The efficacy of traction for back and neck pain: a systematic, blinded review of randomized clinical trial methods

Department of Epidemiology, University of Limburg, The Netherlands.

BACKGROUND AND PURPOSE. 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. SUBJECTS. 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%). CONCLUSION AND DISCUSSION. 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.

This article has been cited by other articles:

				R. Chou and L. H. Huffman Nonpharmacologic Therapies for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline Ann Intern Med, October 2, 2007; 147(7): 492 - 504. [Abstract] [Full Text] [PDF]

				A. I Binder Cervical spondylosis and neck pain BMJ, March 10, 2007; 334(7592): 527 - 531. [Full Text] [PDF]

				F. H. Shen, D. Samartzis, and G. B.J. Andersson Nonsurgical Management of Acute and Chronic Low Back Pain J. Am. Acad. Ortho. Surg., August 1, 2006; 14(8): 477 - 487. [Abstract] [Full Text] [PDF]

				S. Carette and M. G. Fehlings Cervical Radiculopathy N. Engl. J. Med., July 28, 2005; 353(4): 392 - 399. [Full Text] [PDF]

				A. B. Douglass and E. T. Bope Evaluation and Treatment of Posterior Neck Pain in Family Practice J Am Board Fam Med, November 1, 2004; 17(suppl_1): S13 - S22. [Abstract] [Full Text] [PDF]

				E. L. Hurwitz, H. Morgenstern, P. Harber, G. F. Kominski, F. Yu, and A. H. Adams A Randomized Trial of Chiropractic Manipulation and Mobilization for Patients With Neck Pain: Clinical Outcomes From the UCLA Neck-Pain Study Am J Public Health, October 1, 2002; 92(10): 1634 - 1641. [Abstract] [Full Text] [PDF]

				D. Smith, N. McMurray, and P. Disler Early intervention for acute back injury: can we finally develop an evidence-based approach? Clinical Rehabilitation, January 1, 2002; 16(1): 1 - 11. [Abstract] [PDF]

				K. Mounce Back pain Rheumatology, January 1, 2002; 41(1): 1 - 5. [Full Text] [PDF]

				Philadelphia Panel Members, Clinical Specialty Experts, J. Albright, R. Allman, R. P. Bonfiglio, A. Conill, B. Dobkin, A. A Guccione, S. M Hasson, R. Russo, et al. Philadelphia Panel Evidence-Based Clinical Practice Guidelines on Selected Rehabilitation Interventions for Low Back Pain Physical Therapy, October 1, 2001; 81(10): 1641 - 1674. [Abstract] [Full Text] [PDF]

				Philadelphia Panel Members, Clinical Specialty Experts, J. Albright, R. Allman, R. P. Bonfiglio, A. Conill, B. Dobkin, A. A Guccione, S. M Hasson, R. Russo, et al. Philadelphia Panel Evidence-Based Clinical Practice Guidelines on Selected Rehabilitation Interventions for Neck Pain Physical Therapy, October 1, 2001; 81(10): 1701 - 1717. [Abstract] [Full Text] [PDF]

				L. C Li and C. Bombardier Physical Therapy Management of Low Back Pain: An Exploratory Survey of Therapist Approaches Physical Therapy, April 1, 2001; 81(4): 1018 - 1028. [Abstract] [Full Text] [PDF]

				B. W Koes, R. J P M Scholten, J. M A Mens, and L. M Bouter Efficacy of non-steroidal anti-inflammatory drugs for low back pain: a systematic review of randomised clinical trials Ann Rheum Dis, April 1, 1997; 56(4): 214 - 223. [Abstract] [Full Text]