The quality of evidence is downgraded by inconsistency (variability in results).
The recommendation attaches a relatively high value on avoiding potential adverse effects of traction.
A Cochrane review [Abstract] 1 included 32 studies with a total of 2762 subjects. For people with mixed symptom patterns (acute, subacute and chronic LBP with and without sciatica), traction made little or no difference in pain intensity, functional status, global improvement or return to work when compared to placebo, sham traction or no treatment (Table 1). Similarly, when comparing the combination of physiotherapy plus traction with physiotherapy alone or when comparing traction with other treatments, traction made little or no difference in pain intensity, functional status or global improvement (Table 2).
For people with LBP with sciatica and acute, subacute or chronic pain, traction had no impact on pain intensity, functional status or global improvement compared with controls and other treatments, as well as when the combination of traction plus physiotherapy was compared with physiotherapy alone.
For chronic LBP without sciatica, traction probably did little or no difference in pain intensity when compared with sham treatment. Adverse effects were reported in seven of the 32 studies. These included increased pain, aggravation of neurological signs and subsequent surgery.
| Table 1. Traction compared with placebo, sham or no treatment for people with low-back pain with and without sciatica | ||
| Outcomes | Effects | No of Participants(studies) |
| Pain intensity | 1 trial showed that there was no difference in pain intensity between the 2 groups (MD -4, 95% CI -17.7 to 9.7). | 60(1) |
| Functional status | Not measured. | |
| Global improvement | 1 trial showed that there was no difference in global improvement between the 2 groups (RD 0.06, 95% CI -0.16 to 0.28) | 81(1) |
| Return to work | Not measured. | |
| 1 trial reported aggravation of neurological signs in 28% of the traction group, 20% of the light traction group and 20% of the placebo group. | ||
| Table 2. Traction compared with any other treatment for people with low-back pain with and without sciatica | ||
| Outcomes | Effects | No of Participants(studies) |
| Pain intensity | 3 trials, of which 1 compared traction with 2 other types of treatment, showed no difference greater than 5 points on the VAS scale between the 2 groups (MD -2.90 (95% CI -8.53 to 2.93) to 4.50 (95% CI -0.45 to 9.45). | 304(3) |
| Functional status | 3 trials, of which 1 compared traction to 2 other types of treatment and used 2 types of questionnaires to assess functional status, showed no difference between the 2 groups (SMD -0.08 (95% CI -0.39 to 0.23) to 0.51 (95% CI -0.12 to 1.14)). | 350(3) |
| Global improvement | 1 trial showed no difference in global improvement (RD 0.05, 95% CI -0.1 to 0.2). | 42(1) |
| Return to work | Not measured. | |
| Adverse effects | 1 trial reported temporary deterioration of low-back pain in 17% of the traction group and 15% of the exercise group. | |
Date of latest search: 2013-05-13
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