Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane (BS), Italy.
Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane (BS), Italy.
Pulmonology. 2019 Jul-Aug;25(4):236-247. doi: 10.1016/j.pulmoe.2018.12.008. Epub 2019 Feb 7.
Manual therapy (MT) has been proposed in pulmonary rehabilitation programmes for patients with chronic obstructive pulmonary disease (COPD), but an updated systematic review of the evidence is lacking. We aimed to systematically review the effectiveness of MT interventions, alone or added to exercise, on lung function, exercise capacity and quality of life in COPD patients, compared to other therapies (e.g. exercise alone) or no treatment.
We searched MEDLINE, EMBASE, Physiotherapy Evidence Database, and Cochrane Central Register of Controlled Trials databases, using the terms: COPD, manual therapy, manipulation, joint mobilisation, osteopathic manipulation. Only randomised controlled trials (RCT) were considered.
Out of 555 articles screened, 6 fulfilled the inclusion criteria. The study designs were heterogeneous (with different intervention schedules) and there was a high risk of bias. No effect on lung function was found, while results on exercise capacity were contrasting. MT had no effect on quality of life, although valid measures were available only in one study. Only mild adverse events were reported.
Few RCTs of poor methodological quality are available on the effects of MT in COPD. More and better quality RCTs are needed before this technique can be included in rehabilitation programmes for these patients.
在慢性阻塞性肺疾病（COPD）患者的肺康复计划中，已经提出了手动疗法（MT），但缺乏对证据的最新系统评价。我们旨在系统地评估 MT 干预措施的有效性，单独或与运动结合，与其他治疗方法（如单独运动）或不治疗相比，对 COPD 患者的肺功能、运动能力和生活质量的影响。
我们使用以下术语搜索了 MEDLINE、EMBASE、物理治疗证据数据库和 Cochrane 对照试验中心注册数据库：COPD、手动疗法、手法、关节松动术、整骨手法。仅考虑随机对照试验（RCT）。
在筛选出的 555 篇文章中，有 6 篇符合纳入标准。研究设计具有异质性（干预方案不同），且存在较高的偏倚风险。未发现 MT 对肺功能有影响，而运动能力的结果则相互矛盾。MT 对生活质量没有影响，尽管只有一项研究提供了有效的测量方法。仅报告了轻度不良事件。
关于 MT 在 COPD 中的作用，仅有少数质量较差的 RCT。在这项技术可以纳入这些患者的康复计划之前，需要更多和更高质量的 RCT。
