Hurley Michael V, Bearne Lindsay M
Academic Department of Physiotherapy, Kings College London, Rehabilitation Research Unit, Dulwich Community Hospital, East Dulwich Grove, London SE22 8PT, UK.
Best Pract Res Clin Rheumatol. 2008 Jun;22(3):419-33. doi: 10.1016/j.berh.2008.01.001.
Management of musculoskeletal conditions by physiotherapy delivers a package of health care designed to reduce pain and improve function. Health-care interventions should be safe, effective, acceptable to patients, deliverable by clinicians, and affordable by health-care providers. Physiotherapy is very safe and popular with patients. While there is good evidence that exercise relieves pain, improves function, and is cost-effective, evidence supporting the use of non-exercise physiotherapeutic interventions is much weaker. There is some support for the efficacy of thermotherapy, transcutaneous electrical neuromuscular stimulation, and massage, all of which are relatively inexpensive and easy to self-administer. There is little evidence to support the efficacy of electrotherapy, acupuncture or manual therapy, which need to be delivered by a therapist, making them expensive and encouraging long-term reliance on others. Despite lack of efficacy, the popularity and powerful placebo effects of physiotherapeutic modalities may have some utility in making more burdensome physiotherapeutic interventions (exercise and self-management advice) more acceptable.
通过物理治疗来管理肌肉骨骼疾病，提供了一套旨在减轻疼痛和改善功能的医疗保健方案。医疗保健干预措施应具备安全性、有效性、患者可接受性、临床医生可实施性以及医疗保健提供者可负担性。物理治疗非常安全且受患者欢迎。虽然有充分证据表明运动能缓解疼痛、改善功能且具有成本效益，但支持使用非运动性物理治疗干预措施的证据则要薄弱得多。对于热疗法、经皮电刺激神经疗法和按摩的疗效有一些支持，这些方法相对便宜且易于自我实施。几乎没有证据支持电疗法、针灸或手法治疗的疗效，这些需要由治疗师实施，因而成本高昂且会导致长期依赖他人。尽管缺乏疗效，但物理治疗方式的普及性和强大的安慰剂效应可能在使更繁重的物理治疗干预措施（运动和自我管理建议）更易被接受方面具有一定作用。
