背景:脊柱推拿治疗(SMT)是脊柱疼痛的指南推荐治疗选择。该建议基于多个系统审查。然而,这些审查未能考虑临床效果可能取决于SMT“申请程序”(即,如何以及在哪里应用SMT)。使用网络荟萃分析,我们旨在调查哪些SMT“应用程序”对减轻疼痛和残疾具有最大的临床有效性,对于任何脊柱疾病,短期和长期随访。我们将通过对推力应用技术和应用部位(患者定位,协助,椎体目标,区域目标,技术名称,部队,和向量,申请选址方法和理由)反对:1.等待名单/无治疗;2.不类似SMT的假干预(例如,超声失谐);3.类似SMT的假干预;4.临床实践指南中不推荐的其他疗法;和5.临床实践指南中推荐的其他疗法。其次,我们将研究上下文元素,包括SMT的程序保真度(SMT是否按计划交付)和临床适用性(SMT是否与临床实践相似)。
方法:我们将包括通过三种搜索策略发现的随机对照试验(RCT),(i)探索性,(ii)系统的,(三)其他已知来源。我们将SMT定义为高速低振幅推力或V级动员。资格是任何RCT评估SMT与任何其他类型的SMT,任何其他主动或虚假干预,或对任何脊柱区域疼痛的成年患者没有治疗控制。RCT必须报告持续疼痛强度和/或残疾结果。两位作者将独立审查标题和摘要筛选,全文筛选,和数据提取。脊柱操纵治疗技术将根据技术应用和应用部位的选择进行分类。我们将使用频率论方法和多个亚组和敏感性分析进行网络荟萃分析。
结论:这将是迄今为止对推力SMT进行的最广泛的回顾,并将使我们能够估计在临床实践中使用的不同SMT应用程序的重要性,并在教育环境中教授。因此,结果适用于临床实践,教育环境,和研究研究。PROSPERO注册:CRD42022375836。
Spinal manipulative therapy (SMT) is a guideline-recommended treatment option for spinal pain. The recommendation is based on multiple systematic reviews. However, these reviews fail to consider that clinical effects may depend on SMT \"application procedures\" (i.e., how and where SMT is applied). Using network meta-analyses, we aim to investigate which SMT \"application procedures\" have the greatest magnitude of clinical effectiveness for reducing pain and disability, for any spinal complaint, at short-term and long-term follow-up. We will compare application procedural parameters by classifying the thrust application technique and the application site (patient positioning, assisted, vertebral target, region target, Technique name, forces, and vectors, application site selection approach and rationale) against: 1. Waiting list/no treatment; 2. Sham interventions not resembling SMT (e.g., detuned ultrasound); 3. Sham interventions resembling SMT; 4. Other therapies not recommended in clinical practice guidelines; and 5. Other therapies recommended in clinical practice guidelines. Secondly, we will examine how contextual elements, including procedural fidelity (whether the SMT was delivered as planned) and clinical applicability (whether the SMT is similar to clinical practice) of the SMT.
We will include randomized controlled trials (RCT) found through three search strategies, (i) exploratory, (ii) systematic, and (iii) other known sources. We define SMT as a high-velocity low-amplitude thrust or grade V mobilization. Eligibility is any RCT assessing SMT against any other type of SMT, any other active or sham intervention, or no treatment control on adult patients with pain in any spinal region. The RCTs must report on continuous pain intensity and/or disability outcomes. Two authors will independently review title and abstract screening, full-text screening, and data extraction. Spinal manipulative therapy techniques will be classified according to the technique application and choice of application sites. We will conduct a network-meta analysis using a frequentist approach and multiple subgroup and sensitivity analyses.
This will be the most extensive review of thrust SMT to date, and will allow us to estimate the importance of different SMT application procedures used in clinical practice and taught across educational settings. Thus, the results are applicable to clinical practice, educational settings, and research studies. PROSPERO registration: CRD42022375836.