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Am Fam Physician. 2006;74(4):651

Clinical Question: Is acupressure more effective than physical therapy for chronic low back pain?

Setting: Outpatient (specialty)

Study Design: Randomized controlled trial (single-blinded)

Allocation: Concealed

Synopsis: The Taiwanese researchers conducting this study enrolled 129 patients who attended an orthopedic clinic for low back pain for at least one month. Based on the Roland and Morris Disability Questionnaire, 63 percent of the enrolled patients had minimal disability, with a score of 0 to 12 out of a possible 24. Using concealed allocation, the researchers assigned the patients to receive six sessions of routine physical therapy or acupressure within one month. Physical therapy could include pelvic manual traction, spinal manipulation, thermotherapy, infrared light therapy, electrical stimulation, or exercise therapy as directed by a physical therapist. Acupressure was administered by one qualified therapist. Analysis was by intention to treat.

Six months after treatment ended, pain, days off from work or school, and satisfaction had improved significantly in the acupressure group. Disability was significantly less in the acupressure group than in the physical therapy group, with an average Roland and Morris score of 2.2 versus 6.7 (P < .0001). Scores on a modified Oswestry Disability Index also were significantly better with acupressure—an average 6.03 points better out of a possible 54 points (P < .001). The number of patients reporting minimal disability was significantly higher using both scoring systems. This study was unblinded, and it is possible that these patients had been exposed previously to acupressure and were likely to respond more favorably to it than to physical therapy. The therapists, however, were blinded to pretreatment assessment.

Bottom Line: Acupressure is significantly more effective than standard physical therapy modalities and exercise at decreasing disability scores and pain in patients with chronic low back pain. (Level of Evidence: 1b)

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

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