3.5.2. Tuina Manual Therapy + Usual Conventional Therapy vs. Usual Conventional Therapy

The level of evidence and recommendations were derived based on 32 RCTs [36,39,46,89,99,121–147] that observed the combined effect of Tuina manual therapy and conventional treatment for LHIVD in terms of pain, function, and overall symptom improvement.

As a result of the meta-analysis, the combination of Tuina manual therapy with conventional treatments, such as acupuncture, herbal medicine, injection, and traction therapy, was more effective in improving the overall symptoms (RR: 1.25, 95% CI: 1.22–1.29, *p* < 0.001), pain (MD, −1.08, 95% CI: 1.21–−0.95, *p* < 0.001), and function (ODI: MD, 2.93, 95% CI: 3.38 –−2.49, *p* < 0.001; JOA: MD, 4.86, 95% CI: 4.19–5.53, *p* < 0.001) than conventional treatment. However, the heterogeneity (I2 = 76%) between studies was high; therefore, the level of evidence was evaluated at one level lower due to inconsistency.

In conclusion, a combination of Tuina manual therapy and conventional treatment is recommended for improving the overall symptoms of LHIVD (A/Moderate).
