Oliveira Victor Hb, Mendonça Karla Mpp, Monteiro Karolinne S, Silva Ivanizia S, Santino Thayla A, Nogueira Patricia Angelica Ms
Federal University of Rio Grande do Norte, Department of Physical Therapy, Avenida Senador Salgado Filho 3000, Lagoa Nova, Natal, Rio Grande do Norte, Brazil, 59078-970.
Federal University of Rio Grande do Norte, PhD Program in Physical Therapy, Avenida Senador Salgado Filho, 300, Bairro Lagoa Nova, Natal, Rio Grande do Norte, Brazil, 59078-970.
Cochrane Database Syst Rev. 2020 Mar 30;3(3):CD013018. doi: 10.1002/14651858.CD013018.pub2.
BACKGROUND: Cystic fibrosis (CF) is the most common life-threatening, inherited disease in white populations which causes several dysfunctions, including postural abnormalities. Physical therapy may help in some consequences of these postural abnormalities, such as pain, trunk deformity and quality of life. OBJECTIVES: To determine the effects of a range of physical therapies for managing postural abnormalities in people with cystic fibrosis, specifically on quality of life, pain and trunk deformity. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches, hand-searched journals and conference abstract books. We also searched the reference lists of relevant articles and reviews. Additional searches were conducted on ClinicalTrials.gov and on the WHO International Clinical Trials Registry Platform for any planned, ongoing and unpublished studies. Date of the last search: 19 March 2020. SELECTION CRITERIA: Randomised controlled trials examining any modality of physical therapy considered relevant for treating postural disorders compared with each other, no physical therapy, sham treatment or usual care in people with CF (of any age or disease severity). DATA COLLECTION AND ANALYSIS: Two review authors independently selected eligible trials, assessed the risk of bias in each trial and extracted the data. We contacted trial authors to obtain missing or additional information. We assessed the quality of the evidence using the GRADE criteria. MAIN RESULTS: Two trials, involving a total of 50 participants with CF and postural abnormalities, were included in this review. One was in people with stable disease (lasting three months) and one in hospital inpatients experiencing an exacerbation (20 days). Both trials compared manual therapy comprising mobilizations to the rib cage and thoracic spine, treatment of specific muscle dysfunction or tight muscle groups; and postural awareness and education versus medical usual care. The age of participants ranged from 17 years to 58 years. Both trials were conducted in the UK. The following outcomes were measured: change in quality of life, change in pain, change in trunk deformity and change in pulmonary function. Manual therapy may make little or no difference to the change in trunk deformity compared to usual care (low-quality evidence). No results could be analysed for quality of life (very low-quality evidence) and pain outcomes (very low-quality evidence) because of the high heterogeneity between trials. It is uncertain whether the intervention improves lung function: forced vital capacity (very low-quality evidence); forced expiratory volume in one second (very low-quality evidence); or Tiffeneau's index (ratio of forced expiratory volume at one second (FEV) and forced vital capacity (FVC)). Only one trial (15 participants) measured functional capacity, and the change in walked distance seemed to favour intervention over usual care, but with the possibility of no effect due to wide confidence intervals. The same trial also reported that six participants in the intervention group had positive comments about the intervention and no adverse events were mentioned. AUTHORS' CONCLUSIONS: Due to methodological limitations in the included trials, and in addition to the very low to low quality of the current evidence, there is limited evidence about the benefits of physical therapies on postural abnormalities in people with CF. Therefore, further well-conducted trials with robust methodologies are required considering a prior inclusion criterion to identify the participants who have postural abnormalities.
背景:囊性纤维化(CF)是白种人群中最常见的危及生命的遗传性疾病,可导致多种功能障碍,包括姿势异常。物理治疗可能有助于改善这些姿势异常带来的一些后果,如疼痛、躯干畸形和生活质量。 目的:确定一系列物理治疗方法对囊性纤维化患者姿势异常的管理效果,特别是对生活质量、疼痛和躯干畸形的影响。 检索方法:我们检索了Cochrane囊性纤维化试验注册库,该注册库由电子数据库检索、手工检索期刊和会议摘要汇编而成。我们还检索了相关文章和综述的参考文献列表。另外在ClinicalTrials.gov和世界卫生组织国际临床试验注册平台上进行了检索,以查找任何计划中的、正在进行的和未发表的研究。最后一次检索日期:2020年3月19日。 入选标准:随机对照试验比较了任何被认为与治疗姿势障碍相关的物理治疗方式,与不进行物理治疗、假治疗或常规护理相比,研究对象为任何年龄或疾病严重程度的CF患者。 数据收集与分析:两位综述作者独立选择符合条件的试验,评估每个试验的偏倚风险并提取数据。我们联系试验作者以获取缺失或额外的信息。我们使用GRADE标准评估证据质量。 主要结果:本综述纳入了两项试验,共50名患有CF和姿势异常的参与者。一项针对病情稳定(持续三个月)的患者,另一项针对病情加重的住院患者(20天)。两项试验均比较了包括胸廓和胸椎松动、特定肌肉功能障碍或紧张肌肉群治疗的手法治疗;姿势意识和教育与医疗常规护理。参与者年龄在17岁至58岁之间。两项试验均在英国进行。测量了以下结果:生活质量变化、疼痛变化、躯干畸形变化和肺功能变化。与常规护理相比,手法治疗对躯干畸形变化可能几乎没有影响或没有影响(低质量证据)。由于试验之间的高度异质性,无法分析生活质量(极低质量证据)和疼痛结果(极低质量证据)。尚不确定该干预措施是否能改善肺功能:用力肺活量(极低质量证据);一秒用力呼气量(极低质量证据);或蒂夫诺指数(一秒用力呼气量(FEV)与用力肺活量(FVC)之比)。只有一项试验(15名参与者)测量了功能能力,步行距离的变化似乎有利于干预而非常规护理,但由于置信区间较宽,可能没有效果。同一项试验还报告说,干预组的6名参与者对干预措施有积极评价,且未提及不良事件。 作者结论:由于纳入试验的方法学局限性,以及当前证据质量极低至低,关于物理治疗对CF患者姿势异常益处的证据有限。因此,需要考虑预先设定的纳入标准,以识别有姿势异常的参与者,进行进一步方法可靠的高质量试验。
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