Abstract:
BACKGROUND:Currently, there is a need for scientific evidence on the efficacy of classical massage therapy for chronic, unspecific back pain, especially for the improvement in functional impairment and long-term pain reduction. According to the National Health Care Guidelines, classical massage for nonspecific low back pain may only be prescribed in combination with exercise therapy and a share of the remuneration. Acupuncture, on the other hand, is recognised in the guidelines as an independent treatment for chronic back pain and is remunerated by health insurance companies. This raises the question of whether classical massage therapy is not inferior compared to acupuncture, based on the therapy of the GERAC study. The Clinic of Naturopathy in Blankenstein, Hattingen uses classical massage therapy subjectively successfully in patients with back pain. To objectify the success of the treatment, a randomised controlled, non-inferiority study was conducted. METHODS:The efficacy of classical massage (KMT, n = 66) was compared with acupuncture therapy (AKU, n = 66) in patients with chronic back pain. The primary endpoint was the non-inferiority of classical massage compared with the acupuncture treatment in respect of the impairment in everyday life, with the help of the Hannover function questionnaire (HFAQ) and the reduction in pain ("Von Korff"-Questionnaire) at the follow-up after one month. RESULTS:In the per-protocol analysis during the period between enrollment in the study and follow-up, the responder rate of the KMT was 56.5% and thus tended to be inferior to the responder rate of the AKU with 62.5% (Δ = - 6%; KIΔ: - 23.5 to + 11.4%). CONCLUSIONS:The results show that classical massage therapy is not significantly inferior to acupuncture therapy in the period from admission to follow-up. Thus, the non-inferiority of the KMT to the AKU cannot be proven in the context of the defined irrelevance area. HINTERGRUND:Es besteht derzeit ein Bedarf an wissenschaftlichen Nachweisen zur Wirksamkeit der klassischen Massagetherapie bei chronischen, unspezifischen Rückenschmerzen in der Verbesserung der Funktionseinschränkung und der Schmerzminderung im Langzeiteffekt. Laut den nationalen Versorgungsleitlinien darf die klassische Massage bei nicht spezifischen Kreuzschmerzen nur in Kombination mit Bewegungstherapie und einem Eigenanteil der Vergütung verordnet werden. Die Akupunktur hingegen wird in den Leitlinien als eigenständige Therapie bei chronischen Rückenschmerzen anerkannt und von den Krankenkassen vergütet. In der Naturheilkundeklinik der Klinik Blankenstein in Hattingen wird die klassische Massagetherapie bei Patienten mit Rückenschmerzen subjektiv erfolgreich eingesetzt. Es stellt sich daher die Frage, ob die klassische Massagetherapie der Akupunktur, angelehnt an die Therapie der GERAC-Studie, nicht unterlegen ist. Um die Behandlungserfolge der Klinik Blankenstein zu objektivieren, wurde eine randomisiert kontrollierte Nichtunterlegenheitsstudie durchgeführt. METHODEN:Bei stationären Patientinnen mit chronischen Rückenschmerzen wurde die Wirksamkeit der klassischen Massagetherapie (KMT, n = 66) mit der Akupunkturtherapie (AKU, n = 66) verglichen. Primäres Zielkriterium war die Nichtunterlegenheit der klassischen Massage gegenüber der Akupunkturbehandlung in Bezug auf die Funktionseinschränkung im Alltag mithilfe des Hannover-Funktionsfragebogens (HFAQ) und der Reduktion der Schmerzintensität (Von-Korff-Fragebogen) beim Follow-up nach 1 Monat. ERGEBNISSE:In der Per-Protocol-Analyse im Zeitraum zwischen Aufnahme in die Studie und Follow-up ist die Responder-Rate der KMT mit 56,5% kleiner als die Responder-Rate der AKU mit 62,5% (Δ = − 6%; KIΔ: − 23,5 bis + 11,4%) und der AKU somit tendenziell unterlegen. SCHLUSSFOLGERUNGEN:Die Ergebnisse zeigen, dass die klassische Massagetherapie der Akupunkturtherapie in der Zeitspanne von Aufnahme bis Follow-up nicht signifikant unterlegen ist. Im Rahmen des festgelegten Irrelevanzbereichs lässt sich die Nichtunterlegenheit der KMT gegenüber der AKU nicht beweisen.
journal_name
Z Orthop Unfalljournal_title
Zeitschrift fur Orthopadie und Unfallchirurgieauthors
Klassen E,Wiebelitz KR,Beer AMdoi
10.1055/a-0715-2332subject
Has Abstractpub_date
2019-06-01 00:00:00pages
263-269issue
3eissn
1864-6697issn
1864-6743journal_volume
157pub_type
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