THE EFFICACY OF TRACTION FOR BACK AND NECK PAIN - A SYSTEMATIC, BLINDED REVIEW OF RANDOMIZED CLINICAL-TRIAL METHODS

Background and Purpose. The purpose of this study was to conduct a sys tematic analysis of the literature to assess the efficacy of traction for patients with neck! or back pain. Subjects. For this purpose, rand omized clinical trials comparing traction with other treatments were s elected. Methods. A computer-aided search of the literature was conduc ted for relevant articles, followed by blinded assessment of the metho ds of the studies. The main outcome measures were (I) scoring for qual ity of the designated conduct of studies (based on a methodological ch ecklist with four main categories: study population, interventions, me asurement of effect, and data presentation) and the main conclusions o f author(s) with regard to traction and (2) calculation of confidence intervals and power of the studies. Results. Only three studies scored more than 50 points (maximum score = 100 points), suggesting that mos t of the selected studies were of poor quality. None of these three st udies showed favorable results for traction. Only four studies, of whi ch one scored more than 50 points, had an acceptable power (1-beta>80% ). Conclusion and Discussion. The available reports of studies on the efficacy of traction for back and neck pain do not allow clear conclus ions due to the methodological flaws in their design and conduct. Most studies lacked power (1-beta) due to small sample sizes. To date, no conclusions can be drawn about whether a specific traction modality fo r back or neck pain is effective, or more efficacious than other treat ments. There are no clear indications, however, that traction is an in effective therapy for back and neck pain. Further trials are needed in which much more attention should be paid to proper design and conduct , as well as to clear descriptions of crucial methodological features and results.