运动疗法对急性腰痛患者的影响：系统评价的系统评价。
Effects of exercise therapy in patients with acute low back pain: a systematic review of systematic reviews.
机构信息
Region Skåne, Healthcare Centre Oxie, Malmö, Sweden.
Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
出版信息
Syst Rev. 2020 Aug 14;9(1):182. doi: 10.1186/s13643-020-01412-8.
BACKGROUND
Acute low back pain is associated with pain and disability, but symptoms are often self-healing. The effectiveness of exercise therapy for acute low back pain remains uncertain with conflicting evidence from systematic reviews. The aim of this systematic review of systematic reviews was to assess the overall certainty of evidence for the effects of exercise therapy, compared with other interventions, on pain, disability, recurrence, and adverse effects in adult patients with acute low back pain.
METHODS
PubMed, the Cochrane library, CINAHL, PEDro, Open Grey, Web of Science, and PROSPERO were searched for systematic reviews of randomized controlled trials. Methodological quality was assessed independently by two authors using AMSTAR. Meta-analyses were performed if possible, using data from the original studies. Data for pain, disability, recurrence, and adverse effects were analyzed. Certainty of evidence was assessed using GRADE.
RESULTS
The searches retrieved 2602 records, of which 134 publications were selected for full-text screening. Twenty-four reviews were included, in which 21 randomized controlled trials (n = 2685) presented data for an acute population, related to 69 comparisons. Overlap was high, 76%, with a corrected covered area of 0.14. Methodological quality varied from low to high. Exercise therapy was categorized into general exercise therapy, stabilization exercise, and McKenzie therapy. No important difference in pain or disability was evident when exercise therapy was compared with sham ultrasound, nor for the comparators usual care, spinal manipulative therapy, advice to stay active, and educational booklet. Neither McKenzie therapy nor stabilization exercise yielded any important difference in effects compared with other types of exercise therapy. Certainty of evidence varied from very low to moderate.
CONCLUSIONS
The findings suggest very low to moderate certainty of evidence that exercise therapy may result in little or no important difference in pain or disability, compared with other interventions, in adult patients with acute low back pain. A limitation of this systematic review is that some included reviews were of low quality. When implementing findings of this systematic review in clinical practice, patients' preferences and the clinician's expertise also should be considered, to determine if and when exercise therapy should be the intervention of choice.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO: CRD46146, available at: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=46146 .
背景
急性腰痛与疼痛和残疾有关，但症状通常会自行缓解。系统评价的证据存在冲突，运动疗法治疗急性腰痛的效果仍不确定。本系统评价旨在评估运动疗法与其他干预措施相比，对成人急性腰痛患者疼痛、残疾、复发和不良反应的总体证据确定性。
方法
通过 PubMed、Cochrane 图书馆、CINAHL、PEDro、Open Grey、Web of Science 和 PROSPERO 检索系统评价随机对照试验。两位作者独立使用 AMSTAR 评估方法学质量。如果可能，使用原始研究的数据进行荟萃分析。分析疼痛、残疾、复发和不良反应的数据。使用 GRADE 评估证据确定性。
结果
检索到 2602 条记录，其中 134 篇文章被选作全文筛选。纳入 24 篇综述，其中 21 项随机对照试验（n=2685）提供了急性人群的数据，涉及 69 项比较。重叠率很高，为 76%，校正覆盖面积为 0.14。方法学质量从低到高不等。运动疗法分为一般运动疗法、稳定运动疗法和麦肯齐疗法。与假超声相比，运动疗法与 sham ultrasound 相比，或与常规护理、脊柱推拿疗法、保持活动建议和教育手册等比较，疼痛或残疾均无明显差异。麦肯齐疗法和稳定运动疗法与其他类型的运动疗法相比，效果也没有显著差异。证据确定性从极低到中等不等。
结论
研究结果表明，在患有急性腰痛的成年患者中，与其他干预措施相比，运动疗法在疼痛或残疾方面可能仅有很小或没有显著差异，证据确定性为极低至中等。本系统评价的局限性在于，一些纳入的综述质量较低。在将本系统评价的结果应用于临床实践时，还应考虑患者的偏好和临床医生的专业知识，以确定运动疗法是否以及何时应成为首选干预措施。
系统评价注册
PROSPERO：CRD46146，可在以下网址获取：https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=46146。
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