397: Tuina for Chronic Low Back Pain: A Systematic Review of Effectiveness and Design

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Non-pharmacological treatments, Assessment and Measurement of Pain/Nociception, Treatment/management

Background and Aims: Chronic low back pain (CLBP) is a leading cause of disability worldwide. Tuina, a traditional Chinese manual therapy, is widely used for CLBP management, particularly in China, yet its reported effectiveness remains heterogeneous across studies. A major source of variability may lie in how Tuina interventions are defined, implemented, and reported. This systematic review aims to evaluate the effectiveness and safety of Tuina for CLBP while systematically examining how Tuina interventions are interpreted and operationalized across clinical studies and whether differences in intervention characteristics are associated with treatment outcomes.

Methods: We conducted a comprehensive search of international and Chinese databases (PubMed, Embase, CENTRAL, Web of Science, Scopus, CNKI, Wanfang, VIP, and SinoMed) from inception to Jan 2026. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Two reviewers independently screened studies using Covidence, with inter-rater agreement assessed by Cohen’s κ. Randomized and controlled clinical studies of Tuina for adults with CLBP were eligible. Risk of bias was assessed using RoB 2.When appropriate, and certainty of evidence was evaluated using the GRADE framework.

Results: The literature search identified 6,714 records across databases (PubMed, 412; Embase, 538; CENTRAL, 264; Web of Science, 623; Scopus, 741; CNKI, 1,986; Wanfang, 1,254; VIP, 553; SinoMed, 343). After removal of duplicates, 5,099 unique records remained for title and abstract screening. Preliminary assessment suggests substantial variability in Tuina intervention components, including manual techniques, treatment targets, dose parameters, and therapeutic rationale. This heterogeneity is expected to influence both quantitative synthesis feasibility and interpretation of clinical outcomes. Full screening and data extraction are ongoing, with subgroup and sensitivity analyses planned to explore sources of heterogeneity.

Conclusions: Tuina research for CLBP is abundant globally, particularly in Chinese databases, but is characterized by marked heterogeneity in intervention design and reporting. By integrating effectiveness evaluation with structured analysis of intervention characteristics, this review aims to clarify what constitutes Tuina therapy in clinical research and to inform standardization, reproducibility, and future trial design in manual therapy for chronic pain.

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Presenting Author: Michael R. Mueller
Submitting Author: TIANYI ZHAO

Senior Author: Brent A. Bauer

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Michael R. Mueller: M.D - Mayo Clinic
• Ivana T. Croghan: PH.D - Mayo Clinic
• Yizhong Zhang: Ph.D - AiTreat Pte. Ltd.
• Brent A. Bauer: M.D - Mayo Clinic