Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
Physiotherapy. 2018 Sep;104(3):264-276. doi: 10.1016/j.physio.2018.05.003. Epub 2018 Jun 2.
OBJECTIVE: This systematic review to aimed to evaluate the effects of orthopaedic manual therapy (OMT) on pain, improving function, and physical performance in patients with knee osteoarthritis (OA). DATA SOURCES: Four databases (PubMed, Web of Science, CENTRAL, and CINAHL) were searched. STUDY SELECTION: Trials were required to compare OMT alone or OMT in combination with exercise therapy, with exercise therapy alone or control. DATA EXTRACTION: Data extraction and risk assessment were done by two independent reviewers. Outcome measures were visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score, WOMAC function score, WOMAC global score, and stairs ascending-descending time. RESULTS: Eleven randomized controlled trials were included (494 subjects), four of which had a PEDro score of 6 or higher, indicating adequate quality. The results of the meta-analysis indicated that reduction of VAS score in OMT compared with the control group was statistically insignificant (SDM: -0.59; 95% CI: -1.54 to -0.36; P=0.224). The reduction of VAS score in OMT compared with exercise therapy group was statistically significant (SDM: -0.78; 95% CI: -1.42 to -0.17; P=0.013). The reduction of WOMAC pain score in OMT compared with the exercise therapy group was statistically significant (SDM: -0.79; 95% CI: -1.14 to -0.43; P=0.001). Similarly, the reduction of WOMAC function score in OMT compared with the exercise therapy group was statistically significant (SDM: -0.85; 95% CI: -1.20 to -0.50; P=0.001). However, the reduction of WOMAC global score in OMT compared with the exercise therapy group was statistically insignificant (SDM: -0.23; 95% CI: -0.54 to -0.09; P=0.164). The reduction of stairs ascending-descending time in OMT compared with the exercise therapy group was statistically significant (SDM: -0.88; 95% CI: -1.48 to -0.29; P=0.004). CONCLUSIONS: This review indicated OMT compared with exercise therapy alone provides short-term benefits in reducing pain, improving function, and physical performance in patients with knee OA. REVIEW REGISTRATION: PROSPERO 2016:CRD42016032799.
目的：本系统评价旨在评估骨科手法治疗（OMT）对膝骨关节炎（OA）患者疼痛、功能改善和身体表现的影响。
数据来源：检索了四个数据库（PubMed、Web of Science、CENTRAL 和 CINAHL）。
研究选择：试验要求比较单独的 OMT 或 OMT 与运动疗法联合治疗，与运动疗法单独或对照组进行比较。
数据提取：两名独立评审员进行数据提取和风险评估。结局测量指标包括视觉模拟评分（VAS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）疼痛评分、WOMAC 功能评分、WOMAC 总体评分和上下楼梯时间。
结果：共纳入 11 项随机对照试验（494 例患者），其中 4 项的 PEDro 评分达到 6 分或更高，表明质量较高。荟萃分析结果表明，与对照组相比，OMT 组的 VAS 评分降低无统计学意义（SMD：-0.59；95%CI：-1.54 至 -0.36；P=0.224）。与运动疗法组相比，OMT 组的 VAS 评分降低有统计学意义（SMD：-0.78；95%CI：-1.42 至 -0.17；P=0.013）。与运动疗法组相比，OMT 组 WOMAC 疼痛评分降低有统计学意义（SMD：-0.79；95%CI：-1.14 至 -0.43；P=0.001）。同样，与运动疗法组相比，OMT 组 WOMAC 功能评分降低有统计学意义（SMD：-0.85；95%CI：-1.20 至 -0.50；P=0.001）。然而，与运动疗法组相比，OMT 组 WOMAC 总体评分降低无统计学意义（SMD：-0.23；95%CI：-0.54 至 -0.09；P=0.164）。与运动疗法组相比，OMT 组上下楼梯时间减少有统计学意义（SMD：-0.88；95%CI：-1.48 至 -0.29；P=0.004）。
结论：本综述表明，与单独运动疗法相比，OMT 可在短期内减轻膝骨关节炎患者的疼痛、改善功能和身体表现。
注册：PROSPERO 2016：CRD42016032799。
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