Blyton Fiona, Chuter Vivienne, Walter Kate E L, Burns Joshua
School of Health Sciences, Faculty of Health, The University of Newcastle, Ourimbah, Australia.
Cochrane Database Syst Rev. 2012 Jan 18;1(1):CD008496. doi: 10.1002/14651858.CD008496.pub2.
About one in every three adults are affected by lower limb muscle cramps. For some people, these cramps reduce quality of life, quality of sleep and participation in activities of daily living. Many interventions are available for lower limb cramps, but some are controversial, no treatment guidelines exist, and often people experience no benefit from the interventions prescribed.
To assess the effects of non-drug, non-invasive treatments for lower limb cramp.
We searched the Cochrane Neuromuscular Disease Group Specialized Register (13 September 2011) using the terms: cramp, spasm, contracture, charley horse and lower limb, lower extremity, foot, calf, leg, thigh, gastrocnemius, hamstring, quadriceps. We also searched CENTRAL (2011, Issue 3), MEDLINE (January 1966 to August 2011) and EMBASE (January 1980 to August 2011) and the reference lists of included studies. There were no language or publication restrictions.
All randomised controlled trials of non-drug, non-invasive interventions trialled over at least four weeks for the prevention of lower limb muscle cramps in any group of people. We excluded, for example, surgery, acupuncture and dry-needling, as invasive interventions. We selected only trials that included at least one of the following outcomes: cramp frequency, cramp severity, health-related quality of life, quality of sleep, participation in activities of daily living and adverse outcomes.
Two authors independently selected trials, assessed risk of bias and cross checked data extraction and analysis. A third author was to arbitrate in the event of disagreement. We asked the authors of five trials for information to assist with screening studies for eligibility and received four responses.
One trial was eligible for inclusion. All participants were age 60 years or over and had received a repeat prescription from their general practitioner of quinine for nighttime cramps in the preceding three months. This review includes data from only those participants who were advised to continue taking quinine. Forty-nine participants were advised to complete lean-to-wall calf muscle stretching held for 10 s three times per day. Forty-eight participants were allocated to a placebo stretching group. After 12 weeks, there was no statistically significant difference in recalled cramp frequency between groups. No "significant" adverse effect was reported. Limitations in the study's design impede interpretation of the results and clinical applicability.
AUTHORS' CONCLUSIONS: There is limited evidence on which to base clinical decisions regarding the use of non-drug therapies for the treatment of lower limb muscle cramp. Serious methodological limitations in the existing evidence hinder clinical application. There is an urgent need to carefully evaluate many of the commonly recommended and emerging non-drug therapies in well designed randomised controlled trials.
约每三名成年人中就有一人受下肢肌肉痉挛影响。对一些人来说，这些痉挛会降低生活质量、睡眠质量并影响日常生活活动参与度。有多种干预措施可用于治疗下肢痉挛，但有些存在争议，尚无治疗指南，而且人们往往无法从所开的干预措施中获益。
评估非药物、非侵入性治疗对下肢痉挛的效果。
我们使用以下术语检索了Cochrane神经肌肉疾病组专业注册库（2011年9月13日）：痉挛、抽搐、挛缩、股痛以及下肢、下肢末端、足部、小腿、腿部、大腿、腓肠肌、腘绳肌、股四头肌。我们还检索了Cochrane系统评价数据库（2011年第3期）、MEDLINE（1966年1月至2011年8月）和EMBASE（1980年1月至2011年8月）以及纳入研究的参考文献列表。没有语言或出版限制。
所有针对任何人群预防下肢肌肉痉挛进行至少四周试验的非药物、非侵入性干预措施的随机对照试验。例如，我们排除了手术、针灸和干针疗法等侵入性干预措施。我们仅选择了至少包括以下一项结局的试验：痉挛频率、痉挛严重程度、健康相关生活质量、睡眠质量、日常生活活动参与度和不良结局。
两名作者独立选择试验、评估偏倚风险并交叉核对数据提取和分析。如有分歧，由第三位作者进行仲裁。我们向五项试验的作者索要信息以协助筛选符合条件的研究，收到了四项回复。
一项试验符合纳入标准。所有参与者年龄均在60岁及以上，且在前三个月从全科医生处获得过用于夜间痉挛的奎宁重复处方。本综述仅纳入了那些被建议继续服用奎宁的参与者的数据。49名参与者被建议每天三次靠墙伸展小腿肌肉，每次保持10秒。48名参与者被分配到安慰剂伸展组。12周后，两组之间回忆起的痉挛频率无统计学显著差异。未报告“显著”不良反应。该研究设计的局限性妨碍了对结果的解释和临床应用。
关于使用非药物疗法治疗下肢肌肉痉挛的临床决策依据的证据有限。现有证据存在严重的方法学局限性，阻碍了临床应用。迫切需要在设计良好的随机对照试验中仔细评估许多常用的和新出现的非药物疗法。
