术前膝关节伸肌锻炼剂量与全膝关节置换术前和术后膝关节伸肌力量的关系：一项随机对照试验的系统评价和荟萃回归分析。
The relationship between prescribed pre-operative knee-extensor exercise dosage and effect on knee-extensor strength prior to and following total knee arthroplasty: a systematic review and meta-regression analysis of randomized controlled trials.
机构信息
Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C) Department of Physical and Occupational Therapy Clinical Research Centre Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
出版信息
Osteoarthritis Cartilage. 2020 Nov;28(11):1412-1426. doi: 10.1016/j.joca.2020.08.011. Epub 2020 Sep 2.
OBJECTIVE
The aim of this systematic review was to evaluate the relationship between prescribed knee-extensor strength exercise dosage in pre-operative exercise intervention and the effect on knee-extensor muscle strength prior to and following TKA. Additional meta-analyses report the effect of pre-habilitation on outcomes prior to and following TKA.
DESIGN
A systematic literature search was performed including RCT's evaluating the effect of pre-operative exercise prior to and following TKA. Meta-regression analysis was performed to evaluate the dose-response relationship between prescribed exercise dose and the pooled effect, measured as standardized mean difference (SMD). The prescribed exercise dose was quantified using a formula accounting for as many exercise descriptors as possible. Risk of bias in the included trials was assessed using the Cochrane Risk of Bias Tool.
RESULTS
Twelve trials with 616 patients were included. Meta-regression analysis showed no relationship between prescribed pre-operative knee-extensor exercise dosage and change in knee-extensor strength neither prior to (slope 0.0005 [95%CI -0.007 to 0.008]) or 3 months following TKA (slope 0.0014 [95%CI -0.006 to 0.009]). Prior to TKA, a moderate effect favoring pre-operative exercise for increase in knee-extensor strength was found (SMD 0.50 [95%CI 0.12 to 0.88]), but not at 3 months following TKA (SMD -0.01 [95%CI -0.45 to 0.43]). Risk of bias was generally assessed as unclear.
CONCLUSION
Meta-regression analysis of existing trials suggests no relationship between the prescribed pre-operative knee-extensor exercise dosage and the change in knee-extensor strength observed prior to and following TKA. Pre-operative exercise including knee-extensor muscle strength exercise increased knee-extensor strength moderately prior to but not 3 months following TKA.
PROTOCOL REGISTRATION
PROSPERO ID (CRD42018076308) (http://www.crd.york.ac.uk/PROSPERO/).
目的
本系统评价旨在评估术前运动干预中规定的膝关节伸肌力量练习剂量与 TKA 前后膝关节伸肌力量的关系。其他荟萃分析报告了术前康复对 TKA 前后结果的影响。
设计
进行了系统的文献检索，包括评估 TKA 前后术前运动对膝关节伸肌力量影响的 RCT。进行了荟萃回归分析，以评估规定的运动剂量与汇总效应之间的剂量反应关系，以标准化均数差（SMD）表示。使用考虑到尽可能多的运动描述符的公式来量化规定的运动剂量。使用 Cochrane 偏倚风险工具评估纳入试验的偏倚风险。
结果
纳入了 12 项包含 616 名患者的试验。荟萃回归分析显示，术前膝关节伸肌运动剂量与 TKA 前后膝关节伸肌力量变化之间无相关性，包括术前（斜率 0.0005 [95%CI-0.007 至 0.008]）和 TKA 后 3 个月（斜率 0.0014 [95%CI-0.006 至 0.009]）。TKA 前，发现术前运动有利于增加膝关节伸肌力量的中度效果（SMD 0.50 [95%CI 0.12 至 0.88]），但 TKA 后 3 个月则没有（SMD-0.01 [95%CI-0.45 至 0.43]）。偏倚风险通常被评估为不明确。
结论
对现有试验的荟萃回归分析表明，术前膝关节伸肌运动剂量与 TKA 前后膝关节伸肌力量变化之间没有关系。术前运动包括膝关节伸肌力量运动，在 TKA 前适度增加了膝关节伸肌力量，但在 TKA 后 3 个月则没有。
注册
PROSPERO 标识符（CRD42018076308）（http://www.crd.york.ac.uk/PROSPERO/）。
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