运动控制训练与强化训练治疗上下肢肌肉骨骼疾病的比较：一项随机对照试验的系统评价和荟萃分析。
Motor Control Exercises Compared to Strengthening Exercises for Upper- and Lower-Extremity Musculoskeletal Disorders: A Systematic Review With Meta-Analyses of Randomized Controlled Trials.
机构信息
School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.
Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada.
出版信息
Phys Ther. 2021 Jul 1;101(7). doi: 10.1093/ptj/pzab072.
OBJECTIVE
The purpose of this review was to compare the efficacy of motor control exercises (MCEs) to strengthening exercises for adults with upper- or lower-extremity musculoskeletal disorders (MSKDs).
METHODS
Electronic searches were conducted up to April 2020 in Medline, Embase, Cochrane CENTRAL, and CINAHL. Randomized controlled trials were identified on the efficacy of MCEs compared to strengthening exercises for adults with upper- or lower-extremity MSKDs. Data were extracted with a standardized form that documented the study characteristics and results. For pain and disability outcomes, pooled mean differences (MDs) and standardized mean differences (SMDs) were calculated using random-effects inverse variance models.
RESULTS
Twenty-one randomized controlled trials (n = 1244 participants) were included. Based on moderate-quality evidence, MCEs lead to greater pain (MD = -0.41 out of 10 points; 95% CI = -0.72 to -0.10; n = 626) and disability reductions (SMD = -0.28; 95% CI = -0.43 to -0.13; n = 713) when compared to strengthening exercises in the short term; these differences are not clinically important. When excluding trials on osteoarthritis (OA) participants and evaluating only the trials involving participants with rotator cuff-related shoulder pain, shoulder instability, hip-related groin pain, or patellofemoral pain syndrome, there is moderate quality evidence that MCEs lead to greater pain (MD = -0.74 out of 10 points; 95% CI = -1.22 to -0.26; n = 293) and disability reductions (SMD = -0.40; 95% CI = -0.61 to -0.19; n = 354) than strengthening exercises in the short term; these differences might be clinically important.
CONCLUSIONS
MCEs lead to statistically greater pain and disability reductions when compared to strengthening exercises among adults with MSKDs in the short term, but these effects might be clinically important only in conditions that do not involve OA. Inclusion of new trials might modify these conclusions.
IMPACT
These results suggest that MCEs could be prioritized over strengthening exercises for adults with the included non-OA MSKDs; however, results are unclear for OA disorders.
目的
本综述旨在比较运动控制训练（MCE）与强化训练对上肢或下肢肌肉骨骼疾病（MSKD）成人的疗效。
方法
截至 2020 年 4 月，我们在 Medline、Embase、Cochrane 中心数据库和 CINAHL 中进行了电子检索。我们确定了比较 MCE 与强化训练对上肢或下肢 MSKD 成人疗效的随机对照试验。使用标准化表格提取研究特征和结果数据。对于疼痛和残疾结局，我们使用随机效应逆方差模型计算了 pooled mean differences (MDs) 和 standardized mean differences (SMDs)。
结果
共纳入 21 项随机对照试验（n=1244 名参与者）。基于中等质量证据，与强化训练相比，MCE 可在短期内更大程度地减轻疼痛（MD=-0.41 分；95%CI=-0.72 至 -0.10；n=626）和残疾（SMD=-0.28；95%CI=-0.43 至 -0.13；n=713）；这些差异无临床意义。当排除针对骨关节炎（OA）患者的试验并仅评估涉及肩袖相关肩痛、肩不稳定、髋关节相关腹股沟痛或髌股关节疼痛综合征患者的试验时，有中等质量证据表明，与强化训练相比，MCE 可在短期内更大程度地减轻疼痛（MD=-0.74 分；95%CI=-1.22 至 -0.26；n=293）和残疾（SMD=-0.40；95%CI=-0.61 至 -0.19；n=354）；这些差异可能具有临床意义。
结论
在短期内，与强化训练相比，MCE 可使 MSKD 成人的疼痛和残疾程度有统计学上的更大改善，但这些效果在不涉及 OA 的情况下可能具有临床意义。纳入新的试验可能会改变这些结论。
影响
这些结果表明，对于纳入的非 OA MSKD 成人，MCE 可优先于强化训练；然而，OA 疾病的结果尚不清楚。
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