OA05.04
Purpose: This systematic review was carried out to identify clinical evidence from RCTs to evaluate the effectiveness and report any adverse effects of integrative treatment for low back pain (LBP). This review also aimed to inform the method of conducting systematic reviews in integrative medicine.
Methods: A literature search of 8 English and 4 Chinese databases for RCTs evaluating the effectiveness of integrative treatments for musculoskeletal related LBP was conducted. Reporting/methodological quality and relevant clinical characteristics were assessed, extracted by two researchers, with consensus by a third reviewer and meta-analyses conducted.
Results: Initially 1470 English and 3358 Chinese studies were identified. Screening titles/abstracts gave 218 English and 739 Chinese articles. After inclusion and exclusion criteria, 13 English, 46 Chinese articles remained (22 acupuncture). Acupuncture combined with traction was the most popular treatment in China (8/17); for other countries acupuncture plus usual care (4/5) was the most popular combination. Favourable improvements were shown in integrative treatments (acupuncture combined with traction/medication/epidural injection/usual care) over conventional medicine (CM) alone – with traction: 5 studies: n=450, visual analogue scale (VAS), standardized mean difference (SMD) −1.43, 95% CI [−1.69, −1.18], p=0.18, I2=34%; 2 studies: Japanese Orthopaedic Association (JOA) score, SMD 0.52, 95% CI [0.02, 1.01]; modified JOA, [SMD 2.50, 95% CI [1.82, 3.19]; with medication: 3 studies: n=234, VAS, SMD −0.89, 95% CI [−1.17, −0.62], p=0.38, I2=2%; 2 studies: n=142, Oswestry pain disability index score, SMD −1.04, 95% CI [−1.40, −0.69], p=0.72, I2=0%); with EI: 1 study: VAS, SMD −1.67 [−2.36, −0.97]; 1 study: JOA score, SMD −1.93 [−2.44, −1.41] and positive results comparing acupuncture plus usual care. Minimal safety data was generated. Chinese studies had poorer reporting/methodological quality.
Conclusion: Previously effectiveness of IM has been inadequately evaluated. Variations in terminology/policy/registration system/education/clinical practice/definition/inter-country differences are problematic. Future studies should focus on the most effective combinations of IM treatment.
Contact: Xiaoyang Hu, hux2@lsbu.ac.uk
