Christensen Robin, Bartels Else Marie, Astrup Arne, Bliddal Henning
The Parker Institute, H:S Frederiksberg Hospital, DK-2000 Frederiksberg, and Copenhagen University Library, Denmark.
Ann Rheum Dis. 2007 Apr;66(4):433-9. doi: 10.1136/ard.2006.065904. Epub 2007 Jan 4.
This review aims to assess by meta-analysis of randomised controlled trials (RCTs) changes in pain and function when overweight patients with knee osteoarthritis (OA) achieve a weight loss. Systematic searches were performed and reference lists from the retrieved trials were searched. RCTs were enclosed in the systematic review if they explicitly stated diagnosis of knee OA and reported a weight change as the only difference in intervention from the control group. Outcome Measures for Arthritis Clinical Trials III outcome variables were considered for analysis. Effect size (ES) was calculated using RevMan, and meta-regression analyses were performed using weighted estimates from the random effects analyses. Among 35 potential trials identified, four RCTs including five intervention/control groups met our inclusion criteria and provided data from 454 patients. Pooled ES for pain and physical disability were 0.20 (95% CI 0 to 0.39) and 0.23 (0.04 to 0.42) at a weight reduction of 6.1 kg (4.7 to 7.6 kg). Meta-regression analysis showed that disability could be significantly improved when weight was reduced over 5.1%, or at the rate of >0.24% reduction per week. Clinical efficacy on pain reduction was present, although not predictable after weight loss. Meta-regression analysis indicated that physical disability of patients with knee OA and overweight diminished after a moderate weight reduction regime. The analysis supported that a weight loss of >5% should be achieved within a 20-week period--that is, 0.25% per week.
本综述旨在通过对随机对照试验（RCT）的荟萃分析，评估超重的膝骨关节炎（OA）患者体重减轻时疼痛和功能的变化。进行了系统检索，并检索了所检索试验的参考文献列表。如果RCT明确声明诊断为膝OA，并报告体重变化是与对照组干预的唯一差异，则将其纳入系统评价。考虑分析关节炎临床试验III结果变量的结局指标。使用RevMan计算效应量（ES），并使用随机效应分析的加权估计进行荟萃回归分析。在确定的35项潜在试验中，4项RCT（包括5个干预/对照组）符合我们的纳入标准，并提供了454例患者的数据。体重减轻6.1 kg（4.7至7.6 kg）时，疼痛和身体残疾的合并ES分别为0.20（95%CI 0至0.39）和0.23（0.04至0.42）。荟萃回归分析表明，当体重减轻超过5.1%或每周减轻率>0.24%时，残疾可得到显著改善。尽管体重减轻后疼痛减轻的临床疗效不可预测，但仍存在。荟萃回归分析表明，中度体重减轻方案后，超重的膝OA患者的身体残疾有所减轻。分析支持应在20周内实现>5%的体重减轻，即每周0.25%。
