Vanti C, Panizzolo A, Turone L, et al. Effectiveness of Mechanical Traction for Lumbar Radiculopathy: A Systematic Review and Meta-Analysis. Phys Ther. 2021 Mar 3;101(3). pii: 6056330. doi: 10.1093/ptj/pzaa231. (Systematic review)

OBJECTIVE: Lumbar radiculopathy (LR) is a pain syndrome caused by compression/irritation of the lumbar nerve root(s). Traction is a well-known and commonly used conservative treatment for LR, although its effectiveness is disputed. The purpose of this systematic review and meta-analysis of randomized controlled trials was to evaluate the effects of different types of traction added to or compared with conservative treatments on pain and disability.

METHODS: Data were obtained from CENTRAL, PUBMED, CINAHL, Scopus, ISI Web of Science, and PEDro from their inception to April 2020. All randomized controlled trials on adults with LR, using mechanical traction, and without any restriction regarding publication time or language were considered. Two reviewers selected the studies, evaluated the quality assessment, and extracted the results. Meta-analysis used a random-effects model. Eight studies met the inclusion criteria, and 5 were meta-analyzed.

RESULTS: Meta-analyses of results from low-quality studies indicated that supine mechanical traction added to physical therapist treatments had significant effects on pain (g = -0.58 [95% confidence interval = -0.87 to -0.29]) and disability (g = -0.78 [95% confidence interval = -1.45 to -0.11]). Analyses of results from high-quality studies of prone mechanical traction added to physical therapist intervention for pain and disability were not significant. These results were also evident at short-term follow-up (up to 3 months after intervention).

CONCLUSION: The literature suggests that, for pain and disability in LR, there is short-term effectiveness of supine mechanical traction when added to physical therapist intervention.

IMPACT: This systematic review may be relevant for clinical practice due to its external validity because the treatments and the outcome measures are very similar to those commonly used in a clinical context.

Discipline Area Score
Physician 5 / 7
Rehab Clinician (OT/PT) 5 / 7
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Rehab Clinician (OT/PT) rater

Interesting how the article title refers solely to lumbar radiculopathy, yet the key words of the publication include 'low back pain'. Further, it is not clear which state of low back pain was considered, acute or chronic. What springs to mind is the monumental work undertaken by the US Agency for Health Care Policy and Research, publication number 95-0642, December 1994. "Spinal traction is not recommended in the treatment of patients with acute low back problems." Degrees of radiculopathy may arise for a multitude of reasons. Without clear delineation of cause, degree, and severity, it is hard to see the justification of a generalisability of utility in this study.
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