[1]姚彬,袁普卫,杨锋,等.不同运动疗法治疗膝骨关节炎有效性的网状mETA分析[J].中医正骨,2023,35(11):18-28.
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不同运动疗法治疗膝骨关节炎有效性的网状mETA分析()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期数:
2023年11期
页码:
18-28
栏目:
文献研究
出版日期:
2023-11-20

文章信息/Info

Title:
Clinical outcomes of different kinesitherapies for treatment of knee osteoarthritis:a network meta-analysis
作者:
姚彬1; 袁普卫1; 杨锋1; 葛腾1; 董佩1; 白元帅2; 康武林2
1.陕西中医药大学第一临床医学院,陕西 咸阳 712000; 2.陕西中医药大学附属医院,陕西 咸阳 712000
Author(s):
YAO Bin1; YUAN Puwei1; YANG Feng1; GE Teng1; DONG Pei1; BAI Yuanshuai2; KANG Wulin2
1.The First Clinical Medical College of Shaanxi University of Chinese Medicine,Xianyang 712000,Shaanxi,China 2.The Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang 712000,Shaanxi,China
关键词:
骨关节炎; 膝;  运动疗法;  网络Meta分析
Keywords:
osteoarthritis; knee;  exercise therapy;  network meta-analysis
摘要:
目的:系统评价不同运动疗法治疗膝骨关节炎(knee osteoarthritis,KOA)的有效性。方法:应用计算机检索中国知网、维普网、万方数据库、中国生物医学文献服务系统、PubMed、Embase和Cochrane Library中关于运动疗法治疗KOA的对比研究文献,检索时限均为建库至2023年2月20日。试验组采用运动疗法(包括水中运动、中国传统功法、本体感觉训练、等速肌力训练、等长肌力训练、瑜伽、骑行、步行等)或运动疗法联合常规治疗(包括健康教育、玻璃酸钠关节腔注射、口服非甾体抗炎药、针灸、推拿、中药口服、中药薰蒸等),对照组单纯采用常规治疗或与试验组不同的运动疗法。依据文献检索及筛选方案筛选出符合要求的文献后,由2名研究人员分别独立进行数据提取和质量评价。采用Stata15.0软件绘制网状关系图,对治疗有效率、膝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities osteoarthritis index,WOMAC)评分、Lysholm膝关节评分进行网状Meta分析,并根据累计概率排名曲线下面积(the surface under the cumulative ranking curve,SUCRA)对干预方法的疗效进行排序。采用比较-校正漏斗图进行发表偏倚检验。结果:共检索到833篇文献,通过逐层筛选最终纳入38篇文献,涉及水中运动、中国传统功法、本体感觉训练、等速肌力训练、等长肌力训练、瑜伽、骑行、步行共8种运动疗法。网状Meta分析结果显示,在治疗有效率方面,不同运动疗法治疗KOA的疗效排序为中国传统功法(SUCRA=80.5%)>水中运动(SUCRA=78.5%)>等速肌力训练(SUCRA=64.4%)>骑行(SUCRA=47.2%)>本体感觉训练(SUCRA=37.2%)>等长肌力训练(SUCRA=36.9%); 在膝关节疼痛VAS评分方面,不同运动疗法治疗KOA的疗效排序为水中运动(SUCRA=85.2%)>等速肌力训练(SUCRA=70.8%)>瑜伽(SUCRA=69.7%)>骑行(SUCRA=64.7%)>本体感觉训练(SUCRA=41.9%)>中国传统功法(SUCRA=41.0%)>等长肌力训练(SUCRA=26.6%)>步行(SUCRA=20.3%); 在WOMAC评分方面,不同运动疗法治疗KOA的疗效排序为水中运动(SUCRA=97.0%)>等速肌力训练(SUCRA=71.8%)>中国传统功法(SUCRA=69.3%)>本体感觉训练(SUCRA=63.8%)>瑜伽(SUCRA=63.1%)>等长肌力训练(SUCRA=41.6%)>步行(SUCRA=22.8%); 在Lysholm膝关节评分方面,不同运动疗法治疗KOA的疗效排序为等速肌力训练(SUCRA=74.2%)>水中运动(SUCRA=67.4%)>本体感觉训练(SUCRA=53.6%)>中国传统功法(SUCRA=47.1%)>等长肌力训练(SUCRA=43.8%)>骑行(SUCRA=40.8%)>步行(SUCRA=33.1%)。结论:现有的证据表明,采用运动疗法治疗KOA时应优先选择中国传统功法、水中运动和等速肌力训练。
Abstract:
Objective:To systematically review the clinical outcomes of different kinesitherapies for treatment of knee osteoarthritis(KOA).Methods:All the comparative study articles about kinesitherapies for treatment of KOA included from database establishing to February 20,2023 were retrieved from the China National Knowledge Internet,Vip Database,Wanfang Database,Chinese Biomedical Literature Service System,PubMed,Embase and Cochrane Library through computer.The patients in experiment group were treated with kinesitherapies(water exercises,traditional Chinese exercises,proprioceptive training,isokinetic muscle strength training,isometric muscle strength training,yoga,cycling,walking,etc.)or combination of kinesitherapies with conventional therapies(health education,intraarticular injection of sodium hyaluronate,oral application of non-steroidal anti-inflammatory drugs(NSAIDs),acupuncture,tuina,oral application of traditional Chinese medicine(TCM),Chinese herbal steaming therapy,etc.); while the ones in control group merely with conventional therapies or kinesitherapies different from those adopted by the experiment group.The articles were screened according to the retrieval and screening scheme.The information was extracted and the methodological quality of included researches in the articles was evaluated independently by two researchers.The reticulation plots were drawn by using Stata15.0 software,and then a reticulated Meta-analysis on clinical effective rate,knee pain visual analogue scale(VAS)score,Western Ontario and McMaster Universities osteoarthritis index(WOMAC)score and Lysholm knee score(LKS)was conducted.Furthermore,the outcomes of the interventions were ranked according to the surface under the cumulative ranking curve(SUCRA),and the publication bias was tested by using comparison-correction funnel plots.Results:Eight hundred and thirty-three articles were searched out.After screening,38 articles were included in the final analysis,involving eight kinds of exercise therapies,i.e.,water exercises,traditional Chinese exercises,proprioceptive training,isokinetic muscle strength training,isometric muscle strength training,yoga,cycling and walking.The results of reticulated Meta-analysis showed that,in treatment of KOA,traditional Chinese exercises(SUCRA=80.5%)behaved best in clinical effective rate,followed by water exercises(SUCRA=78.5%),isokinetic muscle strength training(SUCRA=64.4%),cycling(SUCRA=47.2%),proprioceptive training(SUCRA=37.2%)and isometric muscle strength training(SUCRA=36.9%); water exercises(SUCRA=85.2%)behaved best in knee pain VAS score,followed by isokinetic muscle strength training(SUCRA=70.8%),yoga(SUCRA=69.7%),cycling(SUCRA=64.7%),proprioceptive training(SUCRA=41.9%),traditional Chinese exercises(SUCRA=41.0%),isometric muscle strength training(SUCRA=26.6%)and walking(SUCRA=20.3%); water exercises(SUCRA=97.0%)behaved best in WOMAC score,followed by isokinetic muscle strength training(SUCRA=71.8%),traditional Chinese exercises(SUCRA=69.3%),proprioceptive training(SUCRA=63.8%),yoga(SUCRA=63.1%),isometric muscle strength training(SUCRA=41.6%)and walking(SUCRA=22.8%); and isokinetic muscle strength training(SUCRA=74.2%)behaved best in LKS,followed by water exercises(SUCRA=67.4%),proprioceptive training(SUCRA=53.6%),traditional Chinese exercises(SUCRA=47.1%),isometric muscle strength training(SUCRA=43.8%),cycling(SUCRA=40.8%)and walking(SUCRA=33.1%).Conclusion:Available evidences suggest that,among the kinesitherapies,traditional Chinese exercises,water exercises and isokinetic muscle strength training should be used firstly in treatment of KOA.

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备注/Memo

备注/Memo:
基金项目:国家自然科学基金项目(81973889,81574006); 中医药“双链融合”中青年科研创新团队项目(2022-SLRH-LJ-001); 陕西省中医药重点研究室建设项目(陕中医药发〔2018〕32号); 陕西省重点研发计划项目(2017SF-139)
通讯作者:康武林 E-mail:382910292@qq.com
更新日期/Last Update: 1900-01-01