REVIEW
Systematic review and meta-analysis of the efficacy of tuina for
cervical spondylosis
Mei-Yeh Wang, Pei-Shan Tsai, Pi-Hsia Lee, Wen-Yin Chang and Che-Ming Yang
Aims and objectives. This study performed a meta-analysis of seven parallel-group comparison studies evaluating the efficacy of
tuina in treating cervical spondylosis.
Background. Tuina is a form of Chinese manipulative therapy. It has been used as a modality for the treatment of symptoms
associated with such a musculoskeletal condition as cervical spondylosis. However, evidence regarding the efficacy of tuina for
cervical spondylosis has yet to be determined.
Design. Systematic review.
Methods. Cochrane library, Pubmed, MEDLINE, EBM review, ProQuest Medical Bundle and SCOPUS databases were searched using the following medical subject headings or key words: tuina, tuinaology, manual medicine, massotherapy, cervical
spondylopathy, cervical spondylosis and cervical vertebrae. Chinese research papers were searched through the Chinese electronic periodical services and Wangfane database. The publication date was limited from 1996–2007. Studies were selected if
they were written in English or Chinese, used tuina as a stand-alone modality, used a parallel-group comparison design and
explicated raw data regarding symptoms relief. Two independent reviewers reviewed the selected studies based on the evidence
rating system of the US Preventive Services Task Force. Studies with an evidence rating of II-2 fair or above were included in this
review.
Results. The direction of the effect size for the improvement of blood flow velocity of vertebral artery and basilar artery was not
consistent across studies. Moreover, the pooled effect size was negligible. No evidence supported that tuina could improve
headache and vertigo. A small effect of tuina on the viscosity of blood and plasma was found.
Conclusion. Based on the results of this systematic review, a definitive conclusion regarding the effects of tuina on cervical
spondylosis remains to be determined.
Relevance to clinical practice. The efficacy of tuina is not supported by parallel-group comparison studies.
Key words: complementary alternative medicines, literature review, nurses, nursing, Taiwan, tuina
Accepted for publication: 24 March 2008
Introduction
Cervical spondylosis is a chronic disease that commonly
occurs in middle-aged and older people. The symptoms of
cervical spondylosis might seriously affect the patients’ work
Authors: Mei-Yeh Wang, MSN, Doctoral Student, Graduate Institute
of Medical Sciences, College of Medicine, Taipei Medical University,
Taipei, Taiwan, Instructor, Cardinal Tien College of Healthcare and
Management, Taipei, Taiwan; Pei-Shan Tsai, PhD, Associate
Professor, College of Nursing, Taipei Medical University, Taipei,
Taiwan; Pi-Hsia Lee, EdD, Associate Professor, College of Nursing,
Taipei Medical University, Taipei, Taiwan; Wen-Yin Chang, PhD,
Associate Professor, College of Nursing, Taipei Medical University,
and quality of life (Sari-Kouzel & Cooper 1999). The
degenerative changes of the cervical spine may cause pressure
on the nerve roots of the spinal cord in the cervical area, the
vertebral artery and the sympathetic nerve (McCormack &
Weinstein 1996). In addition, the blood flow velocity of the
Taipei, Taiwan; Che-Ming Yang, MD, JD, PhD, Associate Professor,
School of Health Care Administration, College of Medicine, Taipei
Medical University, Taipei, Taiwan
Correspondence: Pei-Shan Tsai, Associate Professor, College of
Nursing, Taipei Medical University, 250 Wu Hsing St., Taipei 110,
Taiwan. Telephone: 886 2 27361661.
E-mail: ptsai@tmu.edu.tw
Ó 2008 The Authors. Journal compilation Ó 2008 Blackwell Publishing Ltd, Journal of Clinical Nursing, 17, 2531–2538
doi: 10.1111/j.1365-2702.2008.02446.x
2531
M-Y Wang et al.
vertebral artery may be pathologically reduced because of the
degenerative changes in the cervical spine (Strek et al. 1998).
A decreased blood flow velocity in the basilar artery has been
found to be associated with spondylosis-induced vertebral
arteries compression (Olszewski et al. 2006). An association
between vertebral artery blood flow and vertigo has been
demonstrated by Transcranial Doppler Sonography (TCD)
Examination (Olszewski et al. 2006). The pathology can
often be responsible for a range of symptoms such as
dizziness, vertigo, headache, neck rigidity and numbness
and pain in the shoulders, arms and fingers. In severe cases,
paralysis in the limbs can occur (Zhou et al. 2006).
Traditional Chinese medicine has been used to treat this
condition. For example, beneficial effects of acupuncture in
treating cervical spondylopathy have been reported (Dong
et al. 2005, Wang 2005). In addition to acupuncture, tuina
has also been used. Tuina is a traditional Chinese way of
healing. It belongs to the curative manipulation category of
alternative therapies. The basic modular components of tuina
manipulation including pressing (an), kneading (rou), pushing (tui), grasping and pinching (nanie) and rolling (gun) have
beneficial effects in unblocking the obstructions of blood
circulation of the body (Zhou et al. 2006). Other massage
manoeuvres including poking channels, rolling and rotating
manipulation are adopted to reposition the slight displacement of joints, eliminate swelling and to ease the pressure on
ganglion or other tissues (Li et al. 2006, Ma et al. 2006).
It has been claimed that tuina may alleviate spasm of the
soft tissues, neck and shoulder and compression of cervical
blood vessels (Zhou et al. 2006). Thus, patients often use
tuina as a complementary or alternative treatment for
symptom relief and energy rebalance. However, patients
who believed they were making a free choice might base on
biased resources in the lay literature or limited information
about the use and effectiveness. The efficacy has yet to be
confirmed by rigorous scientific research (Ernst & FughBerman 2002). With patients’ increasing interest in tuina,
nurses should evaluate the efficacy of tuina for treatment of
illness-related symptoms.
Aim
The aim of this review was to provide the first systematic
review and a meta-analysis of trials that assessed the efficacy
of tuina in improving symptoms and the vertebral-basilar
artery blood flow velocity and viscosity in individuals with
cervical spondylosis. The specific tuina technique and dosage
were examined. The results may facilitate both patients and
nursing professionals in making informed decisions regarding
the use of tuina in treating cervical spondylosis.
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Methods
A systematic search of Cochrane library, Pubmed, MEDLINE, EBM review, ProQuest Medical Bundle and SCOPUS
databases of papers published between 1996–2007 was
conducted, using the following medical subject headings or
key words: tuina, tuinaology, manual medicine, massotherapy, cervical spondylopathy, cervical spondylosis and cervical
vertebrae. The Chinese articles were searched through the
Chinese electronic periodical services and Wangfane database. The reference lists of included studies and reviews were
also searched for additional studies.
Inclusion/exclusion criteria and quality assessment
Studies were selected if they were written in English or Chinese,
used tuina as a stand-alone modality, used a parallel-group
comparison design and explicitly presented data regarding
symptoms relief. The evidence rating system of the US Preventive Services Task Force (USPSTE; Harris et al. 2001) was
used to judge the quality of selected studies. Two independent
reviewers reviewed the selected studies. The quality and
strength of the studies were evaluated at two separate
categories: study design and internal validity. Hierarchies of
study design were classified into the following levels:
I: Properly designed randomised controlled trial (RCT).
II-1: Well-designed controlled trials without randomisation.
II-2: Well-designed cohort or case-control analytic studies.
II-3: Multiple time series with or without the intervention.
III: Opinions of authorities, descriptive studies and case
reports.
The degree of internal validity was judged by three
elements of the study design: randomisation, participation
rate and the description of withdrawals and/or dropouts. The
rating is divided into three categories: good, fair and poor. A
good study meets all criteria; a fair study meets some of the
criteria but has no fatal flaw; a poor study contains a fatal
flaw. Studies with the evidence rating of II-2 fair or above
were included in this review. Studies that evaluated a
combination of tuina with other modalities, consisted of
<10 subjects in each group, provide insufficient information
regarding the principal measures of effect, or included a
young-aged group were excluded.
Data synthesis
All outcome variables were assessed for the treatment effect
size. The difference between the post-treatment means
divided by the pooled standard deviation was used as the
principal measurements of effect (Cohen 1988). For those
Ó 2008 The Authors. Journal compilation Ó 2008 Blackwell Publishing Ltd, Journal of Clinical Nursing, 17, 2531–2538
Review
Efficacy of tuina
studies that only provided median, range and sample size,
estimated mean and standard deviations were calculated
following the formula proposed by Hozo et al. (2005). The
principal meta-analysis was restricted to a homogenous
aggregation of the data. Each outcome was computed if
there were at least three primary studies with sufficient data.
The heterogeneity between the trials was assessed and a
random-effects model was adopted to calculate the pooled
effect size. Meta-analytic software (MedCalc Software,
Mariakerke, Belgium) was used to implement the calculation.
For those data that the pooled effect size could not be
computed, the individual effect sizes were presented. Interpretation of effect sizes was judged using the original criteria
of effect magnitude proposed by Cohen (1988). Effects of
0Æ2–0Æ5 described as ‘small’, 0Æ51–0Æ8 described as ‘medium’
0Æ8 and above defined as ‘large’.
Results
Abstraction of articles
The initial search strategy generated 86 studies. After
examining the titles and abstracts, 25 potentially relevant
studies were retrieved. Most of these studies were written in
Chinese (24/25). Two project members who were fluent in
both English and Chinese independently reviewed each of the
identified articles to determine eligibility. A total of 12 studies
were excluded because of testing non-specific massage rather
than tuina or using multiple treatment modalities. The
remaining 13 papers were reviewed for study quality based
on the evidence rating system of the USPSTE (Harris et al.
2001). Two studies with poor internal validity and four
studies with insufficient outcome measurements related
information were not selected. A summary of the excluded
studies is presented in Table 1.
Study quality
A total of seven studies met the II-2 fair rating of methodological quality (Fu & Yuan 2001, Wei 2003, Yi & Song
2003, Zhang et al. 2005, Lin et al. 2006, Shao et al. 2006,
Zhang & He 2006). All studies used a parallel-group
comparison design. Among them, six studies randomised
subjects to the treatment or the control group (Table 2). No
study presented the information regarding the participation
or dropout rate.
Table 1 Overview of the excluded studies
Reasons for excluded
Study (year)
Description
A lack of a comparison group
Shou (1999)
A clinical observation of 40 patients with cervical spondylosis of vertebral
artery type receiving tuina
A clinical observation of 567 cases of with cervical spondylosis receiving tuina
The author only provided the percentages of treatment success, symptom relief,
and treatment failure but did not report the post-treatment means and the
standard deviation
The post-treatment means and the standard deviation were not reported.
p-value for the group comparison was reported. However, information
related to the classification of treatment response was lacking
The author only provided the percentages of treatment success, symptom relief,
and treatment failure but did not report the post-treatment means and the
standard deviations
The authors only provided the percentages of treatment success, symptom relief,
and treatment failure but did not report the post-treatment means and the
standard deviations
Tuina was used in combination with Qigong
Two modalities were employed including tuina and digital acupoint pressure
Two modalities including acupuncture and tuina were used
Two modalities including traction tuina and neck exercise were used
The study evaluated the effect of cervical angle restoration therapy
The study evaluated the effect of maneuver treatment
The study evaluated the effect of maneuver treatment
The study evaluated the effect of maneuver treatment
The study evaluated the effect of Dian-xue massage therapy
The study evaluated the effect of vertebral manipulation therapy
The study evaluated the effect of vernier maneuver treatment
The study evaluated the effect of reposition manipulation
Insufficient outcome
measurements-related
information
Zhang (2006)
Cao (1999)
Zheng et al. (2002)
Shu (2004)
Wang et al. (2006)
Multiple treatment modalities
Testing non-specific massage
rather than tuina
Lu (1996)
Wei (2002)
Lin et al. (2004)
Yuan and Li (2005)
Lin and Lin (2001)
Li (2002)
Qian (2002)
Chan (2004)
Zheng (2004)
Hong et al. (2005)
Luo and Wu (2005)
Xiong (2006)
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Parallel-group
comparison
design (NR)
Parallel-group
comparison
design (yes)
Parallel-group
comparison
design (yes)
Parallel-group
comparison
design (yes)
Parallel-group
comparison
design (yes)
Parallel–group
comparison
design (yes)
Yi and Song (2003)
(China)
Zhang et al. (2005)
(China)
Lin et al. (2006)
(China)
Tuina
manipulation
(1) 240
(2) Intervention:
45Æ8 (25–70)
Control: 50Æ5 (26–72)
(1) 120
(2) 48Æ5 (22–72)
Tuina
manipulation
Routine tuina
manipulation
Intervention: 15
(one day apart)
Control: 15
(one day apart)
Intervention: 10 (5 days a
week for 2 weeks)
Control: 20 (daily)
Intervention: 21 days
Control: 8 mg/day
for 21 days
Intervention: 21 (daily)
Control: 21 (daily)
Intervention:
10 days–10 years
Control: 6 days–13 years
NR
Headache vertigo
(Ques)
Vertigo (Ques)
Blood velocity of BA
and VA (TCD)
YiNao manipulation
Neck traction (3–4 kg)
plus selective calcium
channel blockers
Chinese herb
(Danshen injection)
Headache vertigo
(Ques)
Selective calcium
channel blockers
Blood velocity of BA
and VA (TCD)
Tun Du Acupressure
massage
(1) 110
(2) Intervention:
46Æ8 (14Æ6)
Control: 47Æ6 (15Æ3)
Routine tuina
manipulation
(1) 120
(2) Intervention: 47Æ6
Control: 49Æ3
(1) 160
(2) 47Æ5 (3Æ56)
Headache vertigo
(Ques)
Physical traction
plus pain killers
Intervention: 20 (daily)
Control: 20 (daily)
(1) 234
(2) 44Æ5 (23–75)
Routine tuina
manipulation
Tuina
manipulation
Blood and plasma
viscosity
Chinese herbs
(Danshen injection)
Intervention:
<6 months (9)
6 months to 5 years (17)
>5 years (7)
Control: <6 months (8)
6 months to 5 years (16)
>5 years (5)
0–6 months (91)
6–12 months (71)
>12 months (27)
Intervention: 3–24
months (49)
>2 years (6)
Control: 3–24
months (48)
>2 years (5)
Intervention: 10 days
to 8 years
Control: 7 days–10 years
2 days–6 years
Intervention: 15 (daily)
Control: (16 mg/day
for 15 days)
Yuan style tuina (1) 62
manipulation
(2) Intervention:
NR (20–70)
Control: NR (20–70)
Intervention: 30(daily)
Control: 30 (daily)
Main outcomes
(tools)
Control or comparison
condition(s)
Duration of illness
(subjects)
(1) Subjects N (total)
(2) Age mean
(SD)/mean (range)
No. sessions
(frequency)
Treatment
modality
BA, basilar artery; NR, not reported; TCD, transcranial Doppler sonography; VA, vertebral artery; Ques, questionnaires.
Zhang and
He (2006)
(China)
Shao et al. (2006)
(China)
Wei (2003) (China)
Parallel-group
comparison
design (yes)
Study design
(randomisation:
yes/no)
Fu and Yuan
(2001) (China)
Study (year)
(country)
Table 2 Characteristics of abstracted studies
M-Y Wang et al.
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Efficacy of tuina
Study characteristics
Characteristics of all the studies reviewed are summarised in
Table 2. All the studies were carried out in outpatient settings.
The participants in the studies aged from 20–75 years with the
majority (5/7) of the studies having a mean age in the 40s. The
duration of illness ranged from 3 months–10 years. Three
studies included individuals who were in the acute phase of the
illness (Zhang et al. 2005, Shao et al. 2006, Zhang & He
2006). Tuina was implemented in individuals with the
vertebral artery type of cervical spondylosis in most of the
studies (Fu & Yuan 2001, Wei 2003, Zhang et al. 2005, Shao
et al. 2006, Zhang & He 2006). The effects of tuina on the
nerve root type and the sympathetic nerve type were assessed
in one study (Yi & Song 2003). One study did not describe the
specific subtype of cervical spondylosis examined (Lin et al.
2006). The diagnosis of cervical spondylosis was based on the
diagnostic criteria reported by the State administration of
traditional Chinese medicine of the People’s Republic of China
(1994) in one study (Yi & Song 2003). One study adopted the
diagnostic criteria proposed by the Symposium of Cervical
Spondylopathy (1992) (Zhang et al. 2005, Zhang & He
2006). Two studies used a combination of two diagnostic
criteria (Wei 2003, Shao et al. 2006). The efficacy of tuina was
examined in comparison with other treatment modalities
including neck traction, electrotherapy or medication (Fu &
Yuan 2001, Yi & Song 2003, Zhang et al. 2005, Lin et al.
2006, Zhang & He 2006). The effects between different
manual techniques of the tuina were compared in two studies
(Wei 2003, Shao et al. 2006). With the exception of two
studies (Yi & Song 2003, Lin et al. 2006), the control group
underwent the same time-frame and the same number of
contact sessions as the experimental group. No study assesses
the long-term effect after the completion of the treatment
sessions. All of the studies described the procedure in details
but did not provide the reference regarding the rationale for
the selection of the optimal treatment dosage. No study
provided information regarding the credentials or experience
of the tuina practitioners.
Impact of tuina on the blood flow velocity and blood
viscosity
Two studies assessed the effects of tuina on the vertebralbasilar artery blood flow using the TCD (Wei 2003, Shao
et al. 2006). TCD indices reported by these studies included
blood flow velocity of the systolic peak period (Vs), blood
flow velocity of the end-diastolic period (Vd) and the average
blood flow velocity (Vm). One study examined the viscosity
of whole blood and plasma (Fu & Yuan 2001). The pooled
effect size of the blood flow velocity of the vertebral artery or
basilar artery was analysed with a random-effects model
Table 3 The blood flow velocity of the vertebral artery and basilar artery: total sample and subgroup meta-analysis results
Variables
Study
Subjects
VA
VA-Vs
All
980
380
110
110
160
110
110
380
110
110
160
650
110
160
110
110
160
VA-Vd
Wei (2003)*
Wei (2003)
Shao et al. (2006)
Wei (2003)*
Wei (2003)
VA-Vm
BA
BA-Vs
BA-Vd
BA-Vm
Wei (2003)*
Wei (2003)
Shao et al. (2006)
All
Wei (2003)
Shao et al. (2006)
Wei (2003)
Wei (2003)
Shao et al. (2006)
Hedgee’s g (95% CI)
0Æ25
0Æ24
0Æ71
0Æ51
0Æ48
0Æ24
0Æ26
0Æ25
0Æ26
0Æ46
0Æ10
0Æ05
0Æ57
0Æ92
0Æ21
0Æ26
0Æ07
( 0Æ02 to 0Æ51)
( 0Æ52 to 1Æ00)
(0Æ32 to 1Æ10)
(0Æ13 to 0Æ90)
( 0Æ79 to 0Æ16)
( 0Æ14 to 0Æ62)
( 0Æ12 to 0Æ64)
(0Æ04 to 0Æ46)
( 0Æ12 to 0Æ64)
(0Æ08 to 0Æ84)
( 0Æ22 to 0Æ41)
( 0Æ56 to 0Æ45)
(0Æ19 to 0Æ94)
( 1Æ25 to 0Æ60)
( 0Æ58 to 0Æ17)
( 0Æ12 to 0Æ63)
( 0Æ25 to 0Æ38)
Test of homogeneity, Q-value (p-value)
Heterogeneous, 29Æ56 (0Æ0001)
Heterogeneous, 26Æ86 (<0Æ0001)
Homogeneous, 2Æ12 (0Æ347)
Heterogeneous, 40Æ93 (<0Æ0001)
BA, basilar artery; VA, vertebral artery; Vs, blood flow velocity of systolic peak period; Vd, blood flow velocity of the end-diastolic period;
Vm, average blood flow velocity.
*Measured on the left vertebral artery.
Measure the right vertebral artery.
The pooled effect size did not compute because of there were <3 primary studies with sufficient data.
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M-Y Wang et al.
(Table 3). Meta-analysis revealed a small effect size of the
overall blood flow velocity of the vertebral artery (0Æ25; 95%
CI 0Æ02–0Æ51). However, test of homogeneity of variance
was statistically significant (Q = 29Æ56, p = 0Æ0001), indicating heterogeneity of variance in this aggregation of categories. The pooled effect size can only be calculated in
the variable of Vm (0Æ25; 95% CI 0Æ04–0Æ46; Table 3).
The heterogeneous of variance in Vs was found in all of the
subgroup (Table 3). Moreover, the direction of effect for Vs
was not consistent across studies (Table 3). Similarly,
the reviewed studies showed conflicting results in terms of
the improvement in different periods of blood flow velocity
of the basilar artery. In addition, small effects of tuina on the
viscosity of blood and plasma were found (Table 4).
Impact of tuina on the headache and vertigo
The severity of headache and vertigo was evaluated by selfreported questionnaires developed by the authors (Yi & Song
2003, Zhang et al. 2005, Zhang & He 2006) or by the rating
system developed by the State administration of traditional
Chinese medicine of the People’s Republic of China (State
Administration of TCM 1986, Lin et al. 2006). Because the
heterogeneity test of headache and vertigo was statistically
significant, the individual treatment effect size was calculated.
Conflicting results in the improvement of vertigo were found.
Tuina had no beneficial effect on headache (Table 5).
Table 4 The effect size for the blood viscosity
Variables Study (year)
Hedgee’s g
Subjects (95% CI)
Blood
Fu and
62
viscosity Yuan (2001)
Plasma
Fu and
62
viscosity Yuan (2001)
Test of
homogeneity
0Æ21
*
( 0Æ29 to 0Æ70)
0Æ18
*
( 0Æ32 to 0Æ67)
*The pooled effect size did not compute because of there were <3
primary studies with sufficient data.
Discussion
It has been claimed that symptoms such as neck stiffness,
dizzy and pain associated with cervical spondylosis might be
improved following tuina. Although improvement in the
blood flow velocity, blood viscosity, vertigo and headache
were observed after tuina in the treatment group, however,
both the TCD examination and the subjective reports
demonstrated that tuina was no better than the control
condition.
Methodological issues in the included studies
Several methodological issues might account for the negative results demonstrated by this review. Firstly, the
duration of illness in those patients included in this review
ranged from a few days to 13 years. Because of the
prognostic nature of cervical spondylosis, the heterogeneity
of participants might mask the therapeutic effects of tuina.
For example, in one study the improvement rate was
statistically significant higher in the group who suffered
from cervical spondylosis for <six months compared with
those who with illness duration of more than six months
(Yi & Song 2003). The heterogeneity may be reduced by
limiting the present meta-analysis to studies with specific
characteristics. However, the sensitivity analysis that helps
to identify moderating factors on the effects can not be
carried out because insufficient original data on age groups
and illness duration were available. Secondly, other curative interventions such as neck traction and medication
were implemented as control conditions. These interventions might exert a mechanism that is similar to tuina in
treating symptoms associated with cervical spondylosis.
The outcome measurements for these studies might lack
sensitivity and/or specificity to differentiate effects produced
by tuina, acupuncture, neck traction or medication.
Thirdly, the information regarding the credentials or
experience of the tuina practitioners was lacking, which
Table 5 Headache and vertigo: total sample and subgroup meta-analysis results
Variables
Study
Subjects
Vertigo
All
Yi and Song (2003)
Zhang et al. (2005)
Lin et al. (2006)
Zhang and He (2006)
All
Yi and Song (2003)
Zhang et al. (2005)
Zhang and He (2006)
397
55
74
120
148
288
66
74
148
Headache
2536
Hedgee’s g (95% CI)
Test of homogeneity, Q-value (p-value)
Heterogeneous, 81Æ16 (<0Æ0001)
3Æ64
0Æ17
0Æ98
0Æ27
( 4Æ65 to 2Æ64)
( 0Æ30 to 0Æ63)
(0Æ60 to 1Æ37)
( 0Æ59 to 0Æ06)
Heterogeneous, 70Æ80 (<0Æ0001)
6Æ99 ( 8Æ39 to
1Æ18 ( 1Æ68 to
0Æ93 ( 1Æ27 to
5Æ60)
0Æ67)
0Æ59)
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Review
raise the doubt of whether the optimal therapeutic effects
of tuina had been attained in the included studies. Finally,
although six out of seven studies reported randomisation of
group assignments pretreatment non-equivalence between
comparison groups could not be ruled out. Future studies
that adopt a randomised control design, an attention or
sham-treatment control group and carefully selected outcome measurements may be helpful to clarify the specific
therapeutic effects of tuina.
Efficacy of tuina
Acknowledgement
This work was supported by a grant from the Department of
Health, Executive Yuan, Taiwan (DOH96-TD-M-113-020).
Contributions
Study design: MW, PT; data collection: MW, PT; data
analysis: MW, PT, PL, WC, CY and manuscript preparation:
MW, PT.
Limitations of the review
The present review may be prone to a selection or source
bias. Only articles published after 1996 and published in
English or Chinese were selected. It cannot be ruled out that
there were studies in which tuina demonstrated statistically
significant effects on cervical spondylosis but were published
in other languages. A definitive conclusion regarding the
effects of tuina on cervical spondylosis remains to be
determined.
Relevance to clinical practice
In most cases of cervical spondylosis, the conservative
treatments are favourable than surgical intervention unless
pain persists or the progressive neurological deficit is identified (Borghouts et al. 1998). Fear of medication side-effects
and desire for symptom relief were possible reasons for the
increasing use of complementary and alternative medicine
(CAM) by patients (Vincent & Furnham 1999). Nurses
should bear in mind that many patients chose tuina as a way
to empower themselves in the management of their illness
and therefore may not be seeking evidence of efficacy.
Moreover, patient satisfaction and perceived effect have been
identified as important criteria to judge the treatment
outcome in treating neck disorders (Gross et al. 2002).
Because symptoms associated with cervical spondylsis are
complex, the change in blood flow velocity or pain may not
be the only criterion to determine the success of treatment.
The outcomes of complementary therapy for treating symptoms associated with chronic illness should include specific
areas of patient concerns. For example, for those patients
who were most bothered by increased muscle tension, a
reduction in headache should be considered the primary
outcome measure.
In conclusion, the efficacy of tuina remains inconclusive
based on the findings of this systematic review. Tuina might
not have any effect that is superior to other available forms of
treatments for treating symptoms associated with cervical
spondylosis.
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