Bartels Else Marie, Juhl Carsten B, Christensen Robin, Hagen Kåre Birger, Danneskiold-Samsøe Bente, Dagfinrud Hanne, Lund Hans
The Parker Institute, Copenhagen University Hospital, Bispebjerg og Frederiksberg, Frederiksberg, Denmark, DK-2000.
Cochrane Database Syst Rev. 2016 Mar 23;3(3):CD005523. doi: 10.1002/14651858.CD005523.pub3.
Osteoarthritis is a chronic disease characterized by joint pain, tenderness, and limitation of movement. At present, no cure is available. Thus only treatment of the person's symptoms and treatment to prevent further development of the disease are possible. Clinical trials indicate that aquatic exercise may have advantages for people with osteoarthritis. This is an update of a published Cochrane review.
To evaluate the effects of aquatic exercise for people with knee or hip osteoarthritis, or both, compared to no intervention.
We searched the following databases up to 28 April 2015: the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library Issue 1, 2014), MEDLINE (from 1949), EMBASE (from 1980), CINAHL (from 1982), PEDro (Physiotherapy Evidence Database), and Web of Science (from 1945). There was no language restriction.
Randomized controlled clinical trials of aquatic exercise compared to a control group (e.g. usual care, education, social attention, telephone call, waiting list for surgery) of participants with knee or hip osteoarthritis.
Two review authors independently selected trials for inclusion, extracted data and assessed risk of bias of the included trials. We analysed the pooled results using standardized mean difference (SMD) values.
Nine new trials met the inclusion criteria and we excluded two earlier included trials. Thus the number of participants increased from 800 to 1190 and the number of included trials increased from six to 13. Most participants were female (75%), with an average age of 68 years and a body mass index (BMI) of 29.4. Osteoarthritis duration was 6.7 years, with a great variation of the included participants. The mean aquatic exercise duration was 12 weeks. We found 12 trials at low to unclear risk of bias for all domains except blinding of participants and personnel. They showed that aquatic exercise caused a small short term improvement compared to control in pain (SMD -0.31, 95% CI -0.47 to -0.15; 12 trials, 1076 participants) and disability (SMD -0.32, 95% CI -0.47 to -0.17; 12 trials, 1059 participants). Ten trials showed a small effect on quality of life (QoL) (SMD -0.25, 95% CI -0.49 to -0.01; 10 trials, 971 participants). These effects on pain and disability correspond to a five point lower (95% CI three to eight points lower) score on mean pain and mean disability compared to the control group (scale 0 to 100), and a seven point higher (95% CI 0 to 13 points higher) score on mean QoL compared with control group (scale 0 to 100). No included trials performed a radiographic evaluation. No serious adverse events were reported in the included trials with relation to aquatic exercise.
AUTHORS' CONCLUSIONS: There is moderate quality evidence that aquatic exercise may have small, short-term, and clinically relevant effects on patient-reported pain, disability, and QoL in people with knee and hip OA. The conclusions of this review update does not change those of the previous published version of this Cochrane review.
骨关节炎是一种以关节疼痛、压痛和活动受限为特征的慢性疾病。目前尚无治愈方法。因此，只能对患者的症状进行治疗，并采取措施预防疾病的进一步发展。临床试验表明，水上运动可能对骨关节炎患者有益。这是对已发表的Cochrane综述的更新。
评估与不进行干预相比，水上运动对膝骨关节炎或髋骨关节炎患者或两者兼有的患者的影响。
截至2015年4月28日，我们检索了以下数据库：Cochrane对照试验中心注册库（CENTRAL；Cochrane图书馆2014年第1期）、MEDLINE（从1949年起）、EMBASE（从1980年起）、CINAHL（从1982年起）、PEDro（物理治疗证据数据库）和科学引文索引（从1945年起）。没有语言限制。
将水上运动与膝骨关节炎或髋骨关节炎参与者的对照组（如常规护理、教育、社会关注、电话随访、手术等待名单）进行比较的随机对照临床试验。
两名综述作者独立选择纳入试验，提取数据并评估纳入试验的偏倚风险。我们使用标准化均数差值（SMD）值分析汇总结果。
9项新试验符合纳入标准，我们排除了2项早期纳入的试验。因此，参与者人数从800人增加到1190人，纳入试验的数量从6项增加到13项。大多数参与者为女性（75%），平均年龄68岁，体重指数（BMI）为29.4。骨关节炎病程为6.7年，纳入的参与者差异很大。水上运动的平均持续时间为12周。除参与者和人员的盲法外，我们发现12项试验在所有领域的偏倚风险为低至不清楚。这些试验表明，与对照组相比，水上运动在短期内使疼痛（SMD -0.31，95%CI -0.47至-0.15；12项试验，1076名参与者）和残疾（SMD -0.32，95%CI -0.47至-0.17；12项试验，1059名参与者）有小幅改善。10项试验显示对生活质量（QoL）有小幅影响（SMD -0.25，95%CI -0.49至-0.01；10项试验，971名参与者）。这些对疼痛和残疾的影响相当于与对照组相比，平均疼痛和平均残疾得分降低5分（95%CI降低3至8分）（0至100分制），平均QoL得分提高7分（95%CI提高0至13分）（0至100分制）。没有纳入的试验进行影像学评估。纳入试验中未报告与水上运动相关的严重不良事件。
有中等质量的证据表明，水上运动可能对膝骨关节炎和髋骨关节炎患者报告的疼痛、残疾和生活质量有小的、短期的和临床相关的影响。本综述更新的结论与该Cochrane综述先前发表版本的结论没有变化。
