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Traction for low-back pain with or without sciatica.

Abstract

BACKGROUND

Traction is used to treat low-back pain (LBP), often with other treatments.

OBJECTIVES

To determine traction's effectiveness, compared to reference treatments, placebo, sham traction or no treatment for LBP.

SEARCH STRATEGY

We searched CENTRAL (The Cochrane Library 2006, issue 4), MEDLINE, EMBASE, and CINAHL to October 2006, references in relevant reviews and personal files.

SELECTION CRITERIA

Randomized controlled trials (RCTs) involving traction to treat acute (less than four weeks duration), sub-acute (four to 12 weeks) or chronic (more than 12 weeks) non-specific LBP with or without sciatica.

DATA COLLECTION AND ANALYSIS

Study selection, methodological quality assessment and data extraction were done independently by two authors. As there were insufficient data for statistical pooling, we performed a qualitative analysis.

MAIN RESULTS

We included 25 RCTs (2206 patients; 1045 receiving traction). Five trials were considered high quality. For patients with mixed symptom patterns (acute, sub-acute and chronic LBP with and without sciatica) there is: strong evidence of no statistically significant difference in outcomes between traction as a single treatment and placebo, sham or no treatment; moderate evidence that traction as a single treatment is no more effective than other treatments; limited evidence of no significant difference in outcomes between a standard physical therapy program with or without continuous traction. For LBP patients with sciatica (with acute, sub-acute or chronic pain), there is conflicting evidence in several comparisons: autotraction compared to placebo, sham or no treatment; other forms of traction compared to other treatments; different forms of traction. In other comparisons, there were no statistically significant differences; the evidence is moderate for continuous or intermittent traction compared to placebo, sham or no treatment, and limited for light versus normal force traction.

IMPLICATIONS FOR PRACTICE

The results of the available studies involving mixed groups of acute, sub-acute and chronic patients with LBP with and without sciatica were quite consistent, indicating that continuous or intermittent traction as a single treatment for LBP is not likely effective for this group. Traction for patients with sciatica cannot be judged effective at present either, due to inconsistent results and methodological problems in most studies. We conclude that traction as a single treatment for LBP is probably not effective.

IMPLICATIONS FOR RESEARCH

Any future research on traction for patients with LBP should distinguish between symptom pattern and duration, and should be carried out according to the highest methodological standards.

Authors+Show Affiliations

Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, Ontario, Canada, M5G2E9. jclarke@iwh.on.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

17443521

Citation

Clarke, J A., et al. "Traction for Low-back Pain With or Without Sciatica." The Cochrane Database of Systematic Reviews, 2007, p. CD003010.
Clarke JA, van Tulder MW, Blomberg SE, et al. Traction for low-back pain with or without sciatica. Cochrane Database Syst Rev. 2007.
Clarke, J. A., van Tulder, M. W., Blomberg, S. E., de Vet, H. C., van der Heijden, G. J., Bronfort, G., & Bouter, L. M. (2007). Traction for low-back pain with or without sciatica. The Cochrane Database of Systematic Reviews, (2), CD003010.
Clarke JA, et al. Traction for Low-back Pain With or Without Sciatica. Cochrane Database Syst Rev. 2007 Apr 18;(2)CD003010. PubMed PMID: 17443521.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Traction for low-back pain with or without sciatica. AU - Clarke,J A, AU - van Tulder,M W, AU - Blomberg,S E I, AU - de Vet,H C W, AU - van der Heijden,G J M G, AU - Bronfort,G, AU - Bouter,L M, Y1 - 2007/04/18/ PY - 2007/4/20/pubmed PY - 2007/7/18/medline PY - 2007/4/20/entrez SP - CD003010 EP - CD003010 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 2 N2 - BACKGROUND: Traction is used to treat low-back pain (LBP), often with other treatments. OBJECTIVES: To determine traction's effectiveness, compared to reference treatments, placebo, sham traction or no treatment for LBP. SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library 2006, issue 4), MEDLINE, EMBASE, and CINAHL to October 2006, references in relevant reviews and personal files. SELECTION CRITERIA: Randomized controlled trials (RCTs) involving traction to treat acute (less than four weeks duration), sub-acute (four to 12 weeks) or chronic (more than 12 weeks) non-specific LBP with or without sciatica. DATA COLLECTION AND ANALYSIS: Study selection, methodological quality assessment and data extraction were done independently by two authors. As there were insufficient data for statistical pooling, we performed a qualitative analysis. MAIN RESULTS: We included 25 RCTs (2206 patients; 1045 receiving traction). Five trials were considered high quality. For patients with mixed symptom patterns (acute, sub-acute and chronic LBP with and without sciatica) there is: strong evidence of no statistically significant difference in outcomes between traction as a single treatment and placebo, sham or no treatment; moderate evidence that traction as a single treatment is no more effective than other treatments; limited evidence of no significant difference in outcomes between a standard physical therapy program with or without continuous traction. For LBP patients with sciatica (with acute, sub-acute or chronic pain), there is conflicting evidence in several comparisons: autotraction compared to placebo, sham or no treatment; other forms of traction compared to other treatments; different forms of traction. In other comparisons, there were no statistically significant differences; the evidence is moderate for continuous or intermittent traction compared to placebo, sham or no treatment, and limited for light versus normal force traction. IMPLICATIONS FOR PRACTICE: The results of the available studies involving mixed groups of acute, sub-acute and chronic patients with LBP with and without sciatica were quite consistent, indicating that continuous or intermittent traction as a single treatment for LBP is not likely effective for this group. Traction for patients with sciatica cannot be judged effective at present either, due to inconsistent results and methodological problems in most studies. We conclude that traction as a single treatment for LBP is probably not effective. IMPLICATIONS FOR RESEARCH: Any future research on traction for patients with LBP should distinguish between symptom pattern and duration, and should be carried out according to the highest methodological standards. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/17443521/Traction_for_low_back_pain_with_or_without_sciatica_ L2 - https://doi.org/10.1002/14651858.CD003010.pub4 DB - PRIME DP - Unbound Medicine ER -