Jung, Ga Hyeon
(Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Daejeon University)
,
Lee, Hyun
(Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Daejeon University)
,
Kong, Hae Jin
(Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Daejeon University)
,
Ryu, Hwa Yeon
(Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Daejeon University)
,
Ku, Yong Ho
(Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Daejeon University)
,
Kang, Jae Hui
(Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Daejeon University)
This study analyzed randomized controlled trials (RCTs) and case studies investigating Chuna manual therapy and variations of this term, for adolescent idiopathic scoliosis. On June $15^{th}$, 2019, 6 online databases were used to retrieve studies. A total of 527 articles were retrieved, ...
This study analyzed randomized controlled trials (RCTs) and case studies investigating Chuna manual therapy and variations of this term, for adolescent idiopathic scoliosis. On June $15^{th}$, 2019, 6 online databases were used to retrieve studies. A total of 527 articles were retrieved, and 14 RCTs and 20 case studies were selected for review. Typically, the frequency of Chuna therapy was 1-2 times/week. The most common period of treatment was 12 months in RCTs and 3-6 months in case studies. Cobb's angle was the most frequent evaluation index used (11 RCTs and 20 case studies). In control groups, brace treatment was used in 8 RCTs. In 6 RCTs and 20 case studies, Cobb's angle significantly decreased after Chuna therapy, and in 4 RCTs, Chuna therapy was as effective as brace treatment, with no significant difference between groups. Adverse events were not reported except for minor reactions in only 3 case studies. This review suggested that Chuna therapy for adolescent idiopathic scoliosis was more advantageous than and as effective as brace treatment in most cases, although the risk of bias in 13 RCTs was unclear.
This study analyzed randomized controlled trials (RCTs) and case studies investigating Chuna manual therapy and variations of this term, for adolescent idiopathic scoliosis. On June $15^{th}$, 2019, 6 online databases were used to retrieve studies. A total of 527 articles were retrieved, and 14 RCTs and 20 case studies were selected for review. Typically, the frequency of Chuna therapy was 1-2 times/week. The most common period of treatment was 12 months in RCTs and 3-6 months in case studies. Cobb's angle was the most frequent evaluation index used (11 RCTs and 20 case studies). In control groups, brace treatment was used in 8 RCTs. In 6 RCTs and 20 case studies, Cobb's angle significantly decreased after Chuna therapy, and in 4 RCTs, Chuna therapy was as effective as brace treatment, with no significant difference between groups. Adverse events were not reported except for minor reactions in only 3 case studies. This review suggested that Chuna therapy for adolescent idiopathic scoliosis was more advantageous than and as effective as brace treatment in most cases, although the risk of bias in 13 RCTs was unclear.
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문제 정의
Brace treatment is considered a typical method of conservative treatment for AIS. Therefore, this review mainly focused on differences in efficacy between Chuna manual therapy and brace treatment.
제안 방법
Chuna manual therapy had higher compliance, and less psychological sequela, and improved pulmonary function and muscle balance compared with other common treatments for AIS. This review has limitations due to the absence of a consensus naming of manipulation therapy, and outcome measures. A more detailed classification is needed to name various treatment methods of Chuna manual therapy more accurately.
대상 데이터
A total of 527 studies were retrieved from 6 online databases. After removal of duplicates and screening articles to remove studies not related to Chuna manual therapy for AIS, 82 studies were analyzed, and 28 studies (14 RCTs and 20 case studies) were included for data analysis in this review (Tables 1 and 2).
Among the 14 RCTs, there were 2 RCTs with less than 20 patients, 6 RCTs with 50 or more but fewer than 100 cases, and 6 RCTs with more than 100 patients. Among the 14 RCTs there were 1,134 patients in total. In 11 RCTs there were 312 males and 570 females (3 RCTs did not report the gender ratio).
In a single study, 1-5 evaluation indices were used. In RCTs, 1,134 patients were evaluated for 11 indicators. Eleven RCTs (79%) used Cobb’s angle as the evaluation index.
In order to investigate the efficacy of Chuna manual therapy for AIS, searches were performed in the following databases to analyze studies published up until June 15, 2019: PubMed/MEDLINE, Cochrane Library, and China National Knowledge Infrastructure for international publications, and the National Digital Science Library, Research Information Sharing Service and Oriental Medicine Advanced Searching Integrated System for Korean publications. The following keywords were used for the database searches with minor adjustments for each database: “scoliosis,” “idiopathic scoliosis,” “adolescent scoliosis,” “adolescent idiopathic scoliosis” and “Chuna,” “Tuina,” “chiropractic,” “manipulation.
There were 14 of 20 case studies that consisted of less than 10 cases, 1 case study had 12 patients, and 4 case studies had 30 or more cases. Of the total 20 case reports there were 193 patients (60 males and 133 females).
In cases of inconsistency, a third party participated and decided whether to include articles by consensus. There were 34 articles included in this review (14 RCTs, and 20 case reports) (Fig. 1).
There were 66 dropouts in 14 RCTs. One RCT [17] had 17 dropouts out of 140 patients involved, and the reason given was they could not finish the treatment course.
To analyze the efficacy of Chuna manual therapy for AIS, 6 online databases were used, and 34 clinical studies were selected for systematic review in this study. Interestingly, 26 studies were performed in the last decade, indicating an increasing interest in this area.
이론/모형
All 20 case studies used Cobb’s angle as the main index.
Eleven RCTs (79%) used Cobb’s angle as the evaluation index.
In this review, the risk of bias was evaluated using Cochrane’s risk of bias tool.
To show lumbar function, the Roland Morris Disability Questionnaire, range of motion, and torso muscle strength were used in 1 study. The Self-Rating Depression Scale score, and Self-Rating Anxiety Scale scores appeared in 1 RCT, and the Scoliosis Quality of Life Index was used in 1 RCT.
The risk of bias in RCTs was assessed using the Cochrane risk of bias tool.
The risk of bias was assessed for 34 studies using the Cochrane risk of bias tool (Figs. 5 and 6).
The Visual Analogue Scale (VAS) was used for subjective pain< in 3 RCTs (21%). To show lumbar function, the Roland Morris Disability Questionnaire, range of motion, and torso muscle strength were used in 1 study. The Self-Rating Depression Scale score, and Self-Rating Anxiety Scale scores appeared in 1 RCT, and the Scoliosis Quality of Life Index was used in 1 RCT.
성능/효과
Three RCTs (21%) did not use Cobb’s angle as an evaluation index, but reported changes in other criteria. Muscle imbalance was measured by average electromyogram ratio of the surface electromyogram in 5 RCTs (36%), and pulmonary function was measured by vital capacity, the percentage of forced expiratory volume in 1 second of forced vital capacity, and chase volume per minute in 4 RCTs (29%). The Visual Analogue Scale (VAS) was used for subjective pain< in 3 RCTs (21%).
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