The effects of the addition of mechanical traction to physical therapy on low back pain? A systematic review with meta-analysis.

OBJECTIVE: This study aimed to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) on the comparative effects of different types or parameters of lumbar traction in low back pain (LBP). METHODS: CENTRAL, CINAHL, ISI Web of Science, PEDro, PubMed, and Scopus databases were searched from their inception to March 31, 2021. We considered all RCTs comparing different types or parameters of lumbar traction on adults who complained of LBP with or without lumbar radiculopathy (LR). Any restriction regarding publication time or language was applied. Two reviewers independently selected the studies, performed the quality assessment, and extracted the results. Meta-analysis employed a random-effects model. RESULTS: Sixteen studies met the inclusion criteria for qualitative analysis, and five were pooled. Meta-analyses of results from five studies on LBP with LR showed no significant difference between diverse tractions modalities at short-term follow-up. Very low to low-quality evidence supports these results. High-force and low-force traction demonstrated clinically significant improvements in pain. CONCLUSION: The literature suggests the short-term effectiveness of traction on pain in LBP with LR, regardless of the type or the dosage employed. Different effects of traction other the mechanical ones can be hypothesized. This systematic review may be relevant for clinical practice due to the similar effects of different traction types or dosages. LEVEL OF EVIDENCE: Level I, Therapeutic Study.

Vertical traction for lumbar radiculopathy: a systematic review.

BACKGROUND: Only low-quality evidence is currently available to support the effectiveness of different traction modalities in the treatment of lumbar radiculopathy (LR). Yet, traction is still very commonly used in clinical practice. Some authors have suggested that the subgroup of patients presenting signs and symptoms of nerve root compression and unresponsive to movements centralizing symptoms may benefit from lumbar traction. The aim of this study is to conduct a systematic review of randomized controlled trials (RCTs) on the effects of vertical traction (VT) on pain and activity limitation in patients affected by LR. METHODS: We searched the Cochrane Controlled Trials Register, PubMed, CINAHL, Scopus, ISI Web of Science and PEDro from their inception to March 31, 2019 to retrieve RCTs on adults with LR using VT to reduce pain and activity limitation. We considered only trials reporting complete data on outcomes. Two reviewers selected the studies, extracted the results, and performed the quality assessment using the Risk of Bias and GRADE tools. RESULTS: Three studies met the inclusion criteria. Meta-analysis was not possible due to the heterogeneity of the included studies. We found very low quality evidence for a large effect of VT added to bed rest when compared to bed rest alone (g = - 1.01; 95% CI = -2.00 to - 0.02). Similarly, VT added to medication may have a large effect on pain relief when compared to medication alone (g = - 1.13; 95% CI = -1.72 to - 0.54, low quality evidence). Effects of VT added to physical therapy on pain relief were very small when compared to physical therapy without VT (g = - 0.14; 95% CI = -1.03 to 0.76, low quality evidence). All reported effects concerned short-term effect up to 3 months post-intervention. CONCLUSIONS: With respect to short-term effects, VT may have a positive effect on pain relief if added to medication or bed rest. Long-term effects of VT are currently unknown. Future higher quality research is very likely to have an important impact on our confidence in the estimate of effect and may change these conclusions.

Effectiveness of Mechanical Traction for Lumbar Radiculopathy: A Systematic Review and Meta-Analysis.

OBJECTIVE: Lumbar radiculopathy (LR) is a pain syndrome caused by compression/irritation of the lumbar nerve root(s). Traction is a well-known and commonly used conservative treatment for LR, although its effectiveness is disputed. The purpose of this systematic review and meta-analysis of randomized controlled trials was to evaluate the effects of different types of traction added to or compared with conservative treatments on pain and disability. METHODS: Data were obtained from CENTRAL, PUBMED, CINAHL, Scopus, ISI Web of Science, and PEDro from their inception to April 2020. All randomized controlled trials on adults with LR, using mechanical traction, and without any restriction regarding publication time or language were considered. Two reviewers selected the studies, evaluated the quality assessment, and extracted the results. Meta-analysis used a random-effects model. Eight studies met the inclusion criteria, and 5 were meta-analyzed. RESULTS: Meta-analyses of results from low-quality studies indicated that supine mechanical traction added to physical therapist treatments had significant effects on pain (g = -0.58 [95% confidence interval = -0.87 to -0.29]) and disability (g = -0.78 [95% confidence interval = -1.45 to -0.11]). Analyses of results from high-quality studies of prone mechanical traction added to physical therapist intervention for pain and disability were not significant. These results were also evident at short-term follow-up (up to 3 months after intervention). CONCLUSION: The literature suggests that, for pain and disability in LR, there is short-term effectiveness of supine mechanical traction when added to physical therapist intervention. IMPACT: This systematic review may be relevant for clinical practice due to its external validity because the treatments and the outcome measures are very similar to those commonly used in a clinical context.