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Traction for low back pain with or without sciatica: an updated systematic review within the framework of the Cochrane collaboration.
Spine (Phila Pa 1976). 2006 Jun 15; 31(14):1591-9.S

Abstract

STUDY DESIGN

Systematic review.

OBJECTIVE

To determine if traction is more effective than reference treatments, placebo/sham traction, or no treatment for low back pain (LBP).

SUMMARY OF BACKGROUND DATA

Various types of traction are used in the treatment of LBP, often in conjunction with other treatments.

METHODS

We searched MEDLINE, EMBASE, and CINAHL to November 2004, and screened the latest issue of the Cochrane Library (2004, issue 4) and references in relevant reviews and our personal files. We selected randomized controlled trials (RCTs) involving any type of traction for the treatment of acute (less than 4 weeks duration), subacute (4-12 weeks), or chronic (more than 12 weeks) nonspecific LBP with or without sciatica. Sets of 2 reviewers independently performed study selection, methodological quality assessment, and data extraction. Because available studies did not provide sufficient data for statistical pooling, we performed a qualitative "levels of evidence" analysis, systematically estimating the strength of the cumulative evidence on the difference/lack of difference observed in trial outcomes.

RESULTS

A total of 24 RCTs (2177 patients) were included. There were 5 trials considered high quality. For mixed groups of patients with LBP with and without sciatica, we found: (1) strong evidence that there is no statistically significant difference in short or long-term outcomes between traction as a single treatment, (continuous or intermittent) and placebo, sham, or no treatment; (2) moderate evidence that traction as a single treatment is no more effective than other treatments; and (3) limited evidence that adding traction to a standard physiotherapy program does not result in significantly different outcomes. For LBP with sciatica, we found conflicting evidence in several of the comparisons: autotraction compared to placebo, sham, or no treatment; other forms of traction compared to other treatments; and different forms of traction. In the remaining comparisons, there were no statistically significant differences; level of evidence is moderate regarding continuous or intermittent traction compared to placebo, sham, or no treatment, and is limited regarding different forms of traction.

CONCLUSION

Based on the current evidence, intermittent or continuous traction as a single treatment for LBP cannot be recommended for mixed groups of patients with LBP with and without sciatica. Neither can traction be recommended for patients with sciatica because of inconsistent results and methodological problems in most of the studies involved. However, because high-quality studies within the field are scarce, because many are underpowered, and because traction often is supplied in combination with other treatment modalities, the literature allows no firm negative conclusion that traction, in a generalized sense, is not an effective treatment for patients with LBP.

Authors+Show Affiliations

Institute for Work & Health, Toronto, Ontario, Canada. jclarke@iwh.on.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

16778694

Citation

Clarke, Judy, et al. "Traction for Low Back Pain With or Without Sciatica: an Updated Systematic Review Within the Framework of the Cochrane Collaboration." Spine, vol. 31, no. 14, 2006, pp. 1591-9.
Clarke J, van Tulder M, Blomberg S, et al. Traction for low back pain with or without sciatica: an updated systematic review within the framework of the Cochrane collaboration. Spine. 2006;31(14):1591-9.
Clarke, J., van Tulder, M., Blomberg, S., de Vet, H., van der Heijden, G., & Bronfort, G. (2006). Traction for low back pain with or without sciatica: an updated systematic review within the framework of the Cochrane collaboration. Spine, 31(14), 1591-9.
Clarke J, et al. Traction for Low Back Pain With or Without Sciatica: an Updated Systematic Review Within the Framework of the Cochrane Collaboration. Spine. 2006 Jun 15;31(14):1591-9. PubMed PMID: 16778694.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Traction for low back pain with or without sciatica: an updated systematic review within the framework of the Cochrane collaboration. AU - Clarke,Judy, AU - van Tulder,Maurits, AU - Blomberg,Stefan, AU - de Vet,Henrica, AU - van der Heijden,Geert, AU - Bronfort,Gert, PY - 2006/6/17/pubmed PY - 2006/8/4/medline PY - 2006/6/17/entrez SP - 1591 EP - 9 JF - Spine JO - Spine VL - 31 IS - 14 N2 - STUDY DESIGN: Systematic review. OBJECTIVE: To determine if traction is more effective than reference treatments, placebo/sham traction, or no treatment for low back pain (LBP). SUMMARY OF BACKGROUND DATA: Various types of traction are used in the treatment of LBP, often in conjunction with other treatments. METHODS: We searched MEDLINE, EMBASE, and CINAHL to November 2004, and screened the latest issue of the Cochrane Library (2004, issue 4) and references in relevant reviews and our personal files. We selected randomized controlled trials (RCTs) involving any type of traction for the treatment of acute (less than 4 weeks duration), subacute (4-12 weeks), or chronic (more than 12 weeks) nonspecific LBP with or without sciatica. Sets of 2 reviewers independently performed study selection, methodological quality assessment, and data extraction. Because available studies did not provide sufficient data for statistical pooling, we performed a qualitative "levels of evidence" analysis, systematically estimating the strength of the cumulative evidence on the difference/lack of difference observed in trial outcomes. RESULTS: A total of 24 RCTs (2177 patients) were included. There were 5 trials considered high quality. For mixed groups of patients with LBP with and without sciatica, we found: (1) strong evidence that there is no statistically significant difference in short or long-term outcomes between traction as a single treatment, (continuous or intermittent) and placebo, sham, or no treatment; (2) moderate evidence that traction as a single treatment is no more effective than other treatments; and (3) limited evidence that adding traction to a standard physiotherapy program does not result in significantly different outcomes. For LBP with sciatica, we found conflicting evidence in several of the comparisons: autotraction compared to placebo, sham, or no treatment; other forms of traction compared to other treatments; and different forms of traction. In the remaining comparisons, there were no statistically significant differences; level of evidence is moderate regarding continuous or intermittent traction compared to placebo, sham, or no treatment, and is limited regarding different forms of traction. CONCLUSION: Based on the current evidence, intermittent or continuous traction as a single treatment for LBP cannot be recommended for mixed groups of patients with LBP with and without sciatica. Neither can traction be recommended for patients with sciatica because of inconsistent results and methodological problems in most of the studies involved. However, because high-quality studies within the field are scarce, because many are underpowered, and because traction often is supplied in combination with other treatment modalities, the literature allows no firm negative conclusion that traction, in a generalized sense, is not an effective treatment for patients with LBP. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/16778694/Traction_for_low_back_pain_with_or_without_sciatica:_an_updated_systematic_review_within_the_framework_of_the_Cochrane_collaboration_ L2 - http://dx.doi.org/10.1097/01.brs.0000222043.09835.72 DB - PRIME DP - Unbound Medicine ER -