Effectiveness of tuina and physiotherapy to manage pain for patients with chronic low back pain: a pragmatic randomized clinical trial.

2026-01-09
BMC complementary medicine and therapies 26(1)
- Ia Choo Celia Tan
- Hao En Matthew Wong
- Fan Qiao
- Wei Min Chong
- Chee Cheong Reuben Soh
- Chin Ee Ho
- Kwok Chee Philip Cheong
- Li Tat John Chen
- Pao Ann Bong
- Ing Hian Niklas Seet
- Xiu Wen Lim
- Qing Yu Ma
- Xuan Zhou
- Long Bin Shen
- Juan Yang
- Jia Xu Chen
- Brent A Bauer
- Boon Keng Tay

PubMed: 41514247
DOI: 10.1186/s12906-025-05234-w

Study Design

Type: Randomized Controlled Trial (RCT)
Sample size: n = 204
Population: 204 participants aged 21 to 75 with chronic non-specific low back pain
Methods: randomized, parallel-controlled, single-blind trial, participants randomly assigned to physiotherapy, Tuina, or combined therapy
Blinding: Single-blind
Duration: two months and five months
Funding: Unclear

Large Human Trial

Background

Chronic non-specific low back pain lacks a defined pathoanatomical cause, leading to diverse treatment methods including physiotherapy and complementary alternative medicine techniques such as Tuina. This study aimed to evaluate the effectiveness of Tuina for managing chronic non-specific low back pain by comparing it to physiotherapy and a combination of physiotherapy and Tuina.

Methods

In this randomized, parallel-controlled, single-blind trial, 204 participants aged 21 to 75 with chronic non-specific low back pain were randomly assigned to physiotherapy, Tuina, or combined therapy. Pain intensity and quality of life were measured with the visual analog scale, 36-Item Short Form Survey and the Oswestry Disability Index, alongside trunk range of motion. Outcomes were assessed at baseline, two months, and five months. Data were analyzed using analysis of variance for within- and between-group comparisons, and post-hoc tests were applied to between-group comparisons.

Results

After two months, all groups had significant improvement in pain scores. Tuina was only significantly better than the combination treatment for reducing pain (p = 0.021; mean difference = - 1.04 [95% CI - 1.85 to - 0.23], Cohen's d = - 0.41). However, no significant difference was observed between Tuina and combined treatment against physiotherapy. Pain scores were not significantly different at five months in all groups. The physiotherapy (p = 0.019; mean difference = - 5.28 [95% CI - 9.44 to - 1.11], d = - 0.44) and combined (p = 0.028; mean difference = 5.59 [95% CI 1.17 to 10.01], d = 0.42) groups showed a significant reduction in Oswestry Disability Index scores compared to Tuina at five months. The combined group had significantly greater 36-Item Short-Form Survey than Tuina (p = 0.012; mean difference = - 71.15 [95% CI - 118.23 to - 24.06], d = - 0.47), but not significantly greater than physiotherapy.

Conclusions

All treatment groups demonstrated improved outcomes post-intervention and at five months. Between-group differences in improvement were significant only for Oswestry Disability Index and 36-Item Short-Form Survey scores at five months. Pain scores showed no significant superiority of physiotherapy over Tuina and combined therapy (d < 0.2), indicating potential use of Tuina in chronic non-specific low back pain management.

Trials registration

ChiMCTR2000004087. URL: https://www.chictr.org.cn/showprojEN.html?proj=62614 . Date of Registration: 27 November 2020.