骨病操作並不比慢性背痛的假性治療更佳


2003年7月8日--根據一項發表於7月Spine中的隨機化研究結果指出,骨病操作並不比慢性背痛的假性治療更佳,可是,兩者都比不治療的效果更好。
  
  北德州大學健康科學中心的John C. Licciardone表示,骨病的操作治療對於急性或次急性的下背痛是有效的,可是它對於治療慢性下背痛的角色仍未清楚。
  
  從2000至2001年在大學門診部招募199名受試者中,91人符合標準,經過隨機化之後進行骨病的操作、假性治療,或者未進行治療,在基準線時,各組間並無顯著差異,所有受試者均允許繼續進行下背痛的一般性治療,其中共有82名患者完成一個月的追蹤評估,71人完成三個月的評估,66人完成六個月的評估。
  
  研究的結果測量包括 SF-36 健康調查,一種將背痛進行分級的10釐米視覺模擬刻度、Roland-Morris失能調查表,針對因背部疼痛而導致失去工作或教育,另外也了解受試者對於背部治療的滿意度。
  
  對應於未治療的控制組,骨病操作組背部疼痛改善情況更明顯,對於背部治療的滿意度顯著地更高、更佳的身體功能及一個月的心智健康,以及在六個月時的共同治療需求較少,可是,假性治療組也有更顯著的背部疼痛改善、較佳的生理功能和滿意度,而且骨病操作組並未顯著地較假性治療組佳。
  
  這項研究限制包括使用醫學院的學生進行操作、在無干預組中使用較常見的治療法、相對上較低的失能程度、缺少統計力已辨別出各組間的微小差異,以及追蹤時失去27%的受試者,因此作者建議,進行額外的研究。
  
  研究人員指出,骨病操作和假性治療似乎對於慢性下背痛都有一些益處,但是仍舊不清楚骨病操作的治療優點是否歸因於操作技術,如運動活動力的範圍或是與患者互動的時間,這些都會表現出安慰的效果。

Osteopathic Manipulation No Be

By Laurie Barclay, MD
Medscape Medical News

July 8, 2003 — Osteopathic manipulation is no better than sham therapy for chronic nonspecific low back pain, according to the results of a randomized trial published in the July issue of Spine. However, both osteopathic and sham manipulation were more effective than no therapy.

"Osteopathic manipulative treatment may be useful for acute or subacute low back pain," write John C. Licciardone, DO, from the University of North Texas Health Science Center in Fort Worth, and colleagues. "However, its role in chronic low back pain is unclear."

Of 199 subjects recruited at a university-based clinic from 2000 through 2001, 91 met eligibility criteria and were randomized to osteopathic manipulative treatment, sham manipulation, or a no-intervention control group. At baseline, there were no significant differences between groups. All subjects were allowed to continue their usual care for low back pain. Of 82 patients who completed the one-month follow-up evaluation, 71 completed the three-month evaluation, and 66 completed the six-month evaluation.

Outcome measures included the SF-36 Health Survey, a 10-cm visual analog scale for overall back pain, the Roland-Morris Disability Questionnaire, lost work or school days because of back pain, and satisfaction with back care.

Compared with the no-intervention control group, the osteopathic manipulation group reported greater improvements in back pain, greater satisfaction with back care, better physical functioning and mental health at one month, and fewer cotreatments at six months. However, the sham manipulation group also reported greater improvements in back pain and physical functioning and greater satisfaction than the control group, and osteopathic manipulation was not significantly better than sham manipulation.

Study limitations include use of medical students to perform manipulation, use of more usual-care interventions in the no-intervention control group, relatively low disability levels, lack of statistical power to detect small differences between groups, and loss of 27% of subjects to follow-up. The authors therefore recommend additional research.

"Osteopathic manipulative treatment and sham manipulation both appear to provide some benefits when used in addition to usual care for the treatment of chronic nonspecific low back pain," the authors write. "It remains unclear whether the benefits of osteopathic manipulative treatment can be attributed to the manipulative techniques themselves or whether they are related to other aspects of osteopathic manipulative treatment, such as range of motion activities or time spent interacting with patients, which may represent placebo effects."

The American Osteopathic Association partially supported this study.

Spine. 2003;28:1355-1362

Reviewed by Gary D. Vogin, MD

    
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