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非特异性慢性脊柱疼痛保守干预措施的比较效果:物理治疗、行为/心理干预还是联合干预?一项系统评价和荟萃分析

Comparative Effectiveness of Conservative Interventions for Nonspecific Chronic Spinal Pain: Physical, Behavioral/Psychologically Informed, or Combined? A Systematic Review and Meta-Analysis.

作者信息

O'Keeffe Mary, Purtill Helen, Kennedy Norelee, Conneely Mairead, Hurley John, O'Sullivan Peter, Dankaerts Wim, O'Sullivan Kieran

机构信息

Department of Clinical Therapies, University of Limerick, Limerick, Ireland.

Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland.

出版信息

J Pain. 2016 Jul;17(7):755-74. doi: 10.1016/j.jpain.2016.01.473. Epub 2016 Feb 1.

Abstract

UNLABELLED

Nonspecific chronic spinal pain (NSCSP) is highly disabling. Current conservative rehabilitation commonly includes physical and behavioral interventions, or a combination of these approaches. Physical interventions aim to enhance physical capacity by using methods such as exercise, manual therapy, and ergonomics. Behavioral/psychologically informed interventions aim to enhance behaviors, cognitions, or mood by using methods such as relaxation and cognitive behavioral therapy. Combined interventions aim to target physical and also behavioral/psychological factors contributing to patients' pain by using methods such as multidisciplinary pain management programs. Because it remains unclear whether any of these approaches are superior, this review aimed to assess the comparative effectiveness of physical, behavioral/psychologically informed, and combined interventions on pain and disability in patients with NSCSP. Ten electronic databases were searched for randomized controlled trials (RCTs) including participants reporting NSCSP. Studies were required to have an "active" conservative treatment control group for comparison. Studies were not eligible if the interventions were from the same domain (eg, if the study compared 2 physical interventions). Study quality was assessed used the Cochrane Back Review Group risk of bias criteria. The treatment effects of physical, behavioral/psychologically informed, and combined interventions were assessed using meta-analyses. Twenty-four studies were included. No clinically significant differences were found for pain and disability between physical, behavioral/psychologically informed, and combined interventions. The simple categorization of interventions into physical, behavioral/psychologically informed, and combined could be considered a limitation of this review, because these interventions may not be easily differentiated to allow accurate comparisons to be made. Further work should consider investigating whether tailoring rehabilitation to individual patients and their perceived risk of chronicity, as seen in recent RCTs for low back pain, can enhance outcomes in NSCSP.

PERSPECTIVE

In this systematic review of RCTs in NSCSP, only small differences in pain or disability were observed between physical, behavioral/psychologically informed, and combined interventions.

摘要

未标注

非特异性慢性脊柱疼痛(NSCSP)具有高度致残性。当前的保守康复治疗通常包括物理和行为干预,或这些方法的组合。物理干预旨在通过运动、手法治疗和人体工程学等方法来增强身体能力。行为/心理知情干预旨在通过放松和认知行为疗法等方法来增强行为、认知或情绪。联合干预旨在通过多学科疼痛管理计划等方法来针对导致患者疼痛的身体以及行为/心理因素。由于尚不清楚这些方法中是否有任何一种更具优势,本综述旨在评估物理、行为/心理知情和联合干预对NSCSP患者疼痛和残疾的比较有效性。检索了十个电子数据库以查找随机对照试验(RCT),其中包括报告NSCSP的参与者。研究需要有一个“积极的”保守治疗对照组进行比较。如果干预措施来自同一领域(例如,如果研究比较两种物理干预措施),则该研究不符合条件。使用Cochrane背部综述组的偏倚风险标准评估研究质量。使用荟萃分析评估物理、行为/心理知情和联合干预的治疗效果。纳入了24项研究。在物理、行为/心理知情和联合干预之间,未发现疼痛和残疾方面有临床显著差异。将干预简单分类为物理、行为/心理知情和联合可能被视为本综述的一个局限性,因为这些干预措施可能不容易区分以进行准确比较。进一步的工作应考虑调查,如最近针对下腰痛的随机对照试验所示,根据个体患者及其感知的慢性风险来定制康复治疗是否可以改善NSCSP的治疗效果。

观点

在这项对NSCSP随机对照试验的系统综述中,在物理、行为/心理知情和联合干预之间,仅观察到疼痛或残疾方面的微小差异。

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