Integrative treatment for low back pain: An exploratory systematic review and meta-analysis of randomized controlled trials.
OBJECTIVE
Low back pain (LBP) is a common musculoskeletal condition often treated using integrative medicine (IM). Most reviews have focused on a single complementary and alternative medicine (CAM) therapy for LBP rather than evaluating wider integrative approaches. This exploratory systematic review aimed to identify randomized controlled trials (RCTs) and provide evidence on the effectiveness, cost effectiveness and adverse effects of integrative treatment for LBP.


METHODS
A literature search was conducted in 12 English and Chinese databases. RCTs evaluating an integrative treatment for musculoskeletal related LBP were included. Reporting, methodological quality and relevant clinical characteristics were assessed and appraised. Metaanalyses were performed for outcomes where trials were sufficiently homogenous.


RESULTS
Fifty-six RCTs were identified evaluating integrative treatment for LBP. Although reporting and methodological qualities were poor, meta-analysis showed a favourable effect for integrative treatment over conventional and CAM treatment for back pain and function at 3 months or less follow-up. Two trials investigated costs, reporting £ 5332 per quality adjusted life years with 6 Alexander technique lessons plus exercise at 12 months follow-up; and an increased total costs of $244 when giving an additional up to 15 sessions of CAM package of care at 12 weeks. Sixteen trials mentioned safety; no severe adverse effects were reported.


CONCLUSIONS
Integrative treatment that combines CAM with conventional therapies appeared to have beneficial effects on pain and function. However, evidence is limited due to heterogeneity, the relatively small numbers available for subgroup analyses and the low methodological quality of the included trials. Identification of studies of true IM was not possible due to lack of reporting of the intervention details (registration No. CRD42013003916).
School of Health and Social Care, London South Bank University, London, UK. hux2@lsbu.ac.uk.
Xiao-Yang
XY
Hu
Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100700, China.
Ni-Ni
NN
Chen
Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100700, China.
Qian-Yun
QY
Chai
Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100700, China.
Guo-Yan
GY
Yang
School of Health and Social Care, London South Bank University, London, UK.
Esmé
E
Trevelyan
School of Health and Social Care, London South Bank University, London, UK.
Ava
A
Lorenc
Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100700, China.
Jian-Ping
JP
Liu
School of Health and Social Care, London South Bank University, London, UK.
Nicola
N
Robinson
exploratory review; integrative medicine; integrative treatment; low back pain; meta-analysis; systematic review