Pourahmadi Mohammadreza, Sahebalam Mohammad, Bagheri Rasool
Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran.
Arch Bone Jt Surg. 2020 Jul;8(4):479-501. doi: 10.22038/abjs.2020.45455.2245.
This systematic review aimed to investigate the effectiveness of proprioceptive neuromuscular facilitation (PNF) training on back pain intensity and functional disability in people with low back pain (LBP).
Totally, five electronic databases, including PubMed/Medline (NLM), Scopus, Google Scholar, PEDro, and Cochrane Central Register of Controlled Clinical Trials were searched up to October 31, 2018. Clinical trials with a concurrent comparison group (s) that compared the effectiveness of PNF training with any other physical therapy intervention were selected. Publication language was restricted to English language articles. Methodologic quality was assessed using the PEDro scale. The measures of continuous variables were summarized as Hedges's .
In total, 20 eligible trials were identified with 965 LBP patients. A large effect size (standardized mean difference [SMD]=-2.14, 95% confidence interval [CI]=3.23 to -1.05) and significant effect were observed favoring the use of PNF training to alleviate back pain intensity in patients with LBP. Moreover, large effect size and the significant result were also determined for the effect of PNF training on functional disability improvement (SMD=-2.68, 95% CI=-3.36 to -2.00) in population with LBP. A qualitative synthesis of results indicated that PNF training can significantly improve sagittal spine ROM. Statistical heterogeneity analysis showed that there was considerable statistical heterogeneity among the selected trials for the primary outcomes (I ≥ 86.6%).
There is a low quality of evidence and weak strength of recommendation that PNF training has positive effects on back pain and disability in LBP people. Further high-quality randomized clinical trials regarding long-term effects of PNF training versus validated control intervention in a clinical setting is recommendable.
本系统评价旨在研究本体感觉神经肌肉促进法（PNF）训练对腰痛患者背痛强度和功能障碍的有效性。
截至2018年10月31日，共检索了五个电子数据库，包括PubMed/Medline（美国国立医学图书馆）、Scopus、谷歌学术、PEDro和Cochrane临床对照试验中心注册库。选择了设有同期对照组的临床试验，这些试验比较了PNF训练与其他物理治疗干预措施的有效性。发表语言仅限于英文文章。使用PEDro量表评估方法学质量。连续变量的测量结果总结为Hedges's 。
共纳入20项符合条件的试验，涉及965例腰痛患者。观察到较大的效应量（标准化均数差[SMD]=-2.14，95%置信区间[CI]=3.23至-1.05），且PNF训练在减轻腰痛患者背痛强度方面具有显著效果。此外，PNF训练对腰痛人群功能障碍改善的效应量也较大且结果显著（SMD=-2.68，95%CI=-3.36至-2.00）。结果的定性综合分析表明，PNF训练可显著改善脊柱矢状面活动度。统计异质性分析显示，所选试验在主要结局方面存在相当大的统计异质性（I²≥86.6%）。
证据质量低，推荐强度弱，表明PNF训练对腰痛患者的背痛和功能障碍有积极作用。建议进一步开展高质量的随机临床试验，比较PNF训练与经过验证的对照干预措施在临床环境中的长期效果。
