Finney Andrew, Healey Emma, Jordan Joanne L, Ryan Sarah, Dziedzic Krysia S
Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK.
Staffordshire Rheumatology Centre, The Haywood Hospital, Burslem, Stoke-on-Trent, UK.
BMC Musculoskelet Disord. 2016 Jul 8;17:266. doi: 10.1186/s12891-016-1125-5.
BACKGROUND: The National Institute for Health and Care Excellence's Osteoarthritis (OA) guidelines recommended that future research should consider the benefits of combination therapies in people with OA across multiple joint sites. However, the clinical effectiveness of such approaches to OA management is unknown. This systematic review therefore aimed to identify the clinical and cost effectiveness of multidisciplinary approaches targeting multiple joint sites for OA in primary care. METHODS: A systematic review of randomised controlled trials. Computerised bibliographic databases were searched (MEDLINE, EMBASE, CINAHL, PsychINFO, BNI, HBE, HMIC, AMED, Web of Science and Cochrane). Studies were included if they met the following criteria; a randomised controlled trial (RCT), a primary care population with OA across at least two different peripheral joint sites (multiple joint sites), and interventions undertaken by at least two different health disciplines (multidisciplinary). The Cochrane 'Risk of Bias' tool and PEDro were used for quality assessment of eligible studies. Clinical and cost effectiveness was determined by extracting and examining self-reported outcomes for pain, function, quality of life (QoL) and health care utilisation. The date range for the search was from database inception until August 2015. RESULTS: The search identified 1148 individual titles of which four were included in the review. A narrative review was conducted due to the heterogeneity of the included trials. Each of the four trials used either educational or exercise interventions facilitated by a range of different health disciplines. Moderate clinical benefits on pain, function and QoL were reported across the studies. The beneficial effects of exercise generally decreased over time within all studies. Two studies were able to show a reduction in healthcare utilisation due to a reduction in visits to a physiotherapist or a reduction in x-rays and orthopaedic referrals. The intervention that showed the most promise used educational interventions delivered by GPs with reinforcement by practice nurses. CONCLUSIONS: There are currently very few studies that target multidisciplinary approaches suitable for OA across multiple joint sites, in primary care. A more consistent approach to outcome measurement in future studies of this nature should be considered to allow for better comparison.
背景:英国国家卫生与临床优化研究所的骨关节炎(OA)指南建议,未来的研究应考虑联合治疗对多关节部位骨关节炎患者的益处。然而,这种OA管理方法的临床效果尚不清楚。因此,本系统评价旨在确定在初级保健中针对多关节部位OA的多学科方法的临床和成本效益。 方法:对随机对照试验进行系统评价。检索计算机化的书目数据库(MEDLINE、EMBASE、CINAHL、PsychINFO、BNI、HBE、HMIC、AME D、科学网和Cochrane)。符合以下标准的研究纳入其中:随机对照试验(RCT)、至少两个不同外周关节部位患有OA的初级保健人群(多关节部位)以及至少两个不同健康学科进行的干预(多学科)。使用Cochrane“偏倚风险”工具和PEDro对符合条件的研究进行质量评估。通过提取和检查自我报告的疼痛、功能、生活质量(QoL)和医疗保健利用结果来确定临床和成本效益。检索的日期范围是从数据库建立到2015年8月。 结果:检索到1148个单独的标题,其中四项纳入本评价。由于纳入试验的异质性,进行了叙述性评价。四项试验中的每一项都使用了由一系列不同健康学科促进的教育或运动干预。各项研究均报告了对疼痛、功能和生活质量有中度临床益处。在所有研究中,运动的有益效果一般随时间而降低。两项研究能够显示出医疗保健利用率的降低,原因是看物理治疗师的次数减少或X光检查和骨科转诊减少。最有前景的干预措施是由全科医生提供教育干预,并由实习护士进行强化。 结论:目前在初级保健中,针对多关节部位适合OA的多学科方法的研究非常少。在这类未来研究中,应考虑采用更一致的结果测量方法,以便进行更好的比较。
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