Meta-analysis Of A Randomized Controlled Trial Of Exercises Of TCM In Treatment Of Nonspecific Low Back Pain

Objective:As As many as 85%of patients with low back pain do not have clear and reasonable explanations for the cause and source of the pain,and most of them cannot find the exact changes in the tissue structure.After the imaging examination has ruled out the lumbar disc herniation,they have no spinal deformity,osteoporosis,Signs of fracture.Therefore,clinically,low back pain and activity limitation caused by lumbar muscle strain,L3 transverse process syndrome,low back myofasciitis and other acute and chronic lumbar diseases are called nonspecific low back pain(NLBP).NLBP is divided into acute(pain lasting less than 6 weeks),subacute(6 weeks to 12 weeks)or chronic(more than 12 weeks)according to its duration.The exact pathogenic factors are still unclear,and the clinical manifestations vary greatly.So it is estimated that5.0%to 10.0%of people with low back pain will develop into chronic low back pain(CLBP).In traditional medicine,guiding and pressing the cross(gong method)are currently widely used in the treatment of NLBP,but there is still a lack of evaluation of their therapeutic effects.Methods:CNKI,Wanfang,VIP,CBM,superstar library,Pub Med,EMBASE and Cochrane databases were searched by computer.The time limit was from the establishment of the database to January 2021.The clinical randomized controlled trials of various traditional Chinese medicine methods in the treatment of non-specific low back pain were collected.The included studies were analyzed according to Stata 16.0 and Review Manager5.4.1 bias risk tool for bias analysis and data statistics,drawing forest map,funnel plot.Results:A total of 19 studies were included in this meta-analysis,all of which were randomized controlled studies without blind method.A total of 1460 patients were included,including 734 cases in the experimental group and 726 cases in the control group,aged between 13 and 69 years old.The types of exercises included Wuqinxi,Baduanjin,Taiji,qigong,Lijin,and other massage techniques.The quality evaluation of NOS in 19articles were all above 7 points,which could be considered as reliable.Finally,four commonly used reference indexes(VAS,ODI,JOA,efficacy evaluation)were evaluated to reflect the treatment.However,most of the literatures did not deal with safety.VAS:19 literatures used VAS,the heterogeneity test results I~2=91.8%(P<0.05),and the random effect model was used for meta-analysis.The VAS changes of the two groups were statistically different[SMD=0,z=6.23,P<0.05],which suggested that the statistical difference ofinternal data in each trial was statistically significant.The funnel plot of VAS was funnel-shaped,and egger’s test was done at the same time,which result was p<0.05,so we determined that there was no publication bias or the bias was small.The sensitivity analysis chart of VAS showed that the distribution of 19 tests was more uniform.ODI:10 literatures were used ODI,heterogeneity test results I~2=96.3%(P<0.05).There was statistical difference in ODI changes between the two groups[SMD=0,z=4.92,P<0.05].The funnel plot of ODI was symmetrical funnel.The egger’s test was performed,the test results showed that P<0.05,so we determined that there was no publication bias or the bias was small;ODI sensitivity analysis showed that 10 tests were evenly distributed.JOA:JOA was used in 3 literatures,and the heterogeneity test was I~2=71.0%(P<0.05).The change of JOA between the two groups was statistically different[SMD=0,z=4.13,P<0.05].The funnel of JOA was symmetrical funnel.The egger’s test was performed,and the test results showed that P<0.05.So we determined that there was no publication bias or the bias was small.The sensitivity analysis of JOA showed that the distribution of the three tests was uniform.Efficacy evaluation:In 10 studies,696 cases were mentioned for efficacy evaluation.In the final follow-up,the effective rate of the experimental group was 95.70%,which was higher than 81.84%of the control group,and the heterogeneity I~2=0(P>0.05).The fixed effect model was used for meta-analysis,and the efficacy change was statistically significant[RR=1,z=5.62,P<0.05].The funnel chart of efficacy evaluation was funnel-shaped,combined with egger’s test.The distribution of mean effective rate and 95%confidence interval of efficacy evaluation was uniform.Conclusion:The heterogeneity of each group was obvious,but the improvement of VAS,JOA and ODI scores in each group showed P<0.05,which indicated that the difference between the experimental group and the control group was caused by intervention factors,which indicated the effectiveness of traditional Chinese medicine in the treatment of NLBP.