O'Connor Seán R, Tully Mark A, Ryan Brigid, Bleakley Chris M, Baxter George D, Bradley Judy M, McDonough Suzanne M
Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom; UKCRC Centre of Excellence for Public Health (Northern Ireland), Queen's University Belfast, Belfast, United Kingdom; Institute of Nursing and Health Research, University of Ulster, United Kingdom.
Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom; UKCRC Centre of Excellence for Public Health (Northern Ireland), Queen's University Belfast, Belfast, United Kingdom.
Arch Phys Med Rehabil. 2015 Apr;96(4):724-734.e3. doi: 10.1016/j.apmr.2014.12.003. Epub 2014 Dec 19.
To systematically review the evidence examining effects of walking interventions on pain and self-reported function in individuals with chronic musculoskeletal pain.
Six electronic databases (MEDLINE, CINAHL, PsychINFO, PEDro, Sport Discus, and the Cochrane Central Register of Controlled Trials) were searched from January 1980 to March 2014.
Randomized and quasi-randomized controlled trials in adults with chronic low back pain, osteoarthritis, or fibromyalgia comparing walking interventions to a nonexercise or nonwalking exercise control group.
Data were independently extracted using a standardized form. Methodological quality was assessed using the U.S. Preventive Services Task Force system.
Twenty-six studies (2384 participants) were included, and suitable data from 17 studies were pooled for meta-analysis, with a random effects model used to calculate between-group mean differences and 95% confidence intervals (CIs). Data were analyzed according to the duration of follow-up (short-term, ≤8wk postrandomization; medium-term, >2mo to 12mo; long-term, >12mo). Interventions were associated with small to moderate improvements in pain at short-term (mean difference , -5.31; 95% CI, -8.06 to -2.56) and medium-term (mean difference, -7.92; 95% CI, -12.37 to -3.48) follow-up. Improvements in function were observed at short-term (mean difference, -6.47; 95% CI, -12.00 to -0.95), medium-term (mean difference, -9.31; 95% CI, -14.00 to -4.61), and long-term (mean difference, -5.22; 95% CI, -7.21 to -3.23) follow-up.
Evidence of fair methodological quality suggests that walking is associated with significant improvements in outcome compared with control interventions but longer-term effectiveness is uncertain. With the use of the U.S. Preventive Services Task Force system, walking can be recommended as an effective form of exercise or activity for individuals with chronic musculoskeletal pain but should be supplemented with strategies aimed at maintaining participation. Further work is required for examining effects on important health-related outcomes in this population in robustly designed studies.
系统评价有关步行干预对慢性肌肉骨骼疼痛患者疼痛及自我报告功能影响的证据。
检索了1980年1月至2014年3月期间的6个电子数据库（MEDLINE、CINAHL、PsychINFO、PEDro、Sport Discus和Cochrane对照试验中央注册库）。
纳入针对慢性下腰痛、骨关节炎或纤维肌痛成人患者的随机和半随机对照试验，比较步行干预与非运动或非步行运动对照组。
使用标准化表格独立提取数据。采用美国预防服务工作组系统评估方法学质量。
纳入26项研究（2384名参与者），并汇总了17项研究的合适数据进行荟萃分析，采用随机效应模型计算组间平均差异和95%置信区间（CI）。根据随访时间（短期，随机分组后≤8周；中期，>2个月至12个月；长期，>12个月）进行数据分析。干预措施在短期（平均差异，-5.31；95%CI，-8.06至-2.56）和中期（平均差异，-7.92；95%CI，-12.37至-3.48）随访时与疼痛的轻度至中度改善相关。在短期（平均差异, -6.47；95%CI，-12.00至-0.95）、中期（平均差异, -9.31；95%CI，-14.00至-4.61）和长期（平均差异, -5.22；95%CI，-7.21至-3.23）随访时观察到功能改善。
方法学质量中等的证据表明，与对照干预相比，步行与结局的显著改善相关，但长期有效性尚不确定。采用美国预防服务工作组系统，可推荐步行作为慢性肌肉骨骼疼痛患者的一种有效运动或活动形式，但应辅以旨在维持参与度的策略。需要开展设计严谨的研究，进一步探讨对该人群重要健康相关结局的影响。
