• Juan Yang, Xuan Zhou, Qingyu Ma, Jeffrey T Woods, Arya B Mohabbat, Alexander Do, Jeffrey S Brault, Mark A Jensen, Kyung-Min Shin, Longbin Shen, Canghuan Zhao, Kwok Chee Philip Cheong, Kejie He, Yu Guo, Zhuoming Chen, Shujie Tang, Yong Tang, Celia Ia Choo Tan, Jiaxu Chen, and Brent A Bauer.
• Division of General Internal Medicine, Mayo Clinic, Rochester, MN.
• Medicine (Baltimore). 2023 Mar 3; 102 (9): e33018e33018.

ObjectiveChronic nonspecific low back pain (CNLBP) is a serious medical and social problem resulting in functional decline and decreased work ability. Tuina, a form of manual therapy, has been sparsely used to treat patients with CNLBP. To systematically assess the efficacy and safety of Tuina for patients with CNLBP.MethodsMultiple English and Chinese literature databases were searched until September 2022 for randomized controlled trials (RCTs) of Tuina in the treatment of CNLBP. The methodological quality was assessed using the Cochrane Collaboration's tool, and certainty of the evidence was determined with the online Grading of Recommendations, Assessment, Development and Evaluation tool.ResultsFifteen RCTs with 1390 patients were included. Tuina demonstrated a significant effect on pain (SMD: -0.82; 95% CI -1.12 to -0.53; P < .001; I2 = 81%) and physical function (SMD: -0.91; 95% CI -1.55 to -0.27; P = .005; I2 = 90%) when compared to control. However, Tuina resulted in no significant improvement for quality of life (QoL) (SMD: 0.58; 95% CI -0.04 to 1.21; P = .07; I2 = 73%;) compared to control. The Grading of Recommendations, Assessment, Development and Evaluation evidence quality was determined to be low level for pain relief, physical function, and QoL measurements. Only six studies reported adverse events; none were serious.ConclusionTuina might be an effective and safe strategy for treating CNLBP in terms of pain and physical function, but not for QoL. The study results should be interpreted with caution for their low-level evidence. More multicenter, large-scale RCTs with a rigorous design are required to further confirm our findings.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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