Taipei, Taiwan - Evaluating disability, pain scores, and functional status, researchers have found that patients with low back pain who receive therapy with the traditional Chinese method of manipulating pressure points experienced sustained benefit for six months. They report that acupressure was more effective than physical therapy in reducing pain and improving function. The findings appear online February 17, 2006 in BMJ [ 1 ].
The investigators recruited about 130 patients with chronic low back pain from a specialist orthopedic clinic in Taiwan. Patients completed a standard disability questionnaire before being randomly assigned to one of two treatment groups. About half of the patients received six sessions of acupressure and the other half received physical therapy. Led by Dr Lisa Li-Chen Hsieh (Institute of Preventive Medicine, National Taiwan University, Taipei), the researchers assessed the results immediately after treatment and again at six months.
They found that the mean disability score after therapy was significantly lower in the acupressure patients than in the physical-therapy group. The team reports that acupressure led to an 89% reduction in disability compared with physical therapy after adjustment for pretreatment disability, and this improvement lasted for six months.
The researchers also observed statistically significant differences between the two groups for all six domains of the core outcome, pain visual scale, and modified Oswestry disability questionnaire.
But the team also points to a number of limitations to their work. They note that 20 patients (more than 15% of subjects) were lost to follow-up at six months. "We do not believe that this would have had much influence on the result," they write. "However, the problem might be ameliorated by using an intention-to-treat method that included patients lost to follow-up in the analysis." In this case, the researchers substituted missing data for patients lost to follow-up with baseline or posttreatment data by assuming no change since last contact.
The effectiveness of any manipulation therapy is highly dependent on the therapist's technique and experience.
"Finally, the effectiveness of any manipulation therapy is highly dependent on the therapist's technique and experience," Hsieh and colleagues add. "We avoided variation across practitioners for acupressure by using only one therapist." They explain that using a single practitioner may enhance the internal validity of the study but also may threaten its external validity.
"We hope that this technique can be imparted to other therapists now that its efficacy has been shown in our study so that acupressure can be used in other populations," they write.
The researchers conclude that their randomized controlled trial provides the basis for comparison across international studies. "How acupressure can be generalized to patients with low back pain is the subject of ongoing research."
Medscape Medical News © 2006
Cite this: Allison Gandey. Randomized controlled trial of acupressure shows benefit - Medscape - Feb 17, 2006.