The efficacy of traction for back pain: A systematic review of randomised controlled trials

Objective: To assess the efficacy of traction for patients with low back pain (LBP) with or without radiating pain, taking into account the clinical technique or parameters used.Data Sources: A computer-aided search of MEDLINE, CI- NAHL, AMED, and the Cochrane Collaboration was con- ducted for randomized controlled trials (RCTs) in the English language, from 1966 to December 2001.Study Selection: RCTs were included if: participants were over the age of 18 years, with LBP with or without radiating pain; the intervention group received traction as the main or sole treatment; the comparison group received sham traction or another conservative treatment; and the study used 1 of 4 primary outcome measures.Data Extraction: The study was conducted in 2 strands. Strand 1 assessed methodologic quality using a specific criteria list recommended by the Cochrane Back Review Group. The strength of the evidence was then rated using the Agency for Health Care Policy and Research system. Strand 2 applied further inclusion criteria based on recommended clinical pa- rameters. One reviewer conducted the selection and data ex- traction.Data Synthesis: Strand 1: 1 study scored 9 points (maxi- mum score, 10 points); the other 12 scored between 0 and 3 points, indicating that most were of poor quality. Nine studies reported negative findings, but only 1 study was of a high quality. Three studies reported positive findings and 1 study was inconclusive. Strand 2: only 4 trials having low method- ologic quality were included, 2 of which reported negative findings, and 2 positive findings.Conclusion: The evidence for the use of traction in LBP remains inconclusive because of the continued lack of meth- odologic rigor and the limited application of clinical parame- ters as used in clinical practice. Further trials, which give attention to these areas, are needed before any firm conclusions and recommendations may be made.