物理治疗对紧张型头痛患者枕下区域的有效性：一项随机对照试验的荟萃分析。
Effectiveness of physical therapy on the suboccipital area of patients with tension-type headache: A meta-analysis of randomized controlled trials.
作者信息
Jiang Wenbin, Li Zhe, Wei Ning, Chang Wenli, Chen Wei, Sui Hong-Jin
机构信息
Department of Anatomy, Dalian Medical University, Dalian.
Department of Anatomy, Guang Dong Medical University, Dong Guan.
出版信息
Medicine (Baltimore). 2019 May;98(19):e15487. doi: 10.1097/MD.0000000000015487.
BACKGROUND
There has been a lot of research on physical therapy for tension-type headaches. However, the efficacy of physical therapy on the suboccipital region remains unclear.
OBJECTIVE
To establish the effectiveness of physical therapy on the suboccipital area of patients with tension-type headache.
METHODS
Databases including Cochrane Library, Medline/Pubmed, CNKI, Embase, and Google Scholar were searched. After independent study selection by 2 authors, data were extracted and collected independently. On 1 hand, authors compared the treatment of the suboccipital area with control group. On the other hand, the efficacy of several physical therapy techniques on the suboccipital region was compared. The quality of the included studies was assessed using the Cochrane Handbook. RevMan 5.3 software was used for data analysis. The primary outcome measures were the cervical range of motion, the visual analog scale, and headache disability inventory.
RESULTS
Six randomized controlled trials with a total of 505 participants were included. Suboccipital soft-tissue inhibition technique (SIT) + occiput-atlas-axis global manipulation (OAA) was more effective than SIT in increasing craniocervical extension at 4 weeks post-treatment, the overall mean differences (MD) was 3.61, 95% confidence interval (CI) (0.89-6.34). There was no difference at 8 weeks post-treatment (MD 2.38, 95% CI -1.02 to 5.78, P = .17). SIT was more effective than SIT + OAA in increasing cervical flexion at 4-week post-treatment (MD -3.36, 95% CI -6.65 to -0.05). SIT + OAA was more effective than SIT on decreasing intensity of pain at 4-week post-treatment (MD -0.91, 95% CI -1.78 to -0.04), but no difference at 8-week (MD -0.43, 95% CI -1.18 to 0.33, P = .27). SIT + OAA was more effective than SIT in reducing the functional score of the headache disability inventory at 4-week post-treatment (MD -4.47, 95% CI -8.44 to -0.50). These results may indicate that the SIT + OAA combined therapy is more effective in short term (4-week), no major difference in longer term (8-week).
CONCLUSION
Combined therapy may be more suitable for the treatment of tension-type headache.
背景
关于紧张型头痛的物理治疗已有大量研究。然而，物理治疗对枕下区域的疗效仍不明确。
目的
确定物理治疗对紧张型头痛患者枕下区域的有效性。
方法
检索Cochrane图书馆、Medline/Pubmed、中国知网、Embase和谷歌学术等数据库。由2位作者独立进行研究筛选后，独立提取和收集数据。一方面，作者将枕下区域的治疗与对照组进行比较。另一方面，比较了几种物理治疗技术对枕下区域的疗效。使用Cochrane手册评估纳入研究的质量。采用RevMan 5.3软件进行数据分析。主要结局指标为颈椎活动范围、视觉模拟量表和头痛残疾评定量表。
结果
纳入6项随机对照试验，共505名参与者。在治疗后4周，枕下软组织抑制技术（SIT）+枕-寰-枢全关节整复术（OAA）在增加颅颈伸展方面比SIT更有效，总体平均差（MD）为3.61，95%置信区间（CI）（0.89 - 6.34）。治疗后8周无差异（MD 2.38，95% CI -1.02至5.78，P = 0.17）。在治疗后4周，SIT在增加颈椎前屈方面比SIT + OAA更有效（MD -3.36，95% CI -6.65至 -0.05）。在治疗后4周，SIT + OAA在减轻疼痛强度方面比SIT更有效（MD -0.91，95% CI -1.78至 -0.04），但在8周时无差异（MD -0.43，95% CI -1.18至0.33，P = 0.27）。在治疗后4周，SIT + OAA在降低头痛残疾评定量表功能评分方面比SIT更有效（MD -4.47，95% CI -8.44至 -0.50）。这些结果可能表明，SIT + OAA联合治疗在短期内（4周）更有效，在长期（8周）无显著差异。
结论
联合治疗可能更适合紧张型头痛的治疗。
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