Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia.
Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
Br J Sports Med. 2020 Nov;54(21):1279-1287. doi: 10.1136/bjsports-2019-100886. Epub 2019 Oct 30.
OBJECTIVE: Examine the effectiveness of specific modes of exercise training in non-specific chronic low back pain (NSCLBP). DESIGN: Network meta-analysis (NMA). DATA SOURCES: MEDLINE, CINAHL, SPORTDiscus, EMBASE, CENTRAL. ELIGIBILITY CRITERIA: Exercise training randomised controlled/clinical trials in adults with NSCLBP. RESULTS: Among 9543 records, 89 studies (patients=5578) were eligible for qualitative synthesis and 70 (pain), 63 (physical function), 16 (mental health) and 4 (trunk muscle strength) for NMA. The NMA consistency model revealed that the following exercise training modalities had the highest probability (surface under the cumulative ranking (SUCRA)) of being best when compared with true control: Pilates for pain (SUCRA=100%; pooled standardised mean difference (95% CI): -1.86 (-2.54 to -1.19)), resistance (SUCRA=80%; -1.14 (-1.71 to -0.56)) and stabilisation/motor control (SUCRA=80%; -1.13 (-1.53 to -0.74)) for physical function and resistance (SUCRA=80%; -1.26 (-2.10 to -0.41)) and aerobic (SUCRA=80%; -1.18 (-2.20 to -0.15)) for mental health. True control was most likely (SUCRA≤10%) to be the worst treatment for all outcomes, followed by therapist hands-off control for pain (SUCRA=10%; 0.09 (-0.71 to 0.89)) and physical function (SUCRA=20%; -0.31 (-0.94 to 0.32)) and therapist hands-on control for mental health (SUCRA=20%; -0.31 (-1.31 to 0.70)). Stretching and McKenzie exercise effect sizes did not differ to true control for pain or function (p>0.095; SUCRA<40%). NMA was not possible for trunk muscle endurance or analgesic medication. The quality of the synthesised evidence was low according to Grading of Recommendations Assessment, Development and Evaluation criteria. SUMMARY/CONCLUSION: There is low quality evidence that Pilates, stabilisation/motor control, resistance training and aerobic exercise training are the most effective treatments, pending outcome of interest, for adults with NSCLBP. Exercise training may also be more effective than therapist hands-on treatment. Heterogeneity among studies and the fact that there are few studies with low risk of bias are both limitations.
目的：研究非特异性慢性下腰痛（NSCLBP）中特定运动训练模式的有效性。 设计：网络荟萃分析（NMA）。 数据来源：MEDLINE、CINAHL、SPORTDiscus、EMBASE、CENTRAL。 入选标准：针对 NSCLBP 成人的运动训练随机对照/临床试验。 结果：在 9543 条记录中，有 89 项研究（患者=5578）符合定性综合分析的条件，70 项（疼痛）、63 项（身体功能）、16 项（心理健康）和 4 项（躯干肌肉力量）符合 NMA 的条件。NMA 一致性模型表明，与真实对照相比，以下运动训练方式最有可能（累积排序曲线下面积（SUCRA）最高）：普拉提治疗疼痛（SUCRA=100%； pooled 标准化均数差值（95%置信区间）：-1.86（-2.54 至-1.19））、阻力（SUCRA=80%；-1.14（-1.71 至-0.56））和稳定/运动控制（SUCRA=80%；-1.13（-1.53 至-0.74））对身体功能和阻力（SUCRA=80%；-1.26（-2.10 至-0.41））以及有氧运动（SUCRA=80%；-1.18（-2.20 至-0.15））对心理健康有帮助。真实对照最有可能（SUCRA≤10%）是所有结局中最差的治疗方法，其次是治疗师不接触的疼痛控制（SUCRA=10%；0.09（-0.71 至 0.89））和身体功能（SUCRA=20%；-0.31（-0.94 至 0.32））和治疗师接触的心理健康控制（SUCRA=20%；-0.31（-1.31 至 0.70））。拉伸和麦肯齐运动对疼痛或功能的效果与真实对照无差异（p>0.095；SUCRA<40%）。对于躯干肌肉耐力或镇痛药物，无法进行 NMA。根据推荐评估、制定和评估标准，综合证据的质量较低。 总结/结论：对于非特异性慢性下腰痛患者，有低质量证据表明，普拉提、稳定/运动控制、阻力训练和有氧运动训练是最有效的治疗方法（取决于关注的结局）。与治疗师的主动治疗相比，运动训练可能也更有效。研究之间存在异质性，并且存在少数低偏倚风险的研究，这都是限制因素。
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