药物和非药物干预治疗非特异性慢性下腰痛的疗效和可接受性：系统评价和网络荟萃分析方案。
Efficacy and acceptability of pharmacological and non-pharmacological interventions for non-specific chronic low back pain: a protocol for a systematic review and network meta-analysis.
机构信息
School of Human Sciences, University of Greenwich, Park Row, London, SE10 9LS, UK.
Centre for Reviews and Dissemination, University of York, York, UK.
出版信息
Syst Rev. 2020 Jun 5;9(1):130. doi: 10.1186/s13643-020-01398-3.
BACKGROUND
Despite the enormous financial and humanistic burden of chronic low back pain (CLBP), there is little consensus on what constitutes the best treatment options from a multitude of competing interventions. The objective of this network meta-analysis (NMA) is to determine the relative efficacy and acceptability of primary care treatments for non-specific CLBP, with the overarching aim of providing a comprehensive evidence base for informing treatment decisions.
METHODS
We will perform a systematic search to identify randomised controlled trials of interventions endorsed in primary care guidelines for the treatment of non-specific CLBP in adults. Information sources searched will include major bibliographic databases (MEDLINE, Embase, CENTRAL, CINAHL, PsycINFO and LILACS) and clinical trial registries. Our primary outcomes will be patient-reported pain ratings and treatment acceptability (all-cause discontinuation), and secondary outcomes will be functional ability, quality of life and patient/physician ratings of overall improvement. A hierarchical Bayesian class-based NMA will be performed to determine the relative effects of different classes of pharmacological (NSAIDs, opioids, paracetamol, anti-depressants, muscle relaxants) and non-pharmacological (exercise, patient education, manual therapies, psychological therapy, multidisciplinary approaches, massage, acupuncture, mindfulness) interventions and individual treatments within a class (e.g. NSAIDs: diclofenac, ibuprofen, naproxen). We will conduct risk of bias assessments and threshold analysis to assess the robustness of the findings to potential bias. We will compute the effect of different interventions relative to placebo/no treatment for both short- and long-term efficacy and acceptability.
DISCUSSION
While many factors are important in selecting an appropriate intervention for an individual patient, evidence for the analgesic effects and acceptability of a treatment are key factors in guiding this selection. Thus, this NMA will provide an important source of evidence to inform treatment decisions and future clinical guidelines.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registry number: CRD42019138115.
背景
尽管慢性下背痛（CLBP）给患者带来了巨大的经济和人文负担，但对于众多竞争干预措施中哪些是最佳治疗选择，仍缺乏共识。本网络荟萃分析（NMA）旨在确定初级保健治疗非特异性 CLBP 的主要治疗方法的相对疗效和可接受性，其总体目标是为治疗决策提供全面的循证依据。
方法
我们将进行系统检索，以确定成人非特异性 CLBP 初级保健指南推荐的干预措施的随机对照试验。检索的信息来源将包括主要的文献数据库（MEDLINE、Embase、CENTRAL、CINAHL、PsycINFO 和 LILACS）和临床试验注册库。我们的主要结局将是患者报告的疼痛评分和治疗可接受性（所有原因停药），次要结局将是功能能力、生活质量和患者/医生对整体改善的评分。将进行分层贝叶斯基于类别的 NMA，以确定不同类别的药物（非甾体抗炎药、阿片类药物、扑热息痛、抗抑郁药、肌肉松弛剂）和非药物（运动、患者教育、手法治疗、心理治疗、多学科方法、按摩、针灸、正念）干预措施以及类内个别治疗（例如 NSAIDs：双氯芬酸、布洛芬、萘普生）的相对效果。我们将进行风险偏倚评估和阈值分析，以评估研究结果对潜在偏倚的稳健性。我们将计算与安慰剂/无治疗相比，不同干预措施的短期和长期疗效和可接受性的效果。
讨论
虽然在为个体患者选择适当的干预措施时，许多因素都很重要，但治疗的镇痛效果和可接受性是指导选择的关键因素。因此，这项 NMA 将为指导治疗决策和未来临床指南提供重要的循证依据。
系统评价注册
PROSPERO 注册号：CRD42019138115。
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