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Yang J, Zhou X, Ma Q, Woods JT, Mohabbat AB, Do A, Brault JS, Jensen MA, Shin KM, Shen L, Zhao C, Cheong KCP, He K, Guo Y, Chen Z, Tang S, Tang Y, Tan CIC, Chen J, Bauer BA. Efficacy and safety of Tuina for chronic nonspecific low back pain: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33018. [PMID: 36862888 PMCID: PMC9981398 DOI: 10.1097/md.0000000000033018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVE Chronic nonspecific low back pain (CNLBP) is a serious medical and social problem resulting in functional decline and decreased work ability. Tuina, a form of manual therapy, has been sparsely used to treat patients with CNLBP. To systematically assess the efficacy and safety of Tuina for patients with CNLBP. METHODS Multiple English and Chinese literature databases were searched until September 2022 for randomized controlled trials (RCTs) of Tuina in the treatment of CNLBP. The methodological quality was assessed using the Cochrane Collaboration's tool, and certainty of the evidence was determined with the online Grading of Recommendations, Assessment, Development and Evaluation tool. RESULTS Fifteen RCTs with 1390 patients were included. Tuina demonstrated a significant effect on pain (SMD: -0.82; 95% CI -1.12 to -0.53; P < .001; I2 = 81%) and physical function (SMD: -0.91; 95% CI -1.55 to -0.27; P = .005; I2 = 90%) when compared to control. However, Tuina resulted in no significant improvement for quality of life (QoL) (SMD: 0.58; 95% CI -0.04 to 1.21; P = .07; I2 = 73%;) compared to control. The Grading of Recommendations, Assessment, Development and Evaluation evidence quality was determined to be low level for pain relief, physical function, and QoL measurements. Only six studies reported adverse events; none were serious. CONCLUSION Tuina might be an effective and safe strategy for treating CNLBP in terms of pain and physical function, but not for QoL. The study results should be interpreted with caution for their low-level evidence. More multicenter, large-scale RCTs with a rigorous design are required to further confirm our findings.
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Affiliation(s)
- Juan Yang
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Xuan Zhou
- Formula-pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Qingyu Ma
- Formula-pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | | | - Arya B. Mohabbat
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Alexander Do
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jeffrey S. Brault
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Mark A. Jensen
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Kyung-Min Shin
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Longbin Shen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Canghuan Zhao
- Department of Acupuncture, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | | | - Kejie He
- Department of Acupuncture, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yu Guo
- Formula-pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Zhuoming Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shujie Tang
- Department of Orthopedics, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Yong Tang
- Department of Orthopedics, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | | | - Jiaxu Chen
- Formula-pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Brent A. Bauer
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
- *Correspondence: Brent A. Bauer, Division of General Internal Medicine, Mayo Clinic, 200 1st St SW Rochester, MN 55905 (e-mail: )
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Posadzki P, Ernst E. The safety of massage therapy: an update of a systematic review. ACTA ACUST UNITED AC 2013. [DOI: 10.1111/fct.12007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Paul Posadzki
- Complementary Medicine, Peninsula Medical School; University of Exeter; Veysey Building, Salmon Pool Lane; Exeter; EX2 4SG; UK
| | - Edzard Ernst
- Complementary Medicine, Peninsula Medical School; University of Exeter; Veysey Building, Salmon Pool Lane; Exeter; EX2 4SG; UK
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