RANDOMIZED CLINICAL-TRIAL OF MANIPULATIVE THERAPY AND PHYSIOTHERAPY FOR PERSISTENT BACK AND NECK COMPLAINTS - RESULTS OF ONE YEAR FOLLOW-UP
RANDOMIZED CLINICAL-TRIAL OF MANIPULATIVE THERAPY AND PHYSIOTHERAPY FOR PERSISTENT BACK AND NECK COMPLAINTS - RESULTS OF ONE YEAR FOLLOW-UP
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DOI：
10.1136/bmj.304.6827.601
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发表时间：
1992-03-07
影响因子：
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通讯作者：
KNIPSCHILD, PG
中科院分区：
文献类型：
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作者：
KOES, BW;BOUTER, LM;KNIPSCHILD, PG
目的-比较手法治疗、物理治疗、全科医生治疗，设计-随机临床试验。背景-荷兰初级卫生保健。患者- 256例非特异性背部和颈部疾病患者。在过去两年内没有接受物理治疗或手法治疗的特定背部和颈部投诉至少持续六周。由手法治疗师、物理治疗师和全科医生酌情决定。物理治疗包括锻炼、按摩和物理治疗（热、电疗、超声波、短波透热疗法）。手法治疗包括脊柱的推拿和活动。全科医生的治疗包括药物（如止痛药）、体位建议、家庭锻炼和（卧床）休息。安慰剂治疗包括失谐短波透热疗法（10分钟）和失谐超声（10分钟）。主要结果测量-由盲法研究助理在10点量表上测量的主诉和身体功能限制的严重程度的变化和由患者在6点量表上测量的总体感知效果。全科医生组和安慰剂组的许多患者在随访期间接受了其他治疗。12个月随访后，手法治疗（4.5）对主要投诉的改善程度大于物理治疗（3.8）（差异0.9; 95%置信区间0.1至1.7）。手法治疗也使身体功能有较大改善（差异0.6; -0.1至1.3）。在6个月和12个月的随访后，两种治疗方法的总体感知效果相似。结论-手法治疗和物理治疗优于全科医生和安慰剂治疗。此外，12个月后，手法治疗略优于物理治疗。
Objective - To compare the effectiveness of manipulative therapy, physiotherapy, treatment by the general practitioner, and placebo therapy in patients with persistent non-specific back and neck complaints.Design - Randomised clinical trial.Setting - Primary health care in the Netherlands.Patients - 256 patients with non-specific back and neck complaints of at least six weeks' duration who had not received physiotherapy or manipulative therapy in the past two years.Interventions - At the discretion of the manipulative therapists, physiotherapists, and general practitioners. Physiotherapy consisted of exercises, massage, and physical therapy (heat, electrotherapy, ultrasound, shortwave diathermy). Manipulative therapy consisted of manipulation and mobilisation of the spine. Treatment by general practitioners consisted of drugs (for example, analgesics), advice about posture, home exercises, and (bed)rest. Placebo treatment consisted of detuned shortwave diathermy (10 minutes) and detuned ultrasound (10 minutes).Main outcome measures - Changes in severity of the main complaint and limitation of physical functioning measured on 10 point scales by a blinded research assistant and global perceived effect measured on a 6 point scale by the patients.Results - Many patients in the general practitioner and placebo groups received other treatment during follow up. Improvement in the main complaint was larger with manipulative therapy (4.5) than with physiotherapy (3.8) after 12 months' follow up (difference 0.9; 95% confidence interval 0.1 to 1.7). Manipulative therapy also gave larger improvements in physical functioning (difference 0.6; -0.1 to 1.3). The global perceived effect after six and 12 months' follow up was similar for both treatments.Conclusions - Manipulative therapy and physiotherapy are better than general practitioner and placebo treatment. Furthermore, manipulative therapy is slightly better than physiotherapy after 12 months.