摘要
目的对脊柱推拿用于腰背及颈部相关疼痛的疗效和安全性的系统评价进行再评价。方法计算机检索Pub Med、EMbase、The Cochrane Library(2015年第1期)、CNKI、CBM、Wan Fang Data和VIP数据库,搜集脊柱推拿用于腰背及颈部疼痛相关的系统评价和Meta分析,检索时间均为从建库至2015年1月30日。由2位研究者独立进行文献筛选、资料提取,并采用AMSTAR工具评价纳入研究的方法学质量。结果最终纳入21篇系统评价。其中20篇对纳入RCT进行了方法学质量评价:2篇采用Jadad量表,5篇采用PEDro量表,6篇采用Cochrane偏倚风险评估工具,7篇采用其他工具。AMSTAR评价结果显示:报告最差的条目为条目1"是否提供了前期设计方案"(18篇未提供)和条目4"发表情况是否已考虑在纳入标准中"(18篇不满足),其次为条目10"是否评估发表偏倚的可能性"(14篇没有)和条目11"是否说明相关利益冲突"(14篇没有,4篇不完全)。结论纳入研究的整体证据质量偏低,有限证据结果显示脊柱推拿治疗急性腰背痛优于慢性腰背痛,短期效果优于长期效果,安全性较好。不同手法的脊柱推拿效果不一,其中整脊手法效果较好。但受纳入研究数量和质量所限,上述结论可能存在偏倚,需开展更多高质量研究予以验证。
Objectives To overview the systematic reviews/meta-analyses （SRs/MAs） of effectiveness and safety of spinal manipulation for low back pain or neck pain. Methods We electronically searched databases including PubMed, EMbase, The Cochrane Library （Issue 1, 2015）, CBM, CNKI, WanFang Data and VIP to collect SRs/MAs of spinal manipulation for low back pain or neck pain from inception to January 30% 2015. Two reviewers independently screened literature, extracted data, and then AMSTAR tool was used to assess the methodological quality of included SRs/MAs. Results A total of 21 SRs/MAs were included. Twenty of them assessed the methodological quality of included original randomized controlled trials （RCTs） with different tools： 2 used Jadad scale, 5 used PEDro scale, 6 used Cochrane bias risk assessment tool and 7 used other tools. The assessment results of AMSTAR tool suggested that： among 11 items, the item 1 of ＂Was an ＇a priori＇ design provided＂ （18 SRs/MAs did not provide） and item 4 of ＂Was a list of studies （included and excluded） provided＂ （18 SRs/MAs did not provide） appeared to be the most problematic, followed by item 10 of＂Was the likelihood of publication bias assessed＂ （14 SRs/MAs did not assess the publication bias） and item 11 of ＂Was the conflict of interest stated＂ （14 SRs/MAs did not provide the conflict of interest and 4 were incomplete）. Conclusions The methodological quality of included SRs/MAs is poor. The limited evidence showed that spinal manipulation is more effective for acute low back pain than chronic low back pain, and the short term effect is better than the long term one.Different spinal manipulation techniques have various effects but are all safe. Chiropractic manipulation may have the best effect. Due to the limitation of quality and quantity of included SRs/MAs, there may be potential bias in the above conclusion that needs more high quality studies to verify.
出处
《中国循证医学杂志》
CSCD
2015年第9期1010-1017,共8页
Chinese Journal of Evidence-based Medicine
基金
国家自然科学基金项目(编号:81373764
81303063)
上海中医药大学教委预算内科研项目(编号:2014YSN16)
上海岳阳中西医结合医院科研项目(编号:30304115285)
