Nonspecific low back pain, a common clinical disease, is with high morbidity and prone to recurrent attacks. Clinical practice has proven that acupuncture and moxibustion therapies have positive effects on nonspecific low back pain, and the therapies are various, yet there is a lack of scientific and normative clinical practice guidelines. Identifying clinical questions is the most important step in developing clinical practice guidelines. This paper summarized the process and experience of the successful identification of clinical questions in the development of Clinical Practice Guideline on Acupuncture and Moxibustion for Nonspecific Low Back Pain by the guideline expert panel using the modified Delphi method, hoping to provide a reference for developing acupuncture and moxibustion-related clinical practice guidelines.
Many randomized controlled trials (RCTs) about motion style acupuncture in the treatment of acute nonspecific low back pain (ANSLBP) have been published recently, but there is no new systematic evaluation for effectiveness and safety of this treatment in ANSLBP.
To systematically evaluate the effectiveness and safety of motion style acupuncture in treating ANSLBP by meta-analysis.
RCTs, crossover studies or cohort studies about effectiveness and safety of motion style acupuncture in treating ANSLBP were retrieved in electronic databases of CNKI, CBM, Wanfang Data, VIP, PubMed, the National Library of Medicine, Embase and the Cochrane Central Register of Controlled Trials from inception to March 25th, 2021. Revman 5.3 was used to complete the Meta-analysis.
All the finally enrolled 17 articles used a design of RCT, including 1 226 patients, and 610 of them were treated with motion style acupuncture (observation group) , and other 616 patients were treated with positive control, blank control, placebo acupuncture or dummy acupuncture (control group) . Meta-analysis showed that, compared with controls treated with Western medicine, the observation group had significantly lower post-treatment VAS score〔MD=-1.54, 95%CI (-2.43, -0.65) , P=0.000 7〕, and Roland-Morris Disability Questionnaire (RMDQ) score〔MD=-3.08, 95%CI (-4.92, -1.24) , P=0.001〕, and significantly higher post-treatment ROM of lumbar vertebra〔MD=-1.42, 95%CI (-1.62, -1.22) , P<0.000 01〕and overall response rate〔RR=1.27, 95%CI (1.19, 1.35) , P<0.000 01〕, but there was no significant difference in post-treatment ODI score between the two groups〔MD=-5.11, 95%CI (-19.12, 8.91) , P=0.48〕. Compared with controls treated with dummy acupuncture, the observation group had significantly lower post-treatment VAS score〔MD=-1.70, 95%CI (-2.05, -1.35) , P<0.000 01〕and RMDQ score〔MD=-3.06, 95%CI (-4.50, -2.70) , P<0.000 01〕. Compared with controls treated with physical therapy, the observation group had significantly lower post-treatment VAS score〔MD=-1.60, 95%CI (-2.06, -1.14) , P<0.000 01〕and RMDQ score〔MD=-3.00, 95%CI (-4.31, -1.69) , P<0.000 01〕. Compared with controls treated with Tuina, the observation group had significantly lower post-treatment VAS score〔MD=-1.50, 95%CI (-1.65, -1.35) , P<0.000 01〕, and significantly higher overall response rate〔RR=1.19, 95%CI (1.09, 1.30) , P=0.000 1〕. Only one RCT reported that the incidence of adverse events in observation group was 13.33% (4/30) during treatment.
Available documentary evidence showed that, motion style acupuncture can effectively relieve the pain and lumbar dysfunction, and improve the ROM of lumbar vertebra and overall response rate in patients with ANSLBP, with high safety, but which still needs to be confirmed by more high-quality, large-sample RCTs.
As an important treatment for chronic nonspecific low back pain (CNSLBP) , the effect of acupuncture on CNSLBP has been studied by numerous randomized controlled trials (RCTs) with the development of research on acupuncture. However, there are some problems in the selection of outcome indicators, which severely hinder the generation of high-quality clinical evidence.
To describe the outcome measures used in RCTs of acupuncture for CNSLBP, providing a basis for the carrying out of relevant research.
Four Chinese databases (CNKI, VIP, Wanfang Data and SinoMed) and three English databases (PubMed, Embase and Cochrane Library) were systematically searched for literature on CNSLBP treated with acupuncture published from January 1, 2017 to March 15, 2022, and the NSLBP core outcome set (COS) used in studies published from database inception to March 15, 2022. According to the enrolment criteria to analyze the following aspects: basic characteristics, classification of clinical outcome indicators, use of composite indicators, and the application of TCM Criteria for Diagnosis and Treatment of Diseases & Syndromes (hereinafter referred to as TCMCDTDS) . In addition, 11 studies published from database inception to March 15, 2022 were enrolled to analyze their basic characteristics and use of COSs of NSLBP. In addition, to analyze the studies' basic characteristics and use of NSLBP COS. The similarities and differences between COSs of NSLBP and outcome measures in the RCTs in recent five years were compared.
Of the included 49 RCTs, four are in English and the other 45 are in Chinese, involving 4 272 cases aged from 18 to 69 years (2 049 in the treatment group, and 2 223 in the control group) . The course of CNSLBP was reported in 38 RCTs. A total of 33 outcome indicators were used in all the RCTs, divided into assessing pain, dysfunction, quality of life, activities of daily living, treatment safety, patient satisfaction, disease recognition, psychological status indicators, and other indicators. The outcome indicator number in one RCT were from 1 to 8. The outcomes were measured twice in 42 RCTs, namely before and after treatment. Safety was reported in only two RCTs. The indicator of "effective rate" in the TCMCDTDS was used in 77.55% (38/49) of the RCTs. The COSs of NSLBP in the aforementioned 11 studies include indicators assessing pain, dysfunction, quality of life, psychological status, social functioning and patient satisfaction. Three of the studies graded the domains of outcome measures in terms of importance, four covered patient satisfaction indicators, five covered psychological assessment indicators, nine used different measurement tools for different outcomes, and one used COSs of NSLBP treated with TCM.
The COSs of NSLBP used in studies and outcome measures in the included RCTs have similarities in the contents involving pain level, dysfunction, quality of life, psychological status and patient satisfaction, and differences in the selection of the type of outcome domain, direction of attention, and measurement tools. The RCTs used both primary and secondary outcome measures, had unclear measurement time points, great heterogeneity in the number of used outcome measures, and non-standard application of outcome measures, and valued efficacy outcomes but undervalued safety indicators. In view of this, we put forward the recommendation on the use of outcome measures for future relevant studies: according to the research characteristics, choosing the recognized outcome measures with reference to available COSs of NSLBP and common measurement tools.
The traditional core stability rehabilitation training has been proven to be effective in improving the rehabilitation in patients with chronic non-specific low back pain (CNSLBP) , but with poor long-term compliance. We independently developed a new core stabilization rehabilitation training program (NO.2021107165452) for CNSLBP patients, but the intervention effects of which are still unclear.
To explore the intervention effect of a novel core stabilization rehabilitation training program in CNSLBP patients.
Twenty-one male CNSLBP patients were recruited from Guangxi Normal University and Guilin College from December 2021 to January 2022, and randomly divided into an experimental group (n=11) and a control group (n=10) , receiving a six-week intervention using the core stabilization rehabilitation training program independently developed by our research group, and traditional core stability rehabilitation training, respectively. The visual analogue scale (VAS) was used to evaluate the pain level. The Oswestry Disability Index (ODI) was used to evaluate the status of lumbar dysfunction. The Hoggan MicroFET 2 was used to measure muscle force and muscle force signals of the flexor muscles, extensor muscles, and rotatores muscles of the low back. The Y-balance test (YBT) was used to assess the dynamic balance ability.
The values of VAS and ODI were significantly reduced in both groups after the intervention (P<0.05) , and they were more lower in the experimental group (P<0.05) . The muscle strength of upper abdominal flexors, spinal extensors, spinal left rotators, and spinal right rotators increased significantly in both groups after the intervention (P<0.05) . The left and right YBT scores were increased notably in both groups after the intervention (P<0.05) , and they were more higher in the experimental group (P<0.05) .
Both kinds of intervention programs could improve the lumbar pain, lumbar dysfunction, the muscle strength of upper abdominal flexors, spinal extensors, and spinal rotators, and dynamic balance in CNSLBP patients, but our core stability rehabilitation training program was more effective in reducing lumbar pain, improving lumbar dysfunction, and enhancing dynamic balance, so this novel program is worth promoting.
