Acupressure Outperforms PT for Low Back Pain 

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

Bottom line
Acupressure was significantly more effective than standard physical therapy modalities and exercise at decreasing disability scores and pain in patients with chronic low back pain. (LOE = 1b)

Reference
Hsieh LL, Kuo CH, Lee LH, Yen AM, Chien KL, Chen TH. Treatment of low back pain by acupressure and physical therapy: randomised controlled trial. BMJ 2006;332:696-700.

Study design
Randomized controlled trial (single-blinded)

Setting
Outpatient (specialty)

Synopsis
The Taiwanese researchers conducting this study enrolled 129 people with low back pain for at least 1 month who attended an orthopedic clinic. Using the Roland and Morris Disability Questionnaire, 63% 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 6 sessions of either routine physical therapy or acupressure within 1 month. Physical therapy could include pelvic manual traction, spinal manipulation, thermotherapy, infrared light therapy, electrical stimulation, and exercise therapy, as directed by a physical therapist. Acupressure therapy was administered by a single acupressure therapist. Analysis was by intention to treat. Six months after treatment ended, pain, days off from work or school, and satisfaction were significantly improved with acupressure. Disability was significantly less in patients treated with acupressure than in those using physical therapy, with an average Roland and Morris score of 2.2 versus 6.7 (P < .0001). Scores on a modified Oswestry Disability Questionnaire 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 Chinese patients had previously been exposed to acupressure and were more likely to respond more favorably to it than to physical therapy. The therapists, however, were blinded to pretreatment assessment.