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[1]姚彬,袁普衛(wèi),楊鋒,等.不同運動療法治療膝骨關(guān)節(jié)炎有效性的網(wǎng)狀mETA分析[J].中醫(yī)正骨,2023,35(11):18-28.
　YAO Bin,YUAN Puwei,YANG Feng,et al.Clinical outcomes of different kinesitherapies for treatment of knee osteoarthritis:a network meta-analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(11):18-28.
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不同運動療法治療膝骨關(guān)節(jié)炎有效性的網(wǎng)狀mETA分析()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期數(shù):
2023年11期
頁碼:
18-28
欄目:
文獻(xiàn)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; 袁普衛(wèi)1; 楊鋒1; 葛騰1; 董佩1; 白元帥2; 康武林2
1.陜西中醫(yī)藥大學(xué)第一臨床醫(yī)學(xué)院,陜西 咸陽 712000; 2.陜西中醫(yī)藥大學(xué)附屬醫(yī)院,陜西 咸陽 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
關(guān)鍵詞:
骨關(guān)節(jié)炎; 膝;  運動療法;  網(wǎng)絡(luò)Meta分析
Keywords:
osteoarthritis; knee;  exercise therapy;  network meta-analysis
摘要:
目的:系統(tǒng)評價不同運動療法治療膝骨關(guān)節(jié)炎(knee osteoarthritis,KOA)的有效性。方法:應(yīng)用計算機檢索中國知網(wǎng)、維普網(wǎng)、萬方數(shù)據(jù)庫、中國生物醫(yī)學(xué)文獻(xiàn)服務(wù)系統(tǒng)、PubMed、Embase和Cochrane Library中關(guān)于運動療法治療KOA的對比研究文獻(xiàn),檢索時限均為建庫至2023年2月20日。試驗組采用運動療法(包括水中運動、中國傳統(tǒng)功法、本體感覺訓(xùn)練、等速肌力訓(xùn)練、等長肌力訓(xùn)練、瑜伽、騎行、步行等)或運動療法聯(lián)合常規(guī)治療(包括健康教育、玻璃酸鈉關(guān)節(jié)腔注射、口服非甾體抗炎藥、針灸、推拿、中藥口服、中藥薰蒸等),對照組單純采用常規(guī)治療或與試驗組不同的運動療法。依據(jù)文獻(xiàn)檢索及篩選方案篩選出符合要求的文獻(xiàn)后,由2名研究人員分別獨立進(jìn)行數(shù)據(jù)提取和質(zhì)量評價。采用Stata15.0軟件繪制網(wǎng)狀關(guān)系圖,對治療有效率、膝關(guān)節(jié)疼痛視覺模擬量表(visual analogue scale,VAS)評分、西安大略和麥克馬斯特大學(xué)骨關(guān)節(jié)炎指數(shù)(Western Ontario and McMaster Universities osteoarthritis index,WOMAC)評分、Lysholm膝關(guān)節(jié)評分進(jìn)行網(wǎng)狀Meta分析,并根據(jù)累計概率排名曲線下面積(the surface under the cumulative ranking curve,SUCRA)對干預(yù)方法的療效進(jìn)行排序。采用比較-校正漏斗圖進(jìn)行發(fā)表偏倚檢驗。結(jié)果:共檢索到833篇文獻(xiàn),通過逐層篩選最終納入38篇文獻(xiàn),涉及水中運動、中國傳統(tǒng)功法、本體感覺訓(xùn)練、等速肌力訓(xùn)練、等長肌力訓(xùn)練、瑜伽、騎行、步行共8種運動療法。網(wǎng)狀Meta分析結(jié)果顯示,在治療有效率方面,不同運動療法治療KOA的療效排序為中國傳統(tǒng)功法(SUCRA=80.5%)>水中運動(SUCRA=78.5%)>等速肌力訓(xùn)練(SUCRA=64.4%)>騎行(SUCRA=47.2%)>本體感覺訓(xùn)練(SUCRA=37.2%)>等長肌力訓(xùn)練(SUCRA=36.9%); 在膝關(guān)節(jié)疼痛VAS評分方面,不同運動療法治療KOA的療效排序為水中運動(SUCRA=85.2%)>等速肌力訓(xùn)練(SUCRA=70.8%)>瑜伽(SUCRA=69.7%)>騎行(SUCRA=64.7%)>本體感覺訓(xùn)練(SUCRA=41.9%)>中國傳統(tǒng)功法(SUCRA=41.0%)>等長肌力訓(xùn)練(SUCRA=26.6%)>步行(SUCRA=20.3%); 在WOMAC評分方面,不同運動療法治療KOA的療效排序為水中運動(SUCRA=97.0%)>等速肌力訓(xùn)練(SUCRA=71.8%)>中國傳統(tǒng)功法(SUCRA=69.3%)>本體感覺訓(xùn)練(SUCRA=63.8%)>瑜伽(SUCRA=63.1%)>等長肌力訓(xùn)練(SUCRA=41.6%)>步行(SUCRA=22.8%); 在Lysholm膝關(guān)節(jié)評分方面,不同運動療法治療KOA的療效排序為等速肌力訓(xùn)練(SUCRA=74.2%)>水中運動(SUCRA=67.4%)>本體感覺訓(xùn)練(SUCRA=53.6%)>中國傳統(tǒng)功法(SUCRA=47.1%)>等長肌力訓(xùn)練(SUCRA=43.8%)>騎行(SUCRA=40.8%)>步行(SUCRA=33.1%)。結(jié)論:現(xiàn)有的證據(jù)表明,采用運動療法治療KOA時應(yīng)優(yōu)先選擇中國傳統(tǒng)功法、水中運動和等速肌力訓(xùn)練。
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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備注/Memo

備注/Memo:
基金項目:國家自然科學(xué)基金項目(81973889,81574006); 中醫(yī)藥“雙鏈融合”中青年科研創(chuàng)新團(tuán)隊項目(2022-SLRH-LJ-001); 陜西省中醫(yī)藥重點研究室建設(shè)項目(陜中醫(yī)藥發(fā)〔2018〕32號); 陜西省重點研發(fā)計劃項目(2017SF-139)
通訊作者:康武林 E-mail:[email protected]
更新日期/Last Update: 1900-01-01