Table 3.
Key data from RCTs of Chuna in musculoskeletal and neurological diseases in the Korean literature.
| Disease classification | First author (Year) | Sample size/conditions | Interventions (regimen) | Main outcomes (intergroup difference) | Author's conclusion | Risk of bias * |
|---|---|---|---|---|---|---|
| Musculoskeletal disease | Lee (2012)18 | 82 patients with neck pain caused by TA | (A) Chuna (2 times weekly for 4 wks, total 8 sessions, n = 45) plus usual care [AT (15 min, 2 times weekly for 4 wks) and herbal medicine (Dangkwisoo-san for 2 wks and Ojucksan for 2 wks)] (B) PA (Hwangryunhaedock-tang herbal injection, 2 times weekly for 4 wks, total 8 sessions, n = 37) plus usual care |
(1) NDI (NS) (2) VAS (NS) |
Both (A) and (B) were considered to be effective and useful for low back pain caused by TA. No significant difference was found between (A) and (B) after 4 wks. However, (A) was more effective than (B) from weeks 2 to 4. | U, U, H, U, U, U |
| Lee (2012)19 | 87 patients with neck pain caused by TA | (A) PA (2 times a week for 4 wks, total 8 sessions, n = 24) plus usual care [AT (15 min, daily for 4 wks), herbal medicine (Dangkwisoo-san for 2 wks and Ojucksan for 2 wks)] (B) Chuna (2 times a week for 4 wks, total 8 sessions, n = 29) plus usual care (C) PA (once a week for 4 wks, total 4 sessions, n = 34), Chuna (once a week for 4 wks, total 4 sessions, n = 34) plus usual care |
(1) VAS (n.r.) (2) NDI (n.r.) |
(A), (B), and (C) were effective after 4 wks for neck pain caused by TA. After 4 wks of treatment, (C) was more effective than (A) and (B) individually for neck pain caused by TA. No statistical significance was found regarding whether (A) or (B) was superior, but (B) tended to be more effective than (A) |
L, U, H, U, U, U | |
| Kim (2011)20 | 20 patients with cervical sprain caused by TA | (A) Chuna (2 times weekly for 4 wks, total 8 sessions, n = 10) plus (B) (B) Usual care [AT (15 min, 2 times weekly for 4 wks, total 8 sessions), herbal medicine (n.r.), PA (Jungsongouhyul herbal injection 2 times weekly for 4 wks, total 8 injections), n = 10] |
(1) VAS (p < 0.05) | (A) was considered to be effective and useful on cervical sprains caused by TA. | U, U, H, U, U, U | |
| Woo (2011)21 | 60 patients with cervical pain caused by TA | (A) Chuna (2 times a week for 2 wks, total 4 sessions, n = 30) plus AT (15 min, 4 sessions, 2 times a week for 2 wks) (B) PA (ouhyul herbal injection, 2 times a week for 2 wks, total 4 injections, n = 30) plus AT (15 min, 2 times a week for 2 wks, total 4 sessions) |
(1) VAS (NS) (2) NDI (NS) |
(A) and (B) were effective in reducing cervical pain caused by traffic accidents. No significant difference was found between (A) and (B). | L, U, H, U, U, U | |
| Park (2007)22 | 10 patients with acute neck pain caused by TA | (A) Chuna (2 times weekly for 2 wks, total 4 sessions, n = 5) plus (B) (B) Usual care [AT (n.r., 4 times weekly, n = 5) plus cupping and physical therapy] |
(1) VAS (NS) (2) PDI (NS) (3) Pressure pain thresholds (NS) |
(A) may have been effective and useful for neck pain caused by TA, but no statistically significant difference was found between (A) and (B). | U, U, H, U, U, U | |
| Ryu (2006)23 | 20 chronic neck pain patients with a hypolordotic cervical spine | (A) Chuna (5 sessions, n = 10) plus (B) (B) AT (5 sessions, n = 10) |
(1) VAS (p < 0.05) | (A) was more effective than (B) in reducing neck pain. | U, U, H, U, U, U | |
| Yun (2012)24 | 38 patients with cervicogenic headache caused by TA | (A) Chuna (20 min, 3 times for 1 wk, n = 20) plus (B) (B) Usual care [AT (20 min, daily for 1 wk), herbal medicine (Kami-hwal-hyeol-tang, 2 times daily for 1 wk), PA (2 sessions for 1 wk), ICT (15 min, 3 sessions for 1 wk), cupping (3 sessions for 1 wk), n = 18] |
(1) VAS (p < 0.05) (2) NDI (p < 0.05) |
(A) had a significant effect on the cervicogenic headache caused by TA, which was more effective than (B). | L, U, H, U, U, U | |
| Jin (2011)25 | 52 patients with TMD | (A) Chuna (2 times weekly for 4 wks, n = 26) plus (B) (B) AT (2 times weekly for 4 wks, n = 26) plus PA |
(1) VAS (NS) (2) FPSC (NS) |
(A) and (B) were considered to be effective and useful in TMD, but additional comparative studies are needed to assess intergroup differences. | U, U, H, U, U, U | |
| Kim (2006)26 | 31 patients with TMD | (A) Chuna (3 trials of distraction per round, translation selectively, total 6 sessions, n = 15) plus muscle release technique (B) AT (20 min, total 6 sessions, n = 16) plus muscle release technique |
(1) MM (p < 0.05) (2) TN (p < 0.05) |
- | L, U, H, U, U, U | |
| Park (2009)27 | 74 patients with LBP | (A) Chuna (5 times, finger pressing technique on 6 AT points, n = 37) (B) TENS (20 min, 100 Hz, 10–30 mA, unilateral placement, n = 37) |
(1) VAS (p < 0.05) | (A) was a practical therapy for patients with LBP. | H, U, H, U, U, U | |
| Kim (2011)28 | 81 patients with LBP caused by TA | (A) Chuna (2 times weekly for 4 wks, total 8 sessions, n = 46) plus usual care [AT (15 min 2 times weekly for 4 wks) and herbal medicine (Dangkwisoo-san for 2 wks and Ojucksan for 2 wks)] (B) PA (Hwangryunhaedock-tang herbal injection, twice weekly for 4 wks, total 8 injections, n = 35) plus Usual care |
(1) ODI (NS) (2) VAS (NS) |
Both (A) and (B) were considered to be effective and useful for LBP caused by TA. No significant difference was found between (A) and (B). However, from weeks 2 to 4, (A) was more effective than (B). | U, U, H, U, H, U | |
| Yoon (2010)29 | 20 patients with acute LBP caused by TA | (A) Chuna (3 times in 1 wk, n.r., n = 10) plus (B) (B) Usual care [AT (15 min, 2 times daily, n.r.), herbal medicine (n.r.), physical therapy (n.r.), n = 10] |
(1) VAS (p < 0.05) | (A) was considered to be effective and useful in lumbar sprains caused by TA. | U, U, H, U, U, U | |
| Lee (2009)30 | 20 patients with LBP caused by TA | (A) Chuna (2 times at second and fourth day after admission, n = 10) plus (B) (B) Usual care [AT (2 times for one day), herbal medicine (n.r.), physical therapy (n.r.), n = 10] |
(1) HRV (NS) (2) VAS (NS) |
(A) appeared to help TA patients in the early stages to reduce pain. (A) appeared to have a positive effect. Further long-term, large-scale studies are necessary. | U, U, H, U, U, U | |
| Kim (2007)31 | 50 hemiplegic patients with shoulder pain | (A) Chuna (5 times weekly for 2 wks, total 10 sessions, n = 26) plus (B) (B) Usual care [AT (n.r.), herbal medicine (n.r.), physical therapy (n.r.), n = 24] |
(1) VAS (p < 0.01) (2) Passive ROM (p < 0.05) (3) Motor grade, difference in meridian electromyography, subluxation grade (NS) |
(A) may have been an efficacious method of improving shoulder pain and passive ROM in stroke patients. | U, U, H, U, U, U | |
| Neurological Diseases | Park (2011)32 | 36 patients with acute peripheral facial palsy | (A) Chuna (n.r., Danmuji Anchu traction technique, n = 18) plus (B) (B) Usual care [(AT (n.r., 2 times for 1 day), herbal medicine (n.r.), PA (once a day, Hominis placenta herbal injection), n = 18] |
(1) Yanagihara's score (p < 0.05) (2) Improvement index (p < 0.05) |
The Danmuji Anchu traction technique was effective for acute peripheral facial paralysis. | U, U, H, U, U, U |
| Bae (2010)33 | 39 patients with stroke-induced hemiplegia | (A) Chuna (daily for 3 wks, n = 20) plus (B) (B) Usual care [AT (30 min, 2 times for 1 day), herbal medicine, physical therapy (ICT, TENS, US, tilting table, Bobath approach), moxibustion, cupping, n = 19] |
(1) MBI (p < 0.05) (2) TCD (p < 0.05) |
Adjusting LLI by Chuna manual treatment was efficacious for the rehabilitation of stroke-induced hemiplegia in terms of ADL and cerebral blood flow. | U, U, H, U, U, U | |
| Kwon (2009)34 | 39 patients with stroke-induced hemiplegia | (A) Chuna (daily for 3 wks, n = 20) plus (B) (B) Usual care [AT (30 min, 2 times for 1 day), herbal medicine, physical therapy (ICT, TENS, US, tilting table, Bobath approach), moxibustion, cupping, n = 19] |
(1) MBI (p < 0.05) (2) BBS (p < 0.05) (3) FMA (p < 0.05) |
Adjusting LLI by Chuna manual treatment was efficacious for the rehabilitation of stroke-induced hemiplegia in terms of ADL balance and lower extremity function. | L, U, H, U, U, U |
* Domains of quality were assessed based on the Cochrane tools for assessing risk of bias, including random sequence generation, allocation concealment, patient blinding, assessor blinding, reporting dropout or withdrawal, selective outcome reporting. “L” indicates a low risk of bias; “U” indicates that the risk of bias is uncertain; “H” indicates a high risk of bias.
ADL, activity of daily living; AT, acupuncture; BBS, Berg Balance Scale; FMA, Fugl-Meyer Assessment; FPSC, Facial Pain Score Scale; HRV, heart-rate variability; ICT, interferential current therapy; LBP, low back pain; LLI, leg length inequality; MBI, Modified Barthel Index; min, minute; MM, mandibular movement; NDI, Neck Disability Index; n.r.; not reported; NS, not significant; ODI, Oswestry Disability Index; PA, pharmacoacupuncture; PDI, Pain Disability Index; RCT, randomized controlled trial; ROM, range of motion; TA, traffic accident; TCD, transcranial Doppler ultrasonography; TENS, transcutaneous electrical nerve stimulator; TMD, temporomandibular joint disorder; TN, temporomandibular joint noise; US, ultrasound; VAS, Visual Analog Scale; wks, weeks.