Ferreira Ricardo Maia, Duarte José Alberto, Gonçalves Rui Soles
Institute Polytechnic of Maia.
University of Porto.
Acta Reumatol Port. 2018 Jul-Sep;43(3):182-200.
Objective - Update the last known umbrella review and summarize the available high-quality evidence from systematic reviews on the effectiveness of non-pharmacological and non-surgical interventions for patients with knee OA. Methods - The systematic reviews were identified thought electronic databases such as, MEDLINE, Embase, Physiotherapy Evidence Database (PEDro), The Cochrane Library, SciELo, Science Direct, Google Scholar, Research Gate and B-ON. The studies selection respected the following terms to guide the search strategy using the P (humans with knee osteoarthritis) I (non-pharmacological and non-surgical treatments) C (pharmacological, surgical, placebo, no intervention, or other non-pharmacological/ non-surgical conservative treatments) O (pain, functional status, stiffness, inflammation, quality of life and patient global assessment) model. Results - Following the PRISMA statement, 41 systematic reviews were found on the electronic databases that could be included in the umbrella review. After methodical analysis (R-AMSTAR), only 35 had sufficient quality to be included. There is gold evidence that Standard Exercise programs can reduce pain and improve physical function in patients with knee OA. Additionally, there is silver evidence for Acupuncture, Aquatic Exercise, Electroacupuncture, Interferential Current, Kinesio Taping, Manual Therapy, Moxibustion, Pulsed Electromagnetic Fields, Tai Chi, Ultrasound, Yoga, and Whole-Body Vibration. For other interventions, the quality of evidence is low or did not show sufficient efficacy from the systematic reviews to support their use. Conclusion - Comparing to last known umbrella review, similar results were achieved on Acupuncture and Exercise interventions to improve the patients' pain, stiffness, function and quality of life, but it was found different results regarding the utilization of Transcutaneous Electrical Nerve Stimulation and Low-Level Laser Therapy as they do not improved the patients' pain and physical function.
目的——更新已知的最新综合评价，并总结来自系统评价的关于非药物和非手术干预对膝骨关节炎患者有效性的现有高质量证据。方法——通过电子数据库识别系统评价，如MEDLINE、Embase、物理治疗证据数据库（PEDro）、考克兰图书馆、SciELo、科学Direct、谷歌学术、Research Gate和B-ON。研究选择遵循以下术语，以使用P（膝骨关节炎患者）、I（非药物和非手术治疗）、C（药物、手术、安慰剂、无干预或其他非药物/非手术保守治疗）、O（疼痛、功能状态、僵硬、炎症、生活质量和患者整体评估）模型指导检索策略。结果——根据PRISMA声明，在电子数据库中发现了41项可纳入综合评价的系统评价。经过方法学分析（R-AMSTAR），只有35项质量足够可纳入。有确凿证据表明，标准运动计划可以减轻膝骨关节炎患者的疼痛并改善身体功能。此外，对于针灸、水上运动、电针、干扰电、肌内效贴、手法治疗、艾灸、脉冲电磁场、太极拳、超声、瑜伽和全身振动有中等证据。对于其他干预措施，证据质量较低，或系统评价未显示出足够的疗效来支持其使用。结论——与已知的最新综合评价相比，针灸和运动干预在改善患者疼痛、僵硬、功能和生活质量方面取得了相似的结果，但在经皮神经电刺激和低强度激光治疗的应用方面发现了不同的结果，因为它们并未改善患者的疼痛和身体功能。
