Objective: Chronic nonspecific low back pain (CNLBP) is a serious medical and social problem resulting in functional decline and decreased work ability. Tuina, a form of manual therapy, has been sparsely used to treat patients with CNLBP. To systematically assess the efficacy and safety of Tuina for patients with CNLBP.Methods: Multiple English and Chinese literature databases were searched until September 2022 for randomized controlled trials (RCTs) of Tuina in the treatment of CNLBP. The methodological quality was assessed using the Cochrane Collaboration's tool, and certainty of the evidence was determined with the online Grading of Recommendations, Assessment, Development and Evaluation tool.Results: Fifteen RCTs with 1390 patients were included. Tuina demonstrated a significant effect on pain (SMD: −0.82; 95% CI −1.12 to −0.53; P < .001; I 2 = 81%) and physical function (SMD: −0.91; 95% CI −1.55 to −0.27; P = .005; I 2 = 90%) when compared to control. However, Tuina resulted in no significant improvement for quality of life (QoL) (SMD: 0.58; 95% CI −0.04 to 1.21; P = .07; I 2 = 73%;) compared to control. The Grading of Recommendations, Assessment, Development and Evaluation evidence quality was determined to be low level for pain relief, physical function, and QoL measurements. Only six studies reported adverse events; none were serious. Conclusion:Tuina might be an effective and safe strategy for treating CNLBP in terms of pain and physical function, but not for QoL. The study results should be interpreted with caution for their low-level evidence. More multicenter, large-scale RCTs with a rigorous design are required to further confirm our findings.
Background Chronic nonspecific low back pain (CNLBP) is one of the most common complex pain conditions, and it is strongly associated with high rates of disability. Even though several studies on Tui na for CNLBP have been reported, to our knowledge there has been no systematic review of the currently available publications. Objective This study aims to develop a protocol for a systematic review and meta-analysis that will evaluate the effectiveness and safety of Tui na therapy for patients with CNLBP. Methods An electronic literature search of PubMed, Embase, MEDLINE, Cochrane Library, Springer, Scopus, World Health Organization International Clinical Trials Registry Platform, Physiotherapy Evidence Database (PEDro), Clarivate Analytics, and Chinese biomedical databases (the China National Knowledge Infrastructure, Wan-fang database, Chinese Scientific Journals Database, and Chinese Biomedical Literature Databases) will be conducted. Studies will be screened by two reviewers independently based on titles and abstracts, followed by a full-text reading with eligibility criteria. Randomized controlled trials involving Tui na for patients with CNLBP will be reviewed. The primary outcomes of the study are improvement of pain, analgesic medication reduction, improvement of functional disability, and degree of satisfaction with the intervention. A secondary outcome is any adverse event of Tui na intervention. Methodological quality and risk of bias will be assessed with the Cochrane Collaboration Risk of Bias Tool. If studies are sufficient, a meta-analysis of the effectiveness will be performed. If possible, we will evaluate publication bias using funnel plots. If substantial heterogeneity between studies is present, and there are sufficient studies, subgroup analyses will be conducted to explain the study findings. Results The review database searches will be initiated in December 2020, with findings expected by January 2021. Conclusions This protocol will establish a framework of a high-quality literature synthesis on the impact of Tui na treatment in patients with CNLBP. The proposed review will determine whether Tui na is effective and safe for CNLBP patients. Trial Registration PROSPERO CRD42020166731; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=166731 International Registered Report Identifier (IRRID) PRR1-10.2196/20615
BACKGROUND Chronic non-specific low back pain (CNLBP) is one of the most common complex conditions strongly associated with high rates of disability. Even though many studies on Tuina for CNLBP patients reported, until now, there is no study synthesize the currently available publications. OBJECTIVE This protocol aims to provide authors the guideline used to systematically review the effect and safety of Tuina therapy for treating patients with CNLBP. METHODS An electronic literature search will be conducted in the following databases: MEDLINE, Embase, Cochrane Library, Springer, Web of Science, Scopus, World Health Organization International Clinical Trials Registry Platform (ICTRP), the Chinese Biomedical Literature Database (CBM), the China National Knowledge Infrastructure (CNKI), Wan-fang database (WAN FANG), Chinese Biomedical Literature Databases (CBM), and Chinese Scientific Journal Database VIP Information (VIP). From database inception to Dec 30, 2019, English, and Chinese language only. Randomized controlled trials (RCTs) involving Tuina for patients with CNLBP will be reviewed. The primary outcomes of the study are an improvement of pain, analgesic medication reduction, improvement of functional disability, and degree of satisfaction with the intervention. A secondary outcome is any adverse event (AE) of Tuina intervention. If samples are enough, a meta-analysis with the software RevMan5.3.5 will be performed. If data permit, a subgroup analysis will be conducted to explain the study findings. RESULTS The study was started on April 30th, 2020. Study results will be submitted for publication in July 2020. CONCLUSIONS This protocol will establish a framework of a high-quality literature synthesis on the impact of Tuina treatment in patients with CNLBP. The proposed review will determine whether Tuina is effective and safe for CNLBP patients. CLINICALTRIAL PROSPERO CRD42020166731
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