Department of Physiotherapy, University of Málaga, Malaga, Spain.
Grupo Clinimetría (F-14), Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain.
BMJ Open. 2020 Nov 19;10(11):e041433. doi: 10.1136/bmjopen-2020-041433.
The objective of this study is to summarise and analyse the current literature about what progression criteria are applied in loading exercise programmes in lower limb tendinopathies and their evidence and effectiveness.
Systematic review.
PubMed, Embase, Scopus and PED were searched from inception to 24 September 2020. The inclusion criteria were randomised controlled trials that included patients with midportion Achilles, patellar or gluteal tendinopathy; assessed function, pain or performance; included at least one group where progressive physical exercise was administered as monotherapy; included at least a control group. We excluded studies that included subjects with previous tendon surgical treatment; studies with control group that conducted a supplemented modality of the exercise performed in the intervention group. A narrative synthesis was conducted. Cohen's d and the percentage of change of main clinical and performance outcomes were obtained. Methodological quality was assessed using the PEDro scale.
Thirty studies that described progression criteria were included. Six types of criteria grouped in two categories were identified and included in a new classification proposal: pain as a primary criterion (evoking and avoid-pain based), and pain and symptom control as a secondary criterion (conditioning stages, fatigue-based, subjective perception and temporary linear increase). Most of the studies applied a pain-based criterion. Criteria based on conditioning stages were also commonly applied. Other criteria such as fatigue, a temporary linear increase, or the subjective perception of the patient's abilities were occasionally applied.
There is a predominant use of pain-based criteria, but the utilisation of these criteria is not supported by strong evidence. This review evidences the need for studies that compare the same exercise programme using different progression criteria. A new classification of the existing progression criteria is proposed based on the use of pain as the primary or secondary criterion.
CRD42018110997.
本研究旨在总结和分析目前关于下肢肌腱病负荷运动方案中应用的进展标准及其证据和效果的文献。
系统评价。
从建库到 2020 年 9 月 24 日，在 PubMed、Embase、Scopus 和 PED 中进行检索。纳入标准为：随机对照试验，纳入中段跟腱、髌腱或臀肌肌腱病患者；评估功能、疼痛或表现；至少有一组接受渐进性物理治疗作为单一疗法；包括对照组。排除标准为：包括有既往肌腱手术治疗的受试者的研究；对照组采用与干预组相同运动方式的补充治疗的研究。进行了叙述性综合分析。获得了主要临床和表现结果的 Cohen's d 和变化百分比。使用 PEDro 量表评估方法学质量。
共纳入 30 项描述进展标准的研究。确定了两种类型的 6 种标准，并将其纳入新的分类建议中：疼痛作为主要标准（诱发和避免疼痛为基础），疼痛和症状控制作为次要标准（适应阶段、疲劳为基础、主观感知和暂时线性增加）。大多数研究采用了基于疼痛的标准。基于适应阶段的标准也经常被采用。其他标准，如疲劳、暂时线性增加或患者能力的主观感知，偶尔被应用。
主要使用基于疼痛的标准，但这些标准的应用没有得到强有力的证据支持。本综述表明需要比较使用不同进展标准的相同运动方案的研究。基于将疼痛作为主要或次要标准，提出了现有进展标准的新分类。
PROSPERO 注册号：CRD42018110997。
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