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The long-term effects of naprapathic manual therapy on back and neck pain - results from a pragmatic randomized controlled trial
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(8):22 BMC Musculoskelet Disord. 2010 Feb 5;11:26409 patients with non-specific pain/disability in the back and/or neck were randomized to be managed with either naprapthic manual therapy or by evidence based advice only. In the long term (56 weeks), naprapathic manual therapy produced greater improvement in pain and disability compared to advice from a physician on staying active and coping with pain.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
4/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
Back and neck pain are common clinical problems, yet the evidence of effectiveness of treatments in the long-term is sparse. Previously, naprapathic manual therapy has been shown to be effective in the short term. This study aimed to observe the long-term effectiveness of naprapathic manual therapy for back and neck pain.
主な研究課題は何ですか？
Is naprapathic manual therapy better than an evidence-based advice for management of pain intensity, disability and health status, in patients with non-specific pain/disability in the back and/or neck?
重要な知見は？
- More participants in the naprapathic manual therapy group achieved a clinically-important improvement in pain intensity and disability at 26 and 52 weeks follow-up.
- The naprapathy group did better in terms of improvement in pain (p=0.002), disability on CPQ score (p=0.005), and disability on WDQ score (p<0.001) at one year follow-up.
- Health-related quality of life questionnaire showed a better result in the naprapathic manual therapy group at both 26 and 52 weeks follow-up, in terms of bodily pain and social function. In other aspects, however, there was no statistical difference between the groups.
最も覚えておくべきことは？
For patients with non-specific back and/or neck pain, naprapathic manual therapy produced a greater improvement in pain and disability, compared to an evidence-based advice provided by a physician in the form of staying active and on how to cope with pain. Since naprapathy has previously been shown to be effective in the short term, naprapathy can now be considered to be effective in both the short and long term.
それが私の患者ケアにどのように影響するか？
Naprapathic manual therapy, having demonstrable efficacy in improving pain and disability in patients with nonspecific back or neck pain, is an effective alternative for consideration when deciding upon the best option in a mix of manual therapies in primary care for these patients.
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