Vicente Hennemann, Patrícia K Ziegelmann, Miriam A Z Marcolino, Bruce B Duncan
{"title":"由经认证的治疗师提供的麦肯锡法治疗慢性腰背痛的方向性偏好:系统回顾与荟萃分析。","authors":"Vicente Hennemann, Patrícia K Ziegelmann, Miriam A Z Marcolino, Bruce B Duncan","doi":"10.1080/10669817.2024.2408084","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To determine the effectiveness of the McKenzie Method compared to any conservative interventions on pain and disability in patients with chronic low back pain (LBP) with directional preference (DP).</p><p><strong>Methods: </strong>We searched six electronic databases up to September 2022. Eligible randomized controlled trials were those assessing the McKenzie Method delivered by credentialed therapists for chronic LBP with DP. Two reviewers independently selected studies, extracted data, assessed risk of bias with the revised Cochrane Risk of Bias 2.0 tool and certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.</p><p><strong>Results: </strong>Five trials (<i>n</i> = 743) were included. There was low-certainty evidence that the McKenzie Method, compared to all other interventions combined, produced clinically important reductions in short-term pain (mean difference [MD] -1.11 points on a 10-point scale; 95% CI -1.83 to -0.40) and in intermediate-term disability (standardized mean difference [SMD] -0.53; 95% CI -0.97 to -0.09). Low-to-moderate certainty evidence showed that the McKenzie Method also resulted in clinically important improvements in short-term pain (MD -1.53; 95% CI -2.51 to -0.54) and disability (SMD -0.50; 95% CI -0.74 to -0.25) when compared specifically to other exercise approaches, and in intermediate-term pain (MD -2.10; 95% CI -2.94 to -1.26) and disability (SMD -1.01; 95% CI -1.58 to -0.43) as well as long-term disability (SMD -0,59; 95% CI -1.14 to -0.03) when compared to minimal intervention. Low-certainty evidence showed usually small, clinically unimportant effects in comparison to manual therapy.</p><p><strong>Conclusion: </strong>We found low-to-moderate certainty evidence that the McKenzie Method was superior to all other interventions combined for up to 6 months for pain and up to 12 months for disability, with clinically important differences versus exercise in the short term and versus minimal interventions in the intermediate term. The only clinically important long-term effect was on disability compared to minimal intervention.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"1-16"},"PeriodicalIF":1.6000,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The McKenzie Method delivered by credentialed therapists for chronic low back pain with directional preference: systematic review with meta-analysis.\",\"authors\":\"Vicente Hennemann, Patrícia K Ziegelmann, Miriam A Z Marcolino, Bruce B Duncan\",\"doi\":\"10.1080/10669817.2024.2408084\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To determine the effectiveness of the McKenzie Method compared to any conservative interventions on pain and disability in patients with chronic low back pain (LBP) with directional preference (DP).</p><p><strong>Methods: </strong>We searched six electronic databases up to September 2022. Eligible randomized controlled trials were those assessing the McKenzie Method delivered by credentialed therapists for chronic LBP with DP. Two reviewers independently selected studies, extracted data, assessed risk of bias with the revised Cochrane Risk of Bias 2.0 tool and certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.</p><p><strong>Results: </strong>Five trials (<i>n</i> = 743) were included. There was low-certainty evidence that the McKenzie Method, compared to all other interventions combined, produced clinically important reductions in short-term pain (mean difference [MD] -1.11 points on a 10-point scale; 95% CI -1.83 to -0.40) and in intermediate-term disability (standardized mean difference [SMD] -0.53; 95% CI -0.97 to -0.09). Low-to-moderate certainty evidence showed that the McKenzie Method also resulted in clinically important improvements in short-term pain (MD -1.53; 95% CI -2.51 to -0.54) and disability (SMD -0.50; 95% CI -0.74 to -0.25) when compared specifically to other exercise approaches, and in intermediate-term pain (MD -2.10; 95% CI -2.94 to -1.26) and disability (SMD -1.01; 95% CI -1.58 to -0.43) as well as long-term disability (SMD -0,59; 95% CI -1.14 to -0.03) when compared to minimal intervention. Low-certainty evidence showed usually small, clinically unimportant effects in comparison to manual therapy.</p><p><strong>Conclusion: </strong>We found low-to-moderate certainty evidence that the McKenzie Method was superior to all other interventions combined for up to 6 months for pain and up to 12 months for disability, with clinically important differences versus exercise in the short term and versus minimal interventions in the intermediate term. The only clinically important long-term effect was on disability compared to minimal intervention.</p>\",\"PeriodicalId\":47319,\"journal\":{\"name\":\"Journal of Manual & Manipulative Therapy\",\"volume\":\" \",\"pages\":\"1-16\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-10-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Manual & Manipulative Therapy\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1080/10669817.2024.2408084\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"REHABILITATION\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Manual & Manipulative Therapy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1080/10669817.2024.2408084","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"REHABILITATION","Score":null,"Total":0}
引用次数: 0
摘要
目的确定麦肯锡方法与任何保守干预相比,对具有方向偏好(DP)的慢性腰背痛(LBP)患者的疼痛和残疾的有效性:我们检索了截至 2022 年 9 月的六个电子数据库。符合条件的随机对照试验是那些评估由经认证的治疗师提供的麦肯锡治疗法对伴有定向偏好的慢性腰背痛患者的治疗效果的试验。两名审稿人独立选择研究、提取数据,使用修订版 Cochrane Risk of Bias 2.0 工具评估偏倚风险,并使用建议评估、发展和评价分级(GRADE)框架评估证据的确定性:结果:共纳入五项试验(n = 743)。有低确定性证据表明,与所有其他干预措施相比,麦肯锡方法可在临床上显著减轻短期疼痛(10分制的平均差[MD]-1.11分;95% CI -1.83 至 -0.40)和中期残疾(标准化平均差[SMD]-0.53;95% CI -0.97至 -0.09)。中低度确定性证据显示,与其他锻炼方法相比,麦肯锡锻炼法对短期疼痛(MD -1.53; 95% CI -2.51 to -0.54)和残疾(SMD -0.50; 95% CI -0.74 to -0.25)也有重要的临床改善作用。25),中期疼痛(MD -2.10;95% CI -2.94至-1.26)和残疾(SMD -1.01;95% CI -1.58 至-0.43)以及长期残疾(SMD -0.59;95% CI -1.14 至-0.03)(与最小干预相比)。低确定性证据显示,与人工疗法相比,人工疗法的疗效通常较小且在临床上并不重要:我们发现中低度确定性证据表明,在长达6个月的疼痛治疗和长达12个月的残疾治疗中,麦肯锡方法优于所有其他干预方法,在短期内,麦肯锡方法与运动疗法相比具有重要的临床差异,在中期内,麦肯锡方法与最小干预方法相比具有重要的临床差异。与最小干预相比,唯一具有临床意义的长期效果是对残疾的影响。
The McKenzie Method delivered by credentialed therapists for chronic low back pain with directional preference: systematic review with meta-analysis.
Objective: To determine the effectiveness of the McKenzie Method compared to any conservative interventions on pain and disability in patients with chronic low back pain (LBP) with directional preference (DP).
Methods: We searched six electronic databases up to September 2022. Eligible randomized controlled trials were those assessing the McKenzie Method delivered by credentialed therapists for chronic LBP with DP. Two reviewers independently selected studies, extracted data, assessed risk of bias with the revised Cochrane Risk of Bias 2.0 tool and certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
Results: Five trials (n = 743) were included. There was low-certainty evidence that the McKenzie Method, compared to all other interventions combined, produced clinically important reductions in short-term pain (mean difference [MD] -1.11 points on a 10-point scale; 95% CI -1.83 to -0.40) and in intermediate-term disability (standardized mean difference [SMD] -0.53; 95% CI -0.97 to -0.09). Low-to-moderate certainty evidence showed that the McKenzie Method also resulted in clinically important improvements in short-term pain (MD -1.53; 95% CI -2.51 to -0.54) and disability (SMD -0.50; 95% CI -0.74 to -0.25) when compared specifically to other exercise approaches, and in intermediate-term pain (MD -2.10; 95% CI -2.94 to -1.26) and disability (SMD -1.01; 95% CI -1.58 to -0.43) as well as long-term disability (SMD -0,59; 95% CI -1.14 to -0.03) when compared to minimal intervention. Low-certainty evidence showed usually small, clinically unimportant effects in comparison to manual therapy.
Conclusion: We found low-to-moderate certainty evidence that the McKenzie Method was superior to all other interventions combined for up to 6 months for pain and up to 12 months for disability, with clinically important differences versus exercise in the short term and versus minimal interventions in the intermediate term. The only clinically important long-term effect was on disability compared to minimal intervention.
期刊介绍:
The Journal of Manual & Manipulative Therapy is an international peer-reviewed journal dedicated to the publication of original research, case reports, and reviews of the literature that contribute to the advancement of knowledge in the field of manual therapy, clinical research, therapeutic practice, and academic training. In addition, each issue features an editorial written by the editor or a guest editor, media reviews, thesis reviews, and abstracts of current literature. Areas of interest include: •Thrust and non-thrust manipulation •Neurodynamic assessment and treatment •Diagnostic accuracy and classification •Manual therapy-related interventions •Clinical decision-making processes •Understanding clinimetrics for the clinician