50-65 Research Reviews

Cherkin DC, Eisenberg D, Sherman KJ, Barlow W, Kaptchuk TJ, Street J et al. Randomized Trial Comparing Traditional Chinese Medical Acupuncture, Therapeutic Massage, and Self-care Education for Chronic Low Back Pain. Arch Intern Med 2001;161(8):1081-8. Summary Two hundred and sixty-two patients aged 20 to 70 years with ‘persistent low back pain’ were randomised to receive ‘Traditional Chinese Medical acupuncture’, massage or self-care educational materials. Up to ten sessions of acupuncture or massage were given over a tenweek period. Primary outcomes were a subjective score on a ‘symptom bothersomeness scale’, and a modified Roland Disability Scale. Outcomes were measured at four weeks, 10 weeks and one year. At 10 weeks massage was superior to self-care in both primary outcome measures. At one year massage was not better than self-care, but was superior to acupuncture. The authors conclude that massage was effective for persistent low back pain. Comment It is not clear from this paper exactly how the statistics were calculated. Mean values for the two primary outcome measures are given, and if the change from baseline is calculated, the self-care group is superior at one year on the disability scale with a numerical reduction of 5.6. The reductions for acupuncture and massage were 4.8 and 5.0 respectively. We are told that massage is superior to acupuncture at one year, yet the difference in the change of scores is only 0.2. On this scale, a change of 2.5 is said to be significant. It is somewhat concerning that the graphs of the changes in the primary outcome measures do not include baseline values, but start at the four week mark. The largest changes had already occurred by this point. What is more concerning is that the results displayed on the graphs are imprecise to the point of being misleading; indeed, in the graph illustrating the changes in the Roland Disability Scale scores, the results for self-care and massage at one year have been reversed, so that the latter appears superior. Furthermore, the figures quoted in the text do not seem to match those in the table of results for the primary outcomes. It is difficult to draw any firm conclusions from this study; however, there does appear to be sufficient detail to refute the authors’ conclusions. At one year, massage did not appear to be superior to the self-care control.