The Literature Evaluation And Clinical Research Of Treating Nonspecific Low Back Pain With Manual Therapy

BackgroundThere is normally no indication for surgery in the case of non-specific low back pain. Most patients tend to seek for conservative treatment. There are different conservative treatments based on the diversity and complexity of the causes of non-specific low back pain. Current researches are not able to achieve the most sufficient and safe conservative treatment of non-specific low back pain. Manipulation, acupuncture, physiotherapy and exercise therapy are in common use of the conservative treatments to the non-specific low back pain, in which manipulation is believed to be the most effective.Purpose:1. To find evidence based medicine of Tuina therapy for nonspecific low back pain, by making Literature research.2. To explore the effectiveness of two types of Tuina therapy in the treatment of non-specific low back pain.Contents and methods:1. systematic review of foreign literatureIn this research we applied the review method of the Cochrane Collaboration, evaluated the researches of non-specific low back pain all over the world. A detailed inclusion and exclusion criteria was developed. A systematic a comprehensive search strategy was prepared according to the criteria.Search on the computerized bibliographic databases, from Cochrane library, MEDLINI EMBASE, EBSCO(ASP+BSP), EBSCOhost for the interrelated references until the December,2013. Outcome were evaluated independently by the two researchers in accordance with the relevant standards of the Cochrane systematic evaluation manual "(Higgins,2008). And statistical analysis was done with the software Rev Manager5.2. 2. Quality assessment of Chinese literatureWith the searching terms of tuina, Lower back pain, lumbar sprain, muscle strain, lumbar three transverse process syndrome, lumbar joint disorder, psoas fasciitis and discogenic low back pain, CNKI, Wanfang,CMCC, and VIP were searched. The General information, diagnostic information, treatment information, efficacy evaluation information, document quality Information of the included studies were evaluated.3. Clinical Research:The70patients who met the inclusion criteria of non-specific low back pain were randomly divided into spinal manipulation group and meridian massage groups. Treatment:(1)Spinal manipulation group:receive a targeted joint adjustment manipulation according to the symptoms and signs of the patients;(2) Meridian massage group:Pressing the following acupoints jinmen, shenmai, kunlun, fuyang, fuliu, gongsun, chengshan and chengjin. Palm rubbing Bladder meridian finally. Twice a week, a total of6times for3weeks.Results:1. systematic review of foreign literatureIn total,12RCTs were selected.8researches showed low risk of bias. In general, the pooled effects for the studied interventions demonstrated the relief or improvement. The lack of studies with a low-risk of bias, especially in regard to SMT precludes any strong conclusions; however, the principal findings, which are based upon low-to very-low-quality evidence, suggest that SMT does not provide a more clinically benificial effect compared with sham manipulation, physiotherapy, exercises or any other intervention for treatment of non-specific low-back pain.2. Quality assessment of Chinese literatureThe retrieved document contains15diagnostic name, as the lack of uniform diagnostic criteria of the disease, Interventions can be basically divided into massage therapy combined therapy and massage therapy alone. Comprehensive treatment is often combined with acupuncture, physiotherapy, drug treatment and other methods. Tuina therapy can be broadly divided into four by technical types of cases:spinal manipulation, Meridian massage, soft tissue massage and several techniques integrated massage techniques. Evaluation literature can be divided into four types of cases:the industry standard, professional scale, unfounded standard. All documents in the random generation, allocation concealment, blinding, data integrity, publication bias exists high risk of bias.3. Clinical Research(1) The difference in the OSW scores of three months follow-up between two groups was statistically significant (P<0.01);(2)The difference in the low back pain VAS scores of first treatment between two groups was statistically significant (P<0.01);(3) The difference in the RP BP VT scores of three months follow-up between two groups was statistically significant (P<0.05);Conelusions:1. In general, these results are in agreement with other recent systematic reviews on SMT, but in contrast with others. Randomized trials with a low risk of bias and adequate sample sizes are direly needed.2. Tuina therapy have significant short and long term effects for chronic non-specific low back pain.3. Comparison of the two methods, spinal manipulation have the advantage of immediate and long-term efficacy.