Brown Courtney K, Southerst Danielle, Côté Pierre, Shearer Heather M, Randhawa Kristi, Wong Jessica J, Yu Hainan, Varatharajan Sharanya, Sutton Deborah, Stern Paula J, D'Angelo Kevin, Dion Sarah, Cox Jocelyn, Goldgrub Rachel, Stupar Maja, Carroll Linda J, Taylor-Vaisey Anne
Graduate Student, Department of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
Research Coordinator, Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, Toronto, ON, Canada.
J Manipulative Physiol Ther. 2016 Feb;39(2):110-120.e1. doi: 10.1016/j.jmpt.2016.01.003.
The purpose of this systematic review was to determine the effectiveness of exercise for the management of soft tissue injuries of the hip, thigh, and knee.
We conducted a systematic review and searched MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, and CINAHL Plus with Full Text from January 1, 1990, to April 8, 2015, for randomized controlled trials (RCTs), cohort studies, and case-control studies evaluating the effect of exercise on pain intensity, self-rated recovery, functional recovery, health-related quality of life, psychological outcomes, and adverse events. Random pairs of independent reviewers screened titles and abstracts and assessed risk of bias using the Scottish Intercollegiate Guidelines Network criteria. Best evidence synthesis methodology was used.
We screened 9494 citations. Eight RCTs were critically appraised, and 3 had low risk of bias and were included in our synthesis. One RCT found statistically significant improvements in pain and function favoring clinic-based progressive combined exercises over a "wait and see" approach for patellofemoral pain syndrome. A second RCT suggests that supervised closed kinetic chain exercises may lead to greater symptom improvement than open chain exercises for patellofemoral pain syndrome. One RCT suggests that clinic-based group exercises may be more effective than multimodal physiotherapy in male athletes with persistent groin pain.
We found limited high-quality evidence to support the use of exercise for the management of soft tissue injuries of the lower extremity. The evidence suggests that clinic-based exercise programs may benefit patients with patellofemoral pain syndrome and persistent groin pain. Further high-quality research is needed.
本系统评价旨在确定运动疗法对髋部、大腿和膝部软组织损伤的治疗效果。
我们进行了一项系统评价，检索了1990年1月1日至2015年4月8日期间的MEDLINE、EMBASE、PsycINFO、Cochrane对照试验中央注册库以及CINAHL Plus全文数据库，以查找评估运动疗法对疼痛强度、自我评定恢复情况、功能恢复、健康相关生活质量、心理结局和不良事件影响的随机对照试验（RCT）、队列研究和病例对照研究。由独立的评审员随机配对筛选标题和摘要，并使用苏格兰校际指南网络标准评估偏倚风险。采用最佳证据综合方法。
我们筛选了9494条引文。对8项RCT进行了严格评价，其中3项偏倚风险较低，被纳入我们的综合分析。一项RCT发现，对于髌股疼痛综合征，基于诊所的渐进性联合运动在疼痛和功能方面的改善在统计学上显著优于“观望”方法。第二项RCT表明，对于髌股疼痛综合征，监督下的闭链运动可能比开链运动能带来更大的症状改善。一项RCT表明，对于患有持续性腹股沟疼痛的男性运动员，基于诊所的团体运动可能比多模式物理治疗更有效。
我们发现支持将运动疗法用于治疗下肢软组织损伤的高质量证据有限。证据表明，基于诊所的运动项目可能对髌股疼痛综合征和持续性腹股沟疼痛患者有益。需要进一步开展高质量的研究。
