Chuna (or Tuina) Manual Therapy for Musculoskeletal Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Table 3

Summary of randomized controlled trials of C(T)MT for pain and function for musculoskeletal diseases.

Author (Year); Country	Types of disease	Design	Sample size; (A/B/C)	Duration weeks	Follow-up weeks	Intervention		Outcome measures	Main results
						Treatment	Control
C(T)MT vs. sham C(T)MT (1)
Sousa et al. [40] (2015); Portugal	Working-related musculoskeletal disorder of professional orchestra musicians	Patient blind,; parallel; 2 arms	69; (39/30)	Immediate effect	nr	C(T)MT (real acupoints)	Sham C(T)MT (nonspecific skin points)	(1) VNRS (pain)	(1)
C(T)MT vs. OIs (48)
Zhu et al. [41] (2007); China	Cervical spondylotic radiculopathy	Parallel; 2 arms	116; (59/57)	4	nr	C(T)MT; (8 sessions)	TR; (30 min/8 sessions)	(1) VAS	(1)
Chen et al. [42] (2009); China	Cervical spondylotic radiculopathy	Parallel; 2 arms	400; (200/200)	34 d	nr	C(T)MT; (30 sessions)	TCM; (tid/30 sessions)	(1) VAS; (2) ADL	(1); (2)
Wang et al. [43] (2009); China	Cervical spondylotic radiculopathy	Parallel; 2 arms	110; (54/56)	2	4	C(T)MT; (7 sessions)	TR; (30 min/14 sessions)	(1) VAS; (2) ROM	(1); (2) NA
Huang [44] (2010); China	Cervical spondylotic radiculopathy	Parallel; 2 arms	60; (30/30)	4	6 m	C(T)MT; (20 min/28 sessions)	TR; (30 min/28 sessions)	(1) VAS; (2) TSS; ①  Neck pain and discomfort; ②  Upper limb pain and numbness; ③  ADL; ④  Distal sensory strength; ⑤  Upper limb tension reflex weakness; ⑥  Spurling’s test	(1); (2) TSS; ①; ②; ③; ④; ⑤; ⑥
Liao et al. [45] (2011); China	Cervical spondylotic radiculopathy	Parallel; 2 arms	111; (56/55)	4	nr	C(T)MT; (8 sessions)	CPD; (tid)	(1) MPQ	(1)
Jiang et al. [46] (2012); China	Cervical spondylotic radiculopathy	Parallel; 2 arms	79; (38/41)	2	nr	C(T)MT; (7 sessions)	TR; (20 min/14 sessions)	(1) VAS	(1)
Qin et al. [47] (2012); China	Cervical spondylotic radiculopathy	Parallel; 2 arms	60; (30/30)	2	nr	C(T)MT; (8 sessions)	TR; (20 min/8 sessions)	(1) TSS; ①  Neck pain and discomfort; ②  Upper limb pain and numbness; ③  ADL; ④  Distal sensory strength; ⑤  Upper limb tension reflex weakness; ⑥  Spurling’s test	(1) TSS; ①; ②; ③  NS; ④; ⑤  NS; ⑥
Xu [48] (2013); China	Cervical spondylotic radiculopathy	Parallel; 2 arms	36; (18/18)	4	nr	C(T)MT; (12 sessions)	TR; (20–30 min/12 sessions)	(1) VAS; (2) TSS	(1); (2)
Xue [49] (2015); China	Cervical spondylotic radiculopathy	Parallel; 2 arms	130; (65/65)	2	nr	C(T)MT; (nr)	TR; (15 min/14 sessions)	(1) VAS; (2) NDI	(1); (2)
Yang [50] (2015); China	Cervical spondylotic radiculopathy	Parallel; 2 arms	72; (36/36)	2	nr	C(T)MT; (30 min/6 sessions)	TR; (20 min/6 sessions)	(1) VAS; (2) NDI; (3) SF-36	(1); (2); (3)
Liu [51] (2015); China	Cervical spondylotic radiculopathy	Parallel; 3 arms	114; (38/38/38)	NA	1 m	C(T)MT; (30 min/4 sessions)	B: TR; (4 sessions); C: MT; (4 sessions)	(1) VAS; (2) ROM	(1); (2) NS (1 w: , 1 m: )
Zhu et al. [52] (2009); China	Cervical spondylosis	Parallel; 2 arms	210; (106/104)	2	1 m	C(T)MT; (7 sessions)	TR; (30 min/7 sessions)	(1) VAS	(1)
Lin et al. [53] (2012); China	Cervical spondylosis	Parallel; 2 arms	70; (35/35)	4	nr	C(T)MT; (12 sessions)	CPD; (tid)	(1) NRS; (2) ROM; (3) MMS	(1); (2); (3)
Yan et al. [54] (2014); China	Cervical spondylosis	Parallel; 2 arms	70; (36/34)	2	nr	C(T)MT; (20 min/6 sessions)	TCM external preparation; (qd/6 sessions)	(1) VAS; (2) CASCS	(1); (2)
Li and Zhou [55] (2016); China	Cervical spondylosis (sympathetic nerve type)	Parallel; 2 arms	80; (40/40)	2	nr	C(T)MT; (10 sessions)	OD	(1) CASCS; (2) JOA	(1); (2) NS
Jin [56] (2008); China	Cervical spondylosis (vertebral artery type)	Parallel; 2 arms	55; (27/28)	2	3 m	C(T)MT; (7 sessions)	TR; (30 min/14 sessions)	(1) TSS; (2) IC	(1); (2) NS
Gao et al. [57] (2011); China	Cervical spondylosis (vertebral artery type)	Parallel; 2 arms	177; (87/90)	14 d	nr	C(T)MT; (7 sessions)	TR; (30 min/14 sessions)	(1) ROM	(1)
Zeng [58] (2015); China	Cervical spondylosis (vertebral artery type)	Parallel; 3 arms	45; (15/15/15)	4	nr	C(T)MT; (30 min/8 sessions)	B: MCT; (8 sessions); C: C(T)MT plus MCT	(1) VAS; (2) TSS	(1) NA; (2) NA
Sun [59] (2007); China	Atlantoaxial joint disorder	Parallel; 2 arms	93; (55/38)	2	1 m	C(T)MT	TR; (30 min/7 sessions)	(1) TSS	(1)
Wang [60] (2012); China	Lower cervical vertebral degenerative instability	Parallel; 2 arms	60; (30/30)	2	1 m	C(T)MT; (10 sessions)	TR; (20 min/10 sessions)	(1) VAS; (2) NDI	(1); (2)
Yang et al. [61] (2014); China	Lower cervical vertebral degenerative instability	Parallel; 2 arms	97; (49/48)	2	nr	C(T)MT; (6 sessions)	TR; (20 min/10 sessions)	(1) NDI	(1)
Chen et al. [62] (2011); China	Cervical shoulder pain	Parallel; 2 arms	68; (35/33)	6 d	nr	C(T)MT; (30 min/6 sessions)	OD; (bid)	(1) VAS	(1)
Chen et al. [63] (2006); China	Lumbar disc herniation	Parallel; 2 arms	233; (122/111)	4	nr	C(T)MT; (15 min/8 sessions)	TR; (20 min/15 sessions)	(1) VAS; (2) ROM; (3) SLR; (4) M-JOA	(1); (2); (3) NS; (4)
Wang [64] (2010); China	Lumbar disc herniation	Parallel; 2 arms	62; (32/30)	3	nr	C(T)MT; (every second day)	TR; (every day)	(1) VAS; (2) JOA; (3) SLRT	(1); (2); (3)
Zhou et al. [65] (2012); China	Lumbar disc herniation	Parallel; 2 arms	65; (32/33)	12 d	nr	C(T)MT; (20 min/6 sessions)	TR; (20 min/10 sessions)	(1) VAS; (2) ODI	(1); (2)
Luo et al. [66] (2013); China	Lumbar disc herniation	Parallel; 2 arms	60; (30/30)	1 m		C(T)MT; (8 sessions)	TR; (30 min/14 sessions)	(1) VAS; (2) JOA; (3) SF-36; ①  PF; ②  RP; ③  BP; ④  SF; ⑤  MH; ⑥  RE; ⑦  VT; ⑧  GH	(1); (2); (3); ①; ②; ③; ④; ⑤; ⑥; ⑦  NS; ⑧
Deng et al. [67] (2012); China	Lumbar disc herniation	Parallel; 2 arms	290; (145/145)	2	A: 3 w; B: 1 y	C(T)MT; (every second day)	OD; (qd)	(1) VAS	(1) A: NS; B:
Zhang et al. [68] (2005); China	Lumbar muscle strain	Parallel; 2 arms	105; (51/54)	5–7 d	nr	C(T)MT; (30 min/5 sessions)	OD	(1) ALBP clinical score	(1)
Xue [69] (2016); China	Lumbar muscle strain	Parallel; 2 arms	63; (32/31)	3-4	3 m	C(T)MT; (30 min/10 sessions)	TR; (20 min/10 sessions)	(1) VAS	(1)
Zhang [70] (2010); China	Lumbar muscle strain	Parallel; 2 arms	62; (31/31)	8	nr	C(T)MT; (30 min/24 sessions)	CPD; (bid)	(1) Symptom score; (2) Sign score	(1) NA; (2) NA
Tian et al. [71] (2015); China	Degenerative scoliosis	Parallel; 2 arms	38; (20/18)	10–15	nr	C(T)MT; (30 min/36 sessions)	OD	(1) VAS; (2) ODI	(1); (2)
Wang et al. [72] (2016); China	Sacrococcygeal pain	Parallel; 2 arms	184; (91/93)	2	3 m	C(T)MT; (6 sessions)	EM (external medicine); (bid)	(1) VAS; (2) Rating scale of sacrococcygeal pain	(1); (2)
Wang et al. [73] (2013); China	Periarthritis of shoulder	Parallel; 2 arms	120; (60/60)	20 d	nr	C(T)MT; (20 sessions)	TCM external preparation	(1) SF-36; ①  PF; ②  RP; ③  BP; ④  SF; ⑤  MH; ⑥  RE; ⑦  VT; ⑧  GH	(1); ①; ②; ③; ④  NS; ⑤; ⑥; ⑦; ⑧
Chen et al. [5] (2013); China	Periarthritis of shoulder	Parallel; 3 arms	120; (40/40/40)	4	nr	C(T)MT; (24 sessions)	B: EA; (24 sessions); C: PT (TENS); (24 sessions)	(1) VAS; (2) ROM	(1); (2)
Xu [74] (2014); China	Acromioclavicular dislocation	Parallel; 2 arms	120; (60/60)	NA	nr	C(T)MT	PT (upper limb abduction splint)	(1) IC	(1)
Xu [75] (2016); China	Humeral fracture	Parallel; 2 arms	94; (47/47)	7 d	7 d	C(T)MT	Surgery	(1) CMS; ①  Pain; ②  Function; ③  ROM; ④  Muscle strength	(1) CM; ①; ②; ③; ④
Pan [76] (2016); China	Humeral fracture	Parallel; 2 arms	64; (32/32)	6	12 m	C(T)MT	Surgery	(1) CMS; (2) IC	(1) NS; (2)
Yang [77] (2004); China	Humeral fracture	Parallel; 2 arms	68; (34/34)	6	nr	C(T)MT	Surgery	(1) IC; (2) ROM	(1) 2 w: NS; 4 w: 6 w: (2) 2 w: NA; 4 w: 6 w:
Pan [78] (2015); China	Radius fracture	Parallel; 2 arms	60; (30/30)	NA	nr	C(T)MT	Surgery	(1) IC	(1)
Li [79] (2016); China	Radius fracture	Parallel; 2 arms	80; (48/32)	NA	NA	C(T)MT	Surgery	(1) Recovery rate of joint function; (2) Time; ①  Swelling subside; ②  Fracture healing; ③  Pain subside; (3) IC	(1); (2) Time; ①; ②; ③; (3)
Ding et al. [80] (2010); China	Lateral epicondylitis of humerus	Parallel; 2 arms	76; (38/38)	2	nr	C(T)MT	PT (IFT); (14 sessions)	(1) VAS; (2) Mayo Score	(1); (2)
Gao and Yan [81] (2014); China	Brachial plexus block	Parallel; 2 arms	200; (120/80)	3	3 m	C(T)MT; (3 sessions)	BT; (3–9 sessions)	(1) VAS; (2) Melle Score	(1); (2)
Tian [82] (2010); China	Knee osteoarthritis	Parallel; 2 arms	60; (30/30)	31 d	nr	C(T)MT; (20 min/30 sessions)	CPD; (bid)	(1) MPQ-SF; (2) JOA	(1); (2)
Chen [83] (2015); China	Knee osteoarthritis	Parallel; 2 arms	60; (30/30)	1 m	nr	C(T)MT; (12 sessions)	OD; (qd)	(1) WOMAC; (2) VAS	(1); (2) NS
Jin [84] (2015); China	Knee osteoarthritis	Parallel; 2 arms	120; (60/60)	4	nr	C(T)MT; (12 sessions)	OD; (qd)	(1) WOMAC; ①  Pain; ②  Stiffness; ③  Physical Function	(1) WOMAC; ①  NS; ②; ③
Li et al. [85] (2016); China	Knee osteoarthritis	Parallel; 2 arms	60; (30/30)	4	nr	C(T)MT; (20 sessions)	OD; (bid)	(1) VAS; (2) JOA	(1); (2)
Ren [86] (2014); China	Ankle fracture, trimalleolar fracture	Parallel; 2 arms	110; (55/55)	NA	nr	C(T)MT	Surgery	(1) IC	(1)
Zhao et al. [87] (2016); China	Calcaneal Fracture	Parallel; 2 arms	66; (34/32)	NA	9–15 m	C(T)MT	Surgery	(1) IC; (2) Fracture healing time; (3) AOFAS scale; ①  Pain; ②  ADL; ③  X-ray	(1); (2) NS; (3) NS; ①  NS; ②  NS; ③  NS
C(T)MT + OIs versus OIs (17)
Chen and Tang [88] (2013); China	Cervical spondylotic radiculopathy	Parallel; 2 arms	60; (30/30)	3	nr	C(T)MT plus TR; (15 sessions)	TR; (15 sessions)	(1) VAS; (2) PRI; (3) PPI	(1); (2); (3)
Zhang and Hai [89] (2016); China	Curvature abnormality	Parallel; 2 arms	70; (36/34)	2	nr	C(T)MT plus TR; (14 sessions)	TR; (14 sessions)	(1) VAS	(1)
Dong and Wang [90] (2014); China	Lumbar disc herniation	Parallel; 2 arms	80; (40/40)	30 d	nr	C(T)MT plus OD (tid), IV (qd)	OD (tid), IV (qd)	(1) ODI; (2) JOA; (3) VAS	(1); (2); (3) NS
Song et al. [91] (2015); China	Lumbar disc herniation	Parallel; 2 arms	60; (30/30)	10 d	nr	C(T)MT plus TR	TR	(1) VAS; (2) JOA	(1); (2)
Yin et al. [92] (2015); China	Lumbar disc herniation	Parallel; 2 arms	50; (25/25)	2	6 m	C(T)MT plus IV (qd)	IV; (qd)	(1) VAS; (2) ODI	(1); (2)
Wu et al. [93] (2016); China	Lumbar disc herniation	Parallel; 2 arms	60; (30/30)	10 d	nr	C(T)MT plus TR; (10 sessions)	TR; (10 sessions)	(1) VAS	(1)
Zhang et al. [94] (2016); China	Thoracolumbar fracture	Parallel; 2 arms	40; (20/20)	1 d	1 d, 3 d	C(T)MT plus Surgery	Surgery (PPF)	(1) VAS	(1)
Yu et al. [95] (2016); China	Thoracolumbar fracture	Parallel; 2 arms	52; (26/26)	1 d	3 d, 2 w, 6 m	C(T)MT plus Surgery	Surgery (PKP)	(1) VAS	(1) NS
Sun et al. [96] (2016); China	Degenerative Scoliosis	Parallel; 2 arms	60; (30/30)	3	nr	C(T)MT plus OD	OD; (tid)	(1) VAS; (2) ODI	(1); (2)
Jia and Sha [97] (2015); China	Ankylosing spondylitis	Parallel; 2 arms	60; (30/30)	4	nr	C(T)MT plus OD	OD; (tid)	(1) VAS; (2) Metrology index of bath ankylosing spondylitis	(1); (2)
Zhang [98] (2015); China	Periarthritis of shoulder	Parallel; 2 arms	78; (39/39)	4	nr	C(T)MT (28 sessions) plus PP (4 sessions)	PP; (4 sessions)	(1) VAS; (2) Symptom score; ①  Shoulder pain; ②  ROM limitation; ③  Shoulder coldness; ④  Shoulder muscular atrophy; ⑤  Numbness and weakness	(1); (2) Symptom Score; ①; ②; ③; ④; ⑤
Shen et al. [99] (2015); China	Periarthritis of shoulder	Parallel; 2 arms	120; (60/60)	1 m	nr	C(T)MT plus PP	PP; (3 sessions)	(1) VAS	(1)
Wu [100] (2011); China	Lateral epicondylitis of humerus	Parallel; 2 arms	22; (11/11)	9 d	nr	C(T)MT plus PT (UT + IFT); (5 sessions)	PT (UT + IFT); (5 sessions)	(1) VAS	(1)
Xiao [101] (2016); China	Knee osteoarthritis	Parallel; 2 arms	70; (35/35)	4	nr	C(T)MT plus RT	RT	(1) HSS Score; ①  Pain; ②  Knee function; ③  ROM; ④  Knee flexion Deformity; ⑤  Stability; ⑥  Muscle strength; (2) SF-36; ①  PF; ②  RP; ③  BP; ④  SF; ⑤  MH; ⑥  RE; ⑦  VT; ⑧  GH	(1) HSS; ①; ②; ③; ④; ⑤; ⑥; (2) SF-36; ①; ②  NS; ③; ④  NS; ⑤; ⑥  NS; ⑦  NS; ⑧  NS
Zhang and Deng [102] (2012); China	After knee surgery pain or function	Parallel; 2 arms	80; (40/40)	Immediate effect	nr	C(T)MT plus RT; (20 min/1 session)	RT	(1) Pain score	(1)
Wang et al. [104] (2012); China	After knee surgery pain or function	Parallel; 2 arms	66; (33/33)	4	nr	C(T)MT + CPM; (20 sessions)	CPM	(1) WOMAC; ①  Pain; ②  Stiffness; ③  Physical Function	(1) WOMAC; ①  NS; ②  NS; ③
Wang et al. [103] (2016); China	Kaschin-Beck disease	Parallel; 2 arms	120; (60/60)	6 m	nr	C(T)MT plus OD	OD	(1) VAS; (2) ROM	(1); (2)

< 0.05; < 0.01; < 0.001; ADL: activities of daily living; ALBP: acute low back pain; AOFAS: American Orthopaedic Foot & Ankle Society; BP: bodily pain; BT: block therapy; CASCS: clinical assessment scale for cervical spondylosis; CMS: Constant-Murley score; C(T)MT: Chuna (or Tuina) manual therapy; CPD: Chinese patent drug; CPM: continuous Passive Training; IC: incidence of complication; IFT: intermediate frequency therapy; GH: general health; HSS: hospital for special surgery; IV: intravenous injection; JOA: joint operation agreement; MCT: microcurrent therapy; MH: mental health; MMS: maximum muscular strength; MPQ: McGill Pain Questionnaire; MPQ-SF: McGill Pain Questionnaire-Short Form; MT: manual therapy; NA: not assessable; NDI: neck disability index; NS: neutral (no significant difference between groups); OD: oral drugs; ODI: Oswestry disability index; OIs: other interventions; PP: pharmacopuncture; PF: physical functioning; PKP: percutaneous kyphoplasty; PPF: percutaneous pedicle fixation; PPI: present pain intensity; PRI: pain rating index; PT: physical therapy; RE: role-emotional; ROM: range of motion; RP: role-physical; RT: rehabilitation treatment; SF: social functioning; SF-36: short form 36 health survey; SLRT: straight leg raising test; TCM: traditional Chinese medicine; TR: traction; TSS: total score of symptoms and signs; UT: ultrasonic treatment; VAS: visual analogue scale; VNRS: visual numeric rating scale; VT: vitality; WOMAC: Western Ontario and McMaster Universities.