Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative
Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative
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DOI：
10.1016/j.jmpt.2017.12.004
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发表时间：
2018-05-01
影响因子：
1.3
通讯作者：
Ornelas, Joseph
中科院分区：
文献类型：
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作者：
Bussieres, Andre E.;Stewart, Gregory;Ornelas, Joseph
目的：本研究的目的是制定成人急性和慢性腰痛（LBP）管理的临床实践指南。目的是制定一份指南，为腰痛患者的初步评估和监测提供最佳实践建议，并将脊柱推拿疗法（SMT）与其他常用的保守疗法进行比较。方法：根据卫生保健研究和质量比较有效性审查机构选择主题领域，具体到脊柱推拿作为非药物干预。专家组更新了Medline的搜索策略。我们使用评估系统评价的测量工具和Cochrane Back Review Group标准对每个问题评估可接受的系统评价和随机对照试验。证据概要用于总结对证据质量的判断，并将建议与支持证据联系起来。使用证据决策框架，指南小组确定了证据的确定性和建议的强度。采用改进的德尔菲法获得共识。该指南由8名成员组成的多学科外部委员会进行同行评审。结果：对于急性（0-3个月）背痛患者，我们建议提供建议（姿势、保持活动）、安慰、教育和自我管理策略，除了SMT，在认为有益的情况下进行常规医疗护理，或SMT和常规医疗护理相结合，以改善疼痛和残疾。对于慢性（bb0 - 3个月）背痛患者，我们建议提供咨询和教育，SMT或SMT作为多模式治疗的一部分（运动、肌筋膜治疗或认为有益的常规医疗护理）。对于慢性背部相关腿部疼痛的患者，我们建议在SMT和家庭运动（定位和稳定运动）的同时提供建议和教育。结论：包括SMT、其他常用的积极干预措施、自我管理建议和锻炼在内的多模式方法是急性和慢性背痛的有效治疗策略，无论是否伴有腿痛。
Objective: The objective of this study was to develop a clinical practice guideline on the management of acute and chronic low back pain (LBP) in adults. The aim was to develop a guideline to provide best practice recommendations on the initial assessment and monitoring of people with low back pain and address the use of spinal manipulation therapy (SMT) compared with other commonly used conservative treatments.Methods: The topic areas were chosen based on an Agency for Healthcare Research and Quality comparative effectiveness review, specific to spinal manipulation as a nonpharmacological intervention. The panel updated the search strategies in Medline. We assessed admissible systematic reviews and randomized controlled trials for each question using A Measurement Tool to Assess Systematic Reviews and Cochrane Back Review Group criteria. Evidence profiles were used to summarize judgments of the evidence quality and link recommendations to the supporting evidence. Using the Evidence to Decision Framework, the guideline panel determined the certainty of evidence and strength of the recommendations. Consensus was achieved using a modified Delphi technique. The guideline was peer reviewed by an 8-member multidisciplinary external committee.Results: For patients with acute (0-3 months) back pain, we suggest offering advice (posture, staying active), reassurance, education and self-management strategies in addition to SMT, usual medical care when deemed beneficial, or a combination of SMT and usual medical care to improve pain and disability. For patients with chronic (>3 months) back pain, we suggest offering advice and education, SMT or SMT as part of a multimodal therapy (exercise, myofascial therapy or usual medical care when deemed beneficial). For patients with chronic back-related leg pain, we suggest offering advice and education along with SMT and home exercise (positioning and stabilization exercises).Conclusions: A multimodal approach including SMT, other commonly used active interventions, self-management advice, and exercise is an effective treatment strategy for acute and chronic back pain, with or without leg pain.