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Integrative treatment for low back pain: An exploratory systematic review and meta-analysis of randomized controlled trials

Integrative treatment for low back pain: An exploratory systematic review and meta-analysis of randomized controlled trials
Integrative treatment for low back pain: An exploratory systematic review and meta-analysis of randomized controlled trials

OBJECTIVE: Low back pain (LBP) is a common musculoskeletal condition often treated using integrative medicine (IM). Most reviews have focused on a single complementary and alternative medicine (CAM) therapy for LBP rather than evaluating wider integrative approaches. This exploratory systematic review aimed to identify randomized controlled trials (RCTs) and provide evidence on the effectiveness, cost effectiveness and adverse effects of integrative treatment for LBP.

METHODS: A literature search was conducted in 12 English and Chinese databases. RCTs evaluating an integrative treatment for musculoskeletal related LBP were included. Reporting, methodological quality and relevant clinical characteristics were assessed and appraised. Metaanalyses were performed for outcomes where trials were sufficiently homogenous.

RESULTS: Fifty-six RCTs were identified evaluating integrative treatment for LBP. Although reporting and methodological qualities were poor, meta-analysis showed a favourable effect for integrative treatment over conventional and CAM treatment for back pain and function at 3 months or less follow-up. Two trials investigated costs, reporting £ 5332 per quality adjusted life years with 6 Alexander technique lessons plus exercise at 12 months follow-up; and an increased total costs of $244 when giving an additional up to 15 sessions of CAM package of care at 12 weeks. Sixteen trials mentioned safety; no severe adverse effects were reported.

CONCLUSION: Integrative treatment that combines CAM with conventional therapies appeared to have beneficial effects on pain and function. However, evidence is limited due to heterogeneity, the relatively small numbers available for subgroup analyses and the low methodological quality of the included trials. Identification of studies of true IM was not possible due to lack of reporting of the intervention details (registration No. CRD42013003916).

Journal Article
1672-0415
Hu, Xiao-Yang
65904b24-3775-4b14-9532-eb703a056655
Chen, Ni-Ni
00d71079-654d-4e43-b4b6-36635ea5189a
Chai, Qian-Yun
de9cc1d9-2a4e-45fd-8666-1efb75deb755
Yang, Guo-Yan
61a737b3-d16d-4f8a-ae89-74630f9c9772
Trevelyan, Esmé
c95e3cf0-6e42-4b2b-bd35-fbd7b70523c0
Lorenc, Ava
7d3ba35f-0a60-4057-bd99-52c839870155
Liu, Jian-Ping
4c1de9c3-e9c2-4d4e-a0a4-dad123a39c76
Robinson, Nicola
96ec8bbf-fd1e-4ce2-be99-17eb1051fed9
Hu, Xiao-Yang
65904b24-3775-4b14-9532-eb703a056655
Chen, Ni-Ni
00d71079-654d-4e43-b4b6-36635ea5189a
Chai, Qian-Yun
de9cc1d9-2a4e-45fd-8666-1efb75deb755
Yang, Guo-Yan
61a737b3-d16d-4f8a-ae89-74630f9c9772
Trevelyan, Esmé
c95e3cf0-6e42-4b2b-bd35-fbd7b70523c0
Lorenc, Ava
7d3ba35f-0a60-4057-bd99-52c839870155
Liu, Jian-Ping
4c1de9c3-e9c2-4d4e-a0a4-dad123a39c76
Robinson, Nicola
96ec8bbf-fd1e-4ce2-be99-17eb1051fed9

Hu, Xiao-Yang, Chen, Ni-Ni, Chai, Qian-Yun, Yang, Guo-Yan, Trevelyan, Esmé, Lorenc, Ava, Liu, Jian-Ping and Robinson, Nicola (2015) Integrative treatment for low back pain: An exploratory systematic review and meta-analysis of randomized controlled trials. Chinese Journal of Integrated Medicine. (doi:10.1007/s11655-015-2125-2).

Record type: Article

Abstract

OBJECTIVE: Low back pain (LBP) is a common musculoskeletal condition often treated using integrative medicine (IM). Most reviews have focused on a single complementary and alternative medicine (CAM) therapy for LBP rather than evaluating wider integrative approaches. This exploratory systematic review aimed to identify randomized controlled trials (RCTs) and provide evidence on the effectiveness, cost effectiveness and adverse effects of integrative treatment for LBP.

METHODS: A literature search was conducted in 12 English and Chinese databases. RCTs evaluating an integrative treatment for musculoskeletal related LBP were included. Reporting, methodological quality and relevant clinical characteristics were assessed and appraised. Metaanalyses were performed for outcomes where trials were sufficiently homogenous.

RESULTS: Fifty-six RCTs were identified evaluating integrative treatment for LBP. Although reporting and methodological qualities were poor, meta-analysis showed a favourable effect for integrative treatment over conventional and CAM treatment for back pain and function at 3 months or less follow-up. Two trials investigated costs, reporting £ 5332 per quality adjusted life years with 6 Alexander technique lessons plus exercise at 12 months follow-up; and an increased total costs of $244 when giving an additional up to 15 sessions of CAM package of care at 12 weeks. Sixteen trials mentioned safety; no severe adverse effects were reported.

CONCLUSION: Integrative treatment that combines CAM with conventional therapies appeared to have beneficial effects on pain and function. However, evidence is limited due to heterogeneity, the relatively small numbers available for subgroup analyses and the low methodological quality of the included trials. Identification of studies of true IM was not possible due to lack of reporting of the intervention details (registration No. CRD42013003916).

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More information

Published date: 26 October 2015
Keywords: Journal Article

Identifiers

Local EPrints ID: 413155
URI: http://eprints.soton.ac.uk/id/eprint/413155
ISSN: 1672-0415
PURE UUID: 1e173823-a878-4b72-aba7-eb05c5e9f8e3
ORCID for Xiao-Yang Hu: ORCID iD orcid.org/0000-0002-3143-7999

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Date deposited: 16 Aug 2017 16:30
Last modified: 16 Mar 2024 04:24

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Contributors

Author: Xiao-Yang Hu ORCID iD
Author: Ni-Ni Chen
Author: Qian-Yun Chai
Author: Guo-Yan Yang
Author: Esmé Trevelyan
Author: Ava Lorenc
Author: Jian-Ping Liu
Author: Nicola Robinson

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