The efficacy of traction for back and neck pain: a systematic, blinded review of randomized clinical trial methods.
OBJECTIVE
The purpose of this study was to conduct a systematic analysis of the literature to assess the efficacy of traction for patients with neck or back pain.


METHODS
For this purpose, randomized clinical trials comparing traction with other treatments were selected.


METHODS
A computer-aided search of the literature was conducted for relevant articles, followed by blinded assessment of the methods of the studies. The main outcome measures were (1) scoring for quality of the designated conduct of studies (based on a methodological checklist with four main categories: study population, interventions, measurement of effect, and data presentation) and the main conclusions of author(s) with regard to traction and (2) calculation of confidence intervals and power of the studies.


RESULTS
Only three studies scored more than 50 points (maximum score = 100 points), suggesting that most of the selected studies were of poor quality. None of these three studies showed favorable results for traction. Only four studies, of which one scored more than 50 points, had an acceptable power (1- beta > 80%).


CONCLUSIONS
The available reports of studies on the efficacy of traction for back and neck pain do not allow clear conclusions due to the methodological flaws in their design and conduct. Most studies lacked power (1-beta) due to small sample sizes. To date, no conclusions can be drawn about whether a specific traction modality for back or neck pain is effective, or more efficacious than other treatments. There are no clear indications, however, that traction is an ineffective therapy for back and neck pain. Further trials are needed in which much more attention should be paid to proper design and conduct, as well as to clear descriptions of crucial methodological features and results.
Department of Epidemiology, University of Limburg, The Netherlands.
G J
GJ
van der Heijden
A J
AJ
Beurskens
B W
BW
Koes
W J
WJ
Assendelft
H C
HC
de Vet
L M
LM
Bouter
D001416:Back Pain / Q000628:therapy*; D015982:Bias; D016001:Confidence Intervals; D006801:Humans; D009333:Neck; D059408:Pain Management; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012107:Research Design; D016037:Single-Blind Method; D014143:Traction; D016896:Treatment Outcome