健康教育对腰痛干预疗效的系统评价和Meta分析

目的:系统评价健康教育对腰痛患者疼痛、功能性活动及生活质量的临床效果。方法:计算机检索EMBASE、Web of Science、PubMed/Medline、The Cochrane Library、VIP、CNKI和WanFang Data数据库,搜索时限从2009年1月~2019年9月。由两名评价员独立筛选文献、提取数据并评价纳入研究的方法学质量,以RevMan 5.3软件进行Meta分析。结果:最终纳入27个研究,共2701例患者。Meta结果显示与对照组相比:①健康教育联合运动疗法在改善腰痛患者疼痛和功能障碍方面具有显著优势,NPRS评分[MD=-1.78,95%CI(-2.67,-0.89),P<0.01]、RMDQ评分[MD=-4.72,95%CI(-7.70,-0.84),P=0.01];②健康教育联合常规治疗在改善疼痛方面并无显著性差异,VAS评分[MD=-0.49,95%CI(-1.04,0.07),P=0.09],但在改善功能障碍方面具有优势,RMDQ评分[MD=-0.97,95%CI(-1.91,-0.02),P=0.04];③加强健康教育在疼痛改善方面具有优势,VAS评分[MD=-0.52,95%CI(-0.93,-0.11),P=0.01]、NPRS评分[MD=-0.41,95%CI(-0.75,-0.08),P=0.01],在改善功能障碍方面均无优势。所有研究在改善生活质量方面均无优势。结论:运动疗法或常规治疗基础上增加健康教育更有利于腰痛患者疼痛缓解,并能更好的改善因腰痛导致的功能障碍。且加强健康教育可能更加有效。受纳入研究数量和质量的限制,以上述结论尚待更多高质量研究予以验证。     

Whole Body Vibration Exercise for Chronic Musculoskeletal Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials

ObjectiveThis study systematically reviews previous work on the effects of whole body vibration exercise (WBVE) on pain associated with chronic musculoskeletal disorders.Data SourcesSeven electronic databases (PubMed, Embase, CINAHL, Web of Science, Cochrane, Physiotherapy Evidence Database [PEDro], and the China National Knowledge Infrastructure) were searched for articles published between January 1980 and September 2018.Study SelectionRandomized controlled trials involving adults with chronic low back pain (CLBP), osteoarthritis (OA), or fibromyalgia were included. Participants in the WBVE intervention group were compared with those in the nontreatment and non-WBVE control groups.Data ExtractionData were independently extracted using a standardized form. Methodological quality was assessed using PEDro.Data SynthesisSuitable data from 16 studies were pooled for meta-analysis. A random effects model was used to calculate between-groups mean differences at 95% confidence interval (CI). The data were analyzed depending on the duration of the follow-up, common disorders, and different control interventions.ResultsAlleviation of pain was observed at medium term (standardized mean difference [SMD], -0.67; 95% CI, -1.14 to -0.21; I², 80%) and long term (SMD, -0.31; 95% CI, -0.59 to -0.02; I², 0%). Pain was alleviated in osteoarthritis (OA) (SMD, -0.37; 95% CI, -0.64 to -0.10; P<.05; I², 22%) and CLBP (SMD, -0.44; 95% CI, -0.75 to -0.13; P<.05; I², 12%). Long-term WBVE could relieve chronic musculoskeletal pain conditions of OA (SMD, -0.46; 95% CI, -0.80 to -0.13; P<.05; I², 0%). WBVE improved chronic musculoskeletal pain compared with the treatment “X” control (SMD, -0.37; 95% CI, -0.61 to -0.12; P<.05; I², 26%), traditional treatment control (SMD, -1.02; 95% CI, -2.44 to 0.4; P>.05; I², 94%) and no treatment control (SMD, -1; 95% CI, -1.76 to -0.24; P<.05; I², 75%).ConclusionsEvidence suggests positive effects of WBVE on chronic musculoskeletal pain, and long durations of WBVE could be especially beneficial. However, WBVE does not significantly relieve chronic musculoskeletal pain compared with the traditional treatment. Further work is required to identify which parameters of WBVE are ideal for patients with chronic musculoskeletal pain.     

Effect of Repetitive Peripheral Magnetic Stimulation on Patients With Low Back Pain: A Meta-analysis of Randomized Controlled Trials

ObjectiveThe purpose of this meta-analysis was to investigate the effects of repetitive peripheral magnetic stimulation (rPMS) on pain intensity, functional mobility, and kinesiophobia in individuals with low back pain (LBP).Data SourcesThe PubMed, Physiotherapy Evidence Database, Embase, Cochrane Library, and Web of Science databases were systematically searched from inception until November 25, 2022.Study SelectionEligible randomized controlled trials contained information on the population (LBP), intervention (rPMS), and outcomes (pain intensity, functional mobility, and kinesiophobia). Participants in the rPMS intervention group were compared with those in sham or other control groups. Two independent researchers searched for, screened, and qualified the articles.Data ExtractionTwo independent researchers extracted key information from each eligible study. The authors’ names, year of publication, setting, total sample size, rPMS parameters, baseline/mean difference (MD), and 95% confidence interval (CI) were extracted using a standardized form, and the methodological quality was assessed using the Physiotherapy Evidence Database score and GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system.Data SynthesisOf 733 studies identified, 6 randomized controlled trials (n = 139) were included for meta-analysis. Compared with sham rPMS or other therapy, rPMS showed significant efficacy in reducing pain intensity (visual analog scale: MD, –1.89; 95% CI, –3.32 to –0.47; P<.05; very low-quality evidence). Significant efficacy was also found in terms of functional disability (Oswestry Disability Index: MD, –8.39; 95% CI, –13.65 to –3.12; P<.001; low-quality evidence). However, there was no statistically significant between-group difference on the Tampa scale of kinesiophobia (MD, –1.81; 95% CI, –7.60 to 3.98; P>.05; very low-quality evidence).ConclusionsThis meta-analysis found very low- to low-quality evidence that rPMS can be used to reduce pain intensity and improve functional disability in individuals with LBP. However, no significant effect of rPMS on kinesiophobia was found.     

Outcomes With Individual Versus Group Physical Therapy for Treating Urinary Incontinence and Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective

To evaluate the existing evidence comparing the outcomes of rehabilitation conducted in a group setting and individual therapy for patients receiving rehabilitation.

Data Sources

Electronic databases MEDLINE, CINAHL, EMBASE, PEDro, and OT Seeker were searched from the earliest date possible to July 2013. Additional references were identified by manual scanning of reference lists.

Study Selection

Randomized controlled trials investigating the effect of group therapy compared with individual therapy for patients receiving rehabilitation were included for review. Two reviewers independently applied the inclusion and exclusion criteria to identify included articles. Initial search identified 1527 potential articles, of which 16 trials with 2337 participants were included in the final review.

Data Extraction

Data extraction was completed for all included trials by one reviewer, using a customized data extraction form. Data were checked for accuracy by a second reviewer. Trials were independently assessed by 2 reviewers for methodological quality using the PEDro scale.

Data Synthesis

Trials meeting inclusion criteria had been conducted in back pain (n=6 studies), urinary incontinence (n=5), learning disability (n=2), hearing loss (n=1), joint replacement (n=1), and aphasia (n=1). Meta-analysis of physical therapy trials in back pain and urinary incontinence reporting sufficient homogeneous data showed no significant difference in outcomes for group versus individual therapy. These results were also supported by qualitative analysis of the remaining studies in these populations, but there is insufficient evidence to draw conclusions regarding other clinical areas.

Conclusions

Evidence shows that providing rehabilitation in a group format results in equivalent clinical outcomes to provision of similar therapy in an individual format in the treatment of back pain and urinary incontinence. There is currently insufficient evidence to draw similar conclusions in other populations or fields of rehabilitation.     

Massage Therapy for Low Back Pain: A Systematic Review

Massage therapy is frequently employed for low back pain (LBP). The aim of this systematic review was to find the evidence for or against its efficacy in this indication. Four randomized clinical trials were located in which massage was tested as a monotherapy for LBP. All were burdened with major methodological flaws. One of these studies suggests that massage is superior to no treatment. Two trials imply that it is equally effective as spinal manipulation or transcutaneous electrical stimulation (TES). One study suggests that it is less effective than spinal manipulation. It is concluded that too few trials of massage therapy exist for a reliable evaluation of its efficacy. Massage seems to have some potential as a therapy for LBP. More investigations of this subject are urgently needed.     

The Underappreciated Placebo Effects and Responses in Randomized Controlled Trials on Neck Pain: A Systematic Review With Meta-analysis

ObjectiveTo quantify placebo effects and responses in randomized controlled trials (RCTs) on neck pain and explore how they would influence the treatment of neck pain.Data SourcesWe searched MEDLINE (PubMed), EMBASE (Ovid), CINAHL (EBSCO), Physiotherapy Evidence Database (PEDro), and World Health Organization International Clinical Trials Registry Platform from the inception of August 15, 2021, to identify relevant RCTs.Study Selection and Data ExtractionThe abstracts and full texts of potential studies were independently screened, and data extraction was also independently performed by 2 researchers. Scales of the score measuring neck pain and the scores both at baseline and the endpoint were extracted.Data SynthesisA total of 60 RCTs were included. The mean improvement in the pain score after placebo treatment was 15.65 (mean difference [MD]=-15.65, 95% confidence interval; CI [-19.19, -12.12]; P<.05), which we defined as the placebo response. In the active groups, it was 25.91 (MD=-25.91, 95% CI [-29.15, -22.68]; P<.05), and in the no-treatment groups, it was 5.80 (MD=-5.80, 95% CI [13.28, 1.69]; P=.13). Using the 3 MDs from the 3 groups, the placebo effect was calculated to account for 38.0% of the pain score improvement in the active group.ConclusionsThe pain scores of patients with neck pain were reduced after treatment with placebos, but the magnitude of pain score reduction was not clinically significant enough. The 38.0% amount of pain score reduction in patients treated with active interventions was caused by placebo. Interventions with considerable clinically significance for neck pain were still required.     

Effect of Resveratrol Supplementation on Inflammatory Markers: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Purpose

The evidence has suggested that resveratrol has anti-inflammatory effect; however, the results are inconsistent and inconclusive. The aim of this study was to assess the effect of resveratrol supplementation on the levels of inflammatory markers through a systematic review and meta-analysis of available randomized controlled trials (RCTs).

Cannabis for Chronic Pain: A Rapid Systematic Review of Randomized Control Trials

BackgroundThe high prevalence of inadequately managed chronic pain indicates the need for alternative and multimodal treatment options. Use of cannabinoids in medicine is becoming a growing area of interest, specifically in the context of chronic pain. The efficacy of cannabinoids for the treatment of chronic pain is not well established.AimsThe objectives of this rapid systematic literature review are to summarize the efficacy and secondary effects of cannabinoids for chronic pain management.DesignRapid systematic review of randomized control trials.ParticipantsIndividuals with chronic pain (n = 1352).MethodsEmbase, Cochrane, PubMed, and CINAHL databases were searched. Inclusion criteria included cannabis of any formulation used to treat chronic pain of any origin.ResultsThirteen randomized controlled trials met the inclusion criteria. Five demonstrated moderate analgesic effects of cannabis for chronic pain, and eight concluded there were no significant impacts on pain in the cannabis-treated group versus the control group.ConclusionsEvidence on the efficacy of cannabinoids for chronic pain shows patient-perceived benefit but inconsistent other treatment effects. These findings indicate cannabinoids may have a modest analgesic effect for chronic neuropathic pain conditions, and that the use of cannabinoids is relatively safe, with few severe adverse events. This review concludes that cannabinoids may have a potential role in chronic pain management. Inconsistent evidence on the efficacy of cannabis to treat chronic pain indicates the need for more studies on a larger scale. Clinicians should draw on available evidence and consider cannabinoids as a potential approach to chronic pain management.     

The Effect of Anastrozole on the Lipid Profile: Systematic Review and Meta-analysis of Randomized Controlled Trials

PurposeWe aimed to investigate the impact of anastrozole administration on the traditional components of the lipid profile (ie, total cholesterol [TC], LDL-C, HDL-C, and triglycerides [TGs]) by means of a systematic review and meta-analysis of randomized controlled trials.MethodsWe searched the PubMed/Medline, Scopus, Embase, and Web of Science databases for relevant randomized controlled trials published in the English language until January 18, 2022. The weighted mean difference (WMD) and 95% CIs were calculated using a random-effects model (DerSimonian and Laird methods).FindingsAnastrozole administration significantly lowered TC concentrations when the treatment duration was ≤3 months (WMD = ?2.73 mg/dL; 95% CI, ?5.09 to ?0.38 mg/dL; P = 0.02) and when the baseline TC concentration was ≥200 mg/dL (WMD = ?3.64 mg/dL; 95% CI, ?6.30 to ?0.98 mg/dL; P = 0.007). HDL-C levels decreased after anastrozole administration when the treatment duration was >3 months (WMD = ?1.67 mg/dL; 95% CI, ?3.24 to ?0.10 mg/dL; P = 0.03). Anastrozole administration had no impact on TG or LDL-C values.ImplicationsAnastrozole administration in humans can decrease TC and HDL-C levels but has no effect on LDL-C or TG concentrations.     

Effect of the Renin-Angiotensin System Inhibitors on Inflammatory Markers: A Systematic Review and Meta-analysis of Randomized Controlled Trials

ObjectiveTo synthesize more conclusive evidence on the anti-inflammatory effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs).MethodsPubMed, Scopus, and Embase were searched from inception until March 1, 2021. We included randomized controlled trials (RCTs) that assessed the effect of ACEIs or ARBs, compared with placebo, on any of the following markers: C-reactive protein (CRP), interleukin 6 (IL-6), or tumor necrosis factor α (TNF-α). Mean changes in the levels of these markers were pooled as a weighted mean difference (WMD) with a 95% CI.ResultsThirty-two RCTs (n=3489 patients) were included in the final analysis. Overall pooled analysis suggested that ACEIs significantly reduced plasma levels of CRP (WMD, ?0.54 [95% CI, ?0.88 to ?0.21]; P=.002; I²=96%), IL-6 (WMD, ?0.84 [95% CI, ?1.03 to ?0.64]; P<.001; I²=0%), and TNF-α (WMD, ?12.75 [95% CI, ?17.20 to ?8.29]; P<.001; I²=99%). Moreover, ARBs showed a significant reduction only in IL-6 (WMD, ?1.34 [95% CI, ?2.65 to ?0.04]; P=.04; I²=85%) and did not significantly affect CRP (P=.15) or TNF-α (P=.97) levels. The lowering effect of ACEIs on CRP levels remained significant with enalapril (P=.006) and perindopril (P=.01) as well as with a treatment duration of less than 24 weeks (WMD, -0.67 [95% CI, ?1.07 to -0.27]; P=.001; I²=94%) and in patients with coronary artery disease (WMD, ?0.75 [95% CI, ?1.17 to ?0.33]; P<.001; I²=96%).ConclusionBased on this meta-analysis, ACEIs showed a beneficial lowering effect on CRP, IL-6, and TNF-α, whereas ARBs were effective as a class in reduction of IL-6 only.     

盐酸氨基葡萄糖治疗椎间盘源性腰痛的随机对照研究

目的探讨单用和联用盐酸氨基葡萄糖与非甾体抗炎药(NSAID)在椎间盘源性腰痛(DLBP)治疗中的有效性。方法 2011年1月-12月72例DLBP患者,男42例,女30例;年龄22～71岁;体重43～84 kg;病程0.5～10年。通过随机数字表的方法,将患者分为3组。A组给予盐酸氨基葡萄糖胶囊750 mg,2次/d,同时给予尼美舒利分散片100 mg,2次/d;B组给予盐酸氨基葡萄糖胶囊750 mg,2次/d;C组给予尼美舒利分散片100 mg,2次/d。3组均用药8周后停药,用药期间停用其他活血化瘀类药物及物理治疗。选取治疗前及治疗后第4、8、16周4个时间点,运用疼痛数字评价量表(NRS)、Oswestry功能障碍指数(ODI)、生活质量评价量表SF-36分别对3组患者的腰痛、腰部功能及生活质量进行评价。结果 63例获得随访,失访率12.5%。各组患者NRS评分、ODI评分、SF-36评分在治疗前后比较差异均有统计学意义(P<0.05),A组疗效明显优于B、C两组,B组治疗后各项数据较治疗前明显改善(P<0.05)。结论单用盐酸氨基葡萄糖治疗DLBP有效,且在停药后,仍有一定疗效,联用NSAID效果更佳;远期疗效有待进一步随访。     

Pain Science Education Plus Exercise Therapy in Chronic Nonspecific Spinal Pain: A Systematic Review and Meta-analyses of Randomized Clinical Trials

Exercise therapy and education are recommended from several guidelines for managing symptoms in chronic nonspecific spinal pain (CNSP) patients. However, no systematic reviews have previously analyzed the effectiveness of pain science education (PSE) plus exercise therapy for managing CNSP related symptoms. Systematic searches were conducted on 10 databases looking for randomized control trials (RCTs) aimed to evaluate the effectiveness on pain, disability, kinesiophobia, and catastrophizing. Data were analyzed using random-effects meta-analyses and studies were appraised using the Cochrane ROB tool and GRADE. A total of eight RCTs (n = 622) were included in the qualitative-analysis and five were selected for meta-analysis. PSE plus exercise therapy showed improvements in pain (5RCTs: short-term: SMD: -0.53 [-0.86,-0.2]; 4RCTs: intermediate-term: SMD: -0.57 [-1.01,-0.14]; low quality), disability (4RCTs: short-term: SMD: -0.24 [-0.53,0.05]; 4RCTs: intermediate-term: SMD: -0.93 [-1.08,-0.03]; low-to-very-low quality), kinesiophobia (3RCTs: short-term: SMD: -0.7 [-1.51,0.11]; 4RCTs: intermediate-term: SMD: -0.93 [-1.57,-0.30]; moderate-to-very-low quality), and catastrophizing (2RCTs: short-term: MD: -3.26 points [-6.15,-0.37]; 3RCTs: intermediate-term: MD: -4.94 points [-8.08,-1.81]; low-to-very-low quality) compared to exercise alone. A qualitative-analysis showed improvements in the experimental group compared to multimodal physiotherapy (1RCT; low-to-very-low quality), whereas no clear benefits were reported compared to PSE alone (1RCT; very-low quality) or no intervention (1RCT; very-low quality). There is low to very-low certainty of the evidence suggesting that PSE plus exercise therapy reduces CNSP related-symptoms.PerspectiveBased on low-quality data from small samples, PSE plus exercise therapy reduces CNSP related symptoms. The evidence requires further investigation due to the limited number of studies with short follow-up periods (CRD42020168968).     

Effect of Exercise and Pharmacological Interventions on Visceral Adiposity: A Systematic Review and Meta-analysis of Long-term Randomized Controlled Trials

Objective

To assess the effectiveness of exercise and pharmacotherapy interventions in reducing visceral adipose tissue (VAT).

The Efficacy of Physical Therapy Modalities in Patients With Hemophilia: A Systematic Review of Randomized Controlled Trials With Meta-analysis

ObjectiveTo evaluate the efficacy of different physical therapy interventions that could validate decisions taken by health care providers in the field of rehabilitation of patients with hemophilia according to the International Classification of Functioning, Disability and Health (ICF), including body functions and structures, activity, and participation.Data SourcesSeven databases—PubMed, Cochrane Library, Scopus, Web of Science, Physiotherapy Evidence Database, Google Scholar, and Clinicaltrials.gov—were systematically searched for randomized controlled trials evaluating any physical therapy modality to manage hemophilia.Study SelectionAfter abstract and full-text filtration, a methodological quality assessment was performed using the Physiotherapy Evidence Database scale for the studies that met the eligibility criteria.Data ExtractionRelevant data were extracted from eligible studies and outcomes were categorized according to the ICF.Data SynthesisUsing Review Manager and Microsoft Excel, a quantitative analysis using standardized mean differences with the 95% confidence interval was completed. Statistical heterogeneity between studies was explored using the I² test. A fixed effect model was applied to all data analyses. If heterogeneity was statistically significant, the Der Simonian and Laird random effects models were used instead.Results35 randomized controlled trials with 1216 participants were included in this systematic review; 13 of them dealt with pediatric patients. Most of the studies were of good quality; 12 studies were of low quality. Meta-analysis showed a significant difference in favor of manual therapy, laser, and therapeutic exercises on selected outcomes of body function and structure, activity, and participation categories of the ICF model.ConclusionThis systematic review recommends using manual therapy and therapeutic exercise modalities to improve join health status in combination with educational sessions to improve the quality of life of patients with hemophilic arthropathy. For pediatric patients with hemophilic arthropathy, using laser therapy is promising for improving functional capacity.     

Autonomic Effects of Spinal Manipulative Therapy: Systematic Review of Randomized Controlled Trials

ObjectiveThe purpose of this study was to systematically review the effects of spinal manipulative therapy (SMT) on autonomic nervous system (ANS)-mediated outcomes, in both symptomatic and healthy populations, and to assess the quality of evidence for the most prevalent outcomes with the Grading of Recommendations, Assessment, Development and Evaluation approach.MethodsPubMed, Cochrane Library, PEDro, Web of Science, and EMBASE were searched from their inception to March 2014. Randomized controlled trials involving SMT, such as mobilization and manipulation, that reported at least 1 outcome related to the ANS, with placebo, control groups, or other SMT techniques as comparators, with either healthy or symptomatic samples were included. The Physiotherapy Evidence Database scale and the Grading of Recommendations, Assessment, Development and Evaluation approach were used to assess risk of bias and the quality of evidence, respectively.ResultsEighteen trials were included in this systematic review. Passive accessory intervertebral mobilization produced sympathoexcitation independently of the treated region (cervical, thoracic, or lumbar spine); although sustained natural apophyseal glides did not influence the ANS, conflicting results were observed regarding manipulation techniques. The overall quality of evidence for all analyzed outcomes ranged from low to very low quality.ConclusionThere is evidence pointing toward the existence of sympathoexcitatory short-term effects following passive accessory intervertebral mobilization mobilizations, but not for sustained natural apophyseal glide mobilizations. There is conflicting evidence regarding the ability of manipulation to elicit sympathoexcitation. However, the low quality of the evidence precludes a definitive conclusion of such effects. Based on the current evidence, there is uncertainty regarding the true effect estimates of SMT on ANS-mediated outcomes.     

Effectiveness of Exercise Interventions for Pain Reduction in People With Multiple Sclerosis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Objective

To systematically review the evidence of the effect of exercise compared with passive control on pain in people with multiple sclerosis.