Massage Combined With Traditional Chinese Exercise In Patients With Lumbar Disc Herniation:A Systematic Review

Objective: The paired and network meta-analysis were used to systematically evaluate the efficacy of massage combined with traditional Chinese exercise(TCE)in the treatment of lumbar disc herniation and rank the advantages and disadvantages.Methods: Eight Chinese and English electronic databases were searched to obtain relevant randomized controlled trials,with the search date from the establishment of the database to January 7,2023.The Cochrane assessment tool and the Jadad scale are used to evaluate the bias risk of the original study;Review Manager 5.4,Stata 15 and Ge MTC are used for data analysis.Results: This study included 12 articles,with a total sample size of 1180 cases.TCEs are involved: Taijiquan,Yijinjing,Baduanjin,Wuqinxi,and Southern Shaolin exercise.The paired Meta-analysis results showed that massage combined with TCE is superior to massage in the total effective rate,cure rate,JOA score,VAS score,ODI score,and recurrence rate(GRADE: from moderate to low);But in the PRI score,it is not clear(GRADE: very low).The subgroup analysis showed that massage combined with TCE of excerpts(several types of TCE)or complete TCE(whole set of TCE)was better than the massage in improving the total effective rate,the cure rate,JOA score and ODI score(P values < 0.05),but the TCE of excerpts group was not better than the massage group in improving the VAS score: MD=-0.68,95% CI[-1.37,0.00].The Bayesian network metaanalysis showed:(1)Total effective rate: Massage combined with complete Baduanjin ranked first;(2)Cure rate: Massage combined with complete Yijinjing ranked first;(3)VAS and ODI scores: Massage combined with Tai Chi and Yijinjing excerpts rank first;(4)JOA scores: Massage combined with excerpts of Wuqinxi rank first;(5)Recurrence rate:Massage combined with excerpts of South Shaolin exercise ranks first.Conclusion: Massage combined with TCE has certain advantages in the treatment of LDH,but the efficacy of excerpted exercises in improving pain is uncertain.Massage combined with complete Baduanjin may be the best choice to improve the total effective rate;Massage combined with complete Yijinjing may be the best choice to improve the cure rate;Massage combined with the selection of the Yijinjing and Taijiquan may be the best choice to improve VAS and ODI scores;Massage combined with selected Wuqinxi may be the best choice to improve JOA score;Massage combined with selected Southern Shaolin exercise may be the best choice to improve the recurrence rate.