School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Montfort Hospital Research Institute, Ottawa, Ontario, Canada.
Phys Ther. 2011 Jun;91(6):843-61. doi: 10.2522/ptj.20100104. Epub 2011 Apr 14.
The objective of this review was to construct an updated evidence-based clinical practice guideline on the use of physical activity and diet for the management of osteoarthritis (OA) in adults (>18 years of age) who are obese or overweight (body mass index ≥25 kg/m(2)).
Articles were extracted from the following databases: MEDLINE, EMBASE (Current Contents), SPORTDiscus, SUM, Scopus, CINAHL, AMED, BIOMED, PubMed, ERIC, the Cochrane Controlled Trials, and PEDro.
The Ottawa Panel and research assistance team strictly applied the inclusion and exclusion criteria from previous Ottawa Panel publications.
An a priori literature search was conducted for articles related to obesity and OA of the lower extremities that were published from January 1, 1966, to November 30, 2010. Inclusion criteria and the methods to grade the recommendations were created by the Ottawa Panel.
were graded based on the strength of evidence (A, B, C, C+, D, D+, or D-) as well as experimental design (I for randomized controlled trials and II for nonrandomized studies). In agreement with previous Ottawa Panel methods, Cochrane Collaboration methods were utilized for statistical analysis. Clinical significance was established by an improvement of ≥15% in the experimental group compared with the control group. There were a total of 79 recommendations from 9 articles. From these recommendations, there were 36 positive recommendations: 21 grade A and 15 grade C+. There were no grade B recommendations, and all recommendations were of clinical benefit.
Further research is needed, as more than half of the trials were of low methodological quality.
This review suggests that physical activity and diet programs are beneficial, specifically for pain relief (9 grade A recommendations) and improved functional status (6 grade A and 7 grade C+ recommendations), for adults with OA who are obese or overweight. The Ottawa Panel was able to demonstrate that when comparing physical activity alone, diet alone, physical activity combined with diet, and control groups, the intervention including physical activity and diet produced the most beneficial results.
本综述旨在构建一个更新的循证临床实践指南，用于管理肥胖或超重（体重指数≥25kg/m²）成人（年龄>18 岁）的骨关节炎（OA），该指南基于体力活动和饮食的应用。
文章从以下数据库中提取：MEDLINE、EMBASE（Current Contents）、SPORTDiscus、SUM、Scopus、CINAHL、AMED、BIOMED、PubMed、ERIC、Cochrane 对照试验和 PEDro。
渥太华小组和研究助理团队严格按照以前渥太华小组出版物的纳入和排除标准进行操作。
对 1966 年 1 月 1 日至 2010 年 11 月 30 日期间发表的与肥胖和下肢 OA 相关的文章进行了预先设定的文献检索。纳入标准和推荐分级方法由渥太华小组制定。
根据证据强度（A、B、C、C+、D、D+或 D-）和实验设计（I 为随机对照试验和 II 为非随机研究）进行分级。根据先前渥太华小组的方法，采用 Cochrane 协作方法进行统计分析。临床意义的建立是通过实验组与对照组相比有≥15%的改善。共 9 篇文章提出了 79 条建议。其中，阳性建议 36 条：21 条 A 级和 15 条 C+级。没有 B 级建议，所有建议均具有临床意义。
由于超过一半的试验方法质量较低，因此需要进一步研究。
本综述表明，对于肥胖或超重的 OA 成人，体力活动和饮食计划是有益的，特别是在缓解疼痛（9 条 A 级建议）和改善功能状态（6 条 A 级和 7 条 C+级建议）方面。渥太华小组能够证明，与单独的体力活动、单独的饮食、体力活动结合饮食以及对照组相比，包含体力活动和饮食的干预措施产生了最有益的结果。
