Bethge M, Müller-Fahrnow W
Charité Universitätsmedizin Berlin, Lehrstuhl für Versorgungssystemforschung und Grundlagen der Qualitätssicherung in der Rehabilitation, Berlin.
Rehabilitation (Stuttg). 2008 Aug;47(4):200-9. doi: 10.1055/s-2008-1077091.
Previous reviews concerning inpatient orthopaedic rehabilitation in Germany stated no convincing evidence of its effectiveness. However, work-related and behavioural-medicine concepts of rehabilitation have for several years been established in order to intensify and broaden conventional rehabilitation. But so far none of the previous studies had compared intensified and conventional rehabilitation within the framework of a systematic review of randomized controlled trials and used a meta-analytic approach.
To assess the effectiveness of intensified inpatient orthopaedic rehabilitation on clinically relevant outcomes in patients with musculoskeletal disorders.
We searched the following databases as of 26 November 2007: MEDLINE from 1966, EMBASE from 1989, PSYNDEX from 1977, PsycINFO from 1980. We included randomized controlled trials (RCTs) that had studied adults with musculoskeletal disorders, who had participated in intensified inpatient orthopaedic rehabilitation in Germany. Outcome measures were self-rated state of health, pain intensity, functioning, and days of sick leave. Standardised mean difference and associated 95% confidence interval were calculated. Cochran's Q statistic was used to assess the heterogeneity of the results, and the I (2) statistic was used to determine any inconsistency between the studies.
Five relevant trials were identified in 15 publications. Four of them were considered to be high-quality RCTs. The trials identified reported 18 randomized comparisons of intensified orthopaedic rehabilitation and conventional orthopaedic rehabilitation. There is strong evidence that intensified rehabilitation improves self-rated state of health when compared with conventional rehabilitation at mid-term and long-term follow-up. There is moderate evidence that intensified rehabilitation with a psychological group intervention reduces pain intensity when compared with conventional rehabilitation at long-term follow-up. There is no evidence of reduced days of sick leave and improved functioning.
The relevant studies provide evidence that intensified rehabilitation improves self-rated state of health and reduces pain intensity in rehabilitants with musculoskeletal disorders.
此前有关德国住院骨科康复的综述表明，尚无令人信服的证据证明其有效性。然而，为了强化和拓展传统康复，与工作相关的康复以及行为医学康复概念已确立多年。但到目前为止，之前的研究均未在随机对照试验的系统评价框架内比较强化康复和传统康复，也未采用荟萃分析方法。
评估强化住院骨科康复对肌肉骨骼疾病患者临床相关结局的有效性。
截至2007年11月26日，我们检索了以下数据库：1966年起的MEDLINE、1989年起的EMBASE、1977年起的PSYNDEX、1980年起的PsycINFO。我们纳入了研究德国成年肌肉骨骼疾病患者强化住院骨科康复情况的随机对照试验（RCT）。结局指标包括自评健康状况、疼痛强度、功能以及病假天数。计算标准化均数差及相关的95%置信区间。采用Cochran's Q统计量评估结果的异质性，并用I²统计量确定研究之间的不一致性。
在15篇出版物中识别出5项相关试验。其中4项被认为是高质量的RCT。所识别出的试验报告了18项强化骨科康复与传统骨科康复的随机对照比较。有强有力的证据表明，与传统康复相比，强化康复在中期和长期随访时能改善自评健康状况。有中等证据表明，在长期随访时，强化康复结合心理小组干预与传统康复相比能降低疼痛强度。没有证据表明病假天数减少和功能改善。
相关研究提供了证据，证明强化康复可改善肌肉骨骼疾病康复者的自评健康状况并降低疼痛强度。
