RSS-Feed abonnieren
DOI: 10.1055/s-0031-1273461
© Georg Thieme Verlag KG Stuttgart · New York
Empfehlungen zur Manuellen Therapie bei lumbalen Rückenschmerzen in klinischen Leitlinien
Systematischer ReviewRecommendations for Manual Therapy in Low Back Pain Clinical GuidelinesA Systematic ReviewPublikationsverlauf
Manuskript eingetroffen: 27.10.2010
Manuskript akzeptiert: 1.3.2011
Publikationsdatum:
25. Juli 2011 (online)

Zusammenfassung
Leitlinien gewinnen für Physiotherapeuten und Ärzte bei der Versorgung von Patienten mit lumbalen Rückenschmerzen (LRS) immer mehr an Bedeutung. Frühere Übersichtsarbeiten zeigen, dass die Manuelle Therapie in Leitlinien kontrovers bewertet wurde. Die vorliegende Arbeit untersuchte die Empfehlungen für Manuelle Therapie und deren Grundlage in ab 2001 veröffentlichten klinischen Leitlinien.
Bei Patienten mit akuten und chronischen LRS ist Manuelle Therapie eine leitliniengerechte Behandlungsform. Die Empfehlungen der Leitlinien sind aber sehr unspezifisch und bieten dem Nutzer nur eine geringe Unterstützung bei der klinischen Entscheidungsfindung. Für bessere und spezifischere Leitlinienempfehlungen ist mehr und einträglichere Forschung erforderlich.
Abstract
Clinical guidelines are gaining increasing importance for physiotherapists and physicians in the care of patients with low back pain (LBP). Previous reviews show that manual therapy is discussed controversially in these guidelines. This article investigated recommendations for manual therapy and their basis in clinical guidelines published from 2001 onwards.
In acute and chronic LBP manual therapy is a guideline-compatible treatment option. However, the guidelines are very unspecific and hardly support the user in clinical decision making. More research and better evidence is needed to strengthen and specify guideline recommendations for the use of manual therapy.
Schlüsselwörter
klinische Leitlinien - lumbale Rückenschmerzen - Manuelle Therapie - spinale Manipulationen - systematischer Review
Key words
clinical guidelines - low back pain - manual therapy - spinal manipulation - systematic review
Literatur
- 1 AGREE Collaboration .Checkliste zur Qualitätsbeurteilung von Leitlinien (AGREE-Instrument) - Deutschsprachige
Version. 2001 http://www.agreecollaboration.org/pdf/de.pdf
Reference Ris Wihthout Link
- 2
AGREE Collaboration .
Development and validation of an international appraisal instrument for assessing
the quality of clinical practice guidelines: the AGREE project.
Qual Saf Health Care.
2003;
12
18-23
Reference Ris Wihthout Link
- 3 Airaksinen O, Brox J I, Cedraschi C et al. Chapter 4. European guidelines for the management of chronic non specific low back
pain. 2004 DOI: www.backpaineurope.org/web/files/WG2_Guidelines.pdf (Europa)
Reference Ris Wihthout Link
- 4
Arnau J M, Vallano A, Lopez A et al.
A critical review of guidelines for low back pain treatment.
Eur Spine J.
2006;
15
543-553
Reference Ris Wihthout Link
- 5 Ashton J, Butler M, Bridge et al. New Zealand Acute Low Back Pain Guide. 2004 http://www.nzgg.org.nz/guidelines/0072/acc1038_col.pdf
Reference Ris Wihthout Link
- 6
Assendelft W JJ, Morten S C, Yu E I et al.
Spinal Manipulative Therapy for Low Back Pain.
Chochrane Database Syst Rev.
2004;
1
CD000447
Reference Ris Wihthout Link
- 7
Borkan J M, Koes B, Reis S et al.
A report from the Second International Forum for Primary Care Research on Low Back
Pain. Reexamining priorities.
Spine.
1998;
23
1992-1996
Reference Ris Wihthout Link
- 8 Boyling J D, Jull G A. Grieve’s Modern Manual Therapy. The Vertebral Column. Edingburgh: Churchill Livingstone; 2004
Reference Ris Wihthout Link
- 9 Brooks P, March L, Bogduk N et al. Evidence-Based Management of Acute Musculoskeletal Pain. A Guide for Clinicians. Brisbane: Australian Academic Press; 2004 http://www.nhmrc.gov.au/publications/synopses/cp94syn.htm
Reference Ris Wihthout Link
- 10 Bundesärztekammer (BÄK), Kassenärztliche Vereinigung (KBV), Arbeitsgemeinschaft der
wissenschaftlichen Medizinischen Gesellschaften (AWMF) .Versorgungsleitlinie Kreuzschmerz. 2010 http://www.versorgungsleitlinien.de/themen/kreuzschmerz
Reference Ris Wihthout Link
- 11
Cherkin D C, Sherman K J, Deyo R A et al.
A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage
therapy and spinal manipulation for back pain.
Ann Intern Med.
2003;
138
898-906
Reference Ris Wihthout Link
- 12
Childs J D, Fritz M J, Flynn T W et al.
A Clinical Prediction Rule to Identify Patients with Low Back Pain Most Likely to
Benefit from Spinal Manipulation: A Validation Study.
Ann Int Med.
2004;
141
920-928
Reference Ris Wihthout Link
- 13
Craig P, Dieppe P, Macintyre S et al.
Medical Research Council Guidance. Developing and evaluating complex interventions:
the new Medical Research Council guidance.
BMJ.
2008;
337
979-983
Reference Ris Wihthout Link
- 14
Deyo R A.
Diagnostic evaluation of LBP: reaching a specific diagnosis is often impossible.
Arch Intern Med.
2002;
162
1444-1447
Reference Ris Wihthout Link
- 15
Evans D W, Lucas N.
What is „manipulation”? A reappraisal.
Manual Therapy.
2010;
15
286-229
Reference Ris Wihthout Link
- 16 Field M J, Lohr K N. Guidelines for clinical practice. From development to use. Washington (DC): National Academy Press; 1992
Reference Ris Wihthout Link
- 17
Flynn T, Fritz J, Whitman J et al.
A Clinical Prediction Rule for Classifying Patients with Low Back Pain Who Demonstrate
Short-Term Improvement with Spinal Manipulation.
Spine.
2002;
24
2835-2843
Reference Ris Wihthout Link
- 18
Fritz J M, Cleland J A, Childs J D.
Subgrouping Patients with Low Back Pain: Evolution of a Classification Approach to
Physical Therapy.
J Orthop Sports Phys Ther.
2007;
37
290-302
Reference Ris Wihthout Link
- 19
Hancock M J, Maher C G, Latimer J et al.
Independent evaluation of a clinical prediction rule for spinal manipulative therapy:
a randomized controlled trial.
Eur Spine J.
2008;
17
936-943
Reference Ris Wihthout Link
- 20 Heijmans W FGJ, Hendriks H JM, Esch van der M et al. KNGF-Guideline. Manual Therapy on low back pain. 2003 http://www.kngfrichtlijnen.nl/downloads/Manual_Therapy_in_case_of_Low_Back_Pain_Guideline.pdf
Reference Ris Wihthout Link
- 21 Institue of Health Economics .Ambassador Program Guideline for the Management of Low Back Pain. Background Document. 2009 http://www.ihe.ca/research/ambassador-program/--low-back-pain/methods
Reference Ris Wihthout Link
- 22 Institute of Health Economics .Guideline for the Evidence-Informed Primary Care Management of Low Back Pain. 2009 http://www.topalbertadoctors.org/informed_practice/clinical_practice_guidelines/complete%20set/Low%20Back%20Pain/backpain_guideline.pdf
Reference Ris Wihthout Link
- 23 International Federation of Orthopaedic Manipulative Therapists .Standards dokumentieren. 2005 http://www.ifomt.org/pdf/Standards_Document_dtFinalVersion.pdf
Reference Ris Wihthout Link
- 24
Kamper S J, Maher C G, Hancock M J et al.
Treatment-Based subgroups of low back pain: A guide to appraisal of research studies
and a summary of current evidence.
Best Pract Res Clin Rheumatol.
2010;
24
181-191
Reference Ris Wihthout Link
- 25
Koes B W, Tulder van M, Ostelo R et al.
Clinical guidelines for the management of low back pain in primary care: an international
comparison.
Spine.
2001;
26
2504-2513
Reference Ris Wihthout Link
- 26
Koes B W, Tulder van M, Lin C W et al.
An updated overview of clinical guidelines for the management of non-specific low
back pain in primary care.
Eur Spine J.
2010;
DOI: 10.1007 /s00586-010-1502-y
Reference Ris Wihthout Link
- 27
Kunz R, Burnand B, Schünemann H J.
Das GRADE-System. Ein internationaler Ansatz zur Vereinheitlichung der Graduierung
von Evidenz und Empfehlungen in Leitlinien.
Internist.
2008;
49
673-680
Reference Ris Wihthout Link
- 28 Laerum E, Dullerud R, Kirksola G et al. Acute low back pain. Interdisciplinary clinical guidelines. Oslo: The Norwegian Back Pain Network; 2002 http://www.ifomt.org/pdf/Norway_Acute_Low_Back.pdf
Reference Ris Wihthout Link
- 29
May S, Littlewood C, Bishop A.
Reliability of procedures used in the physical examination of non-specific low back
pain: A systematic review.
Aust J Physioth.
2006;
52
91-102
Reference Ris Wihthout Link
- 30
May S, Rosedale R.
Prescriptive Clinical Prediction Rules in Back Pain Research: A Systematic Review.
J Man Manip Ther.
2009;
17
36-45
Reference Ris Wihthout Link
- 31
McCarthy C H, Arnall F A, Strimpakos N et al.
The biopsychosocial classification of non-specific low back pain: a systematic review.
Physical Therapy Reviews.
2004;
9
17-30
Reference Ris Wihthout Link
- 32
McCarthy C, Keating J L, Kent P M et al.
Targeted manual therapy for non-specific low-back pain (Protocol).
Cochrane Database of Systematic Reviews.
2010;
Issue 3
CD007135.
DOI: 10.1002 / 14 651858.CD 007 135
Reference Ris Wihthout Link
- 33
Murphy A Y, Teijlingen E R, Gobbi M O.
Inconsistent grading of evidence across countries: a review of low back pain guidelines.
J Manipulative Physiol Ther.
2006;
29
576-581
Reference Ris Wihthout Link
- 34 National Institute for Health and Clinical Excellence .The Guidelines Manual. 2009 http://www.nice.org.uk/media/5F2/44/The_guidelines_manual_2009_-_All_chapters.pdf
Reference Ris Wihthout Link
- 35
Negrini van S, Giovannoni S, Minozzi S et al.
Diagnostic therapeutic flow-charts for low back pain patients: the Italian clinical
guidelines.
Eura Medicophys.
2006;
42
151-170.
www.minervamedica.it/en/journals/europa-medicophysica/article.php?cod=R33Y2006N02A0151
Reference Ris Wihthout Link
- 36 Savigny P, Kuntze S, Watson P et al. Low Back Pain: early management of persistent non-specific low back pain. London: National Collaborating Centre for Primary Care and Royal College of General Practitioners; 2009 http://www.guidance.nice.org.uk/CG88
Reference Ris Wihthout Link
- 37
Schmidt C O, Raspe H, Pfingsten M et al.
Back Pain in the German Adult Population: Prevalence, Severity, and Sociodemographic
Correlates in a Multiregional survey.
Spine.
2007;
15
2005-2011
Reference Ris Wihthout Link
- 38
Shapiro C M.
Comment on: Spinal Manipulation for Low Back Pain.
Ann Intern Med.
2004;
140
665
Reference Ris Wihthout Link
- 39
Shekelle P G, Adams A H, Chassin M R et al.
Spinal manipulation for low back pain.
Ann Int Med.
1992;
117
590-598
Reference Ris Wihthout Link
- 40
Stanton T R, Hancock M J, Maher C G et al.
Critical Appraisal of Clinical Prediction Rules That Aim to Optimize Treatment Selection
for Musculoskeletal Conditions.
Phys Ther.
2010;
90
843-854
Reference Ris Wihthout Link
- 41 Thorson D C, Bonsell J, Hecht S et al. ICSI Institute for Clinical System Improvement. Health care guideline. Adult low back
pain. 2008 http://www.icsi.org/low_back_pain/adult_low_back_pain__8.html
Reference Ris Wihthout Link
- 42
Van Tulder M, Koes B W, Bouter L M.
Conservative treatment of acute and chronic non-specific low back pain: a systematic
review of randomised controlled trials of the most common interventions.
Spine.
1997;
22
2128-2156
Reference Ris Wihthout Link
- 43 Van Tulder M, Becker A, Bekkering T et al. Chapter 3. European guidelines for the management of acute nonspecific low back pain
in primary care. 2004 http://www.backpaineurope.org/web/files/WG1_Guidelines.pdf
Reference Ris Wihthout Link
- 44
UK BEAM Trial Team .
United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: Cost
effectiveness of physical treatments for back pain in primary care.
BMJ.
2004;
329
1381-1385
Reference Ris Wihthout Link
Johannes Grothues
B.Sc. PT, HAWK Hochschule für Angewandte Wissenschaft und Kunst Hildesheim, Fakultät
Soziale Arbeit und Gesundheit
eMail: J.Grothues@gmx.de