現，脊椎推拿在減少痛苦及提高執行日常生活能力方面優於假性治療,但後者早已被證實是無幫助的。然而，在與藥物疼痛治療，物理治療，運動，背痛教室或全科醫師照顧比較之下, 脊椎推拿並沒有特別有效。

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