Aspinall Sara K, Bamber Zoe A, Hignett Sue M, Godsiff Steven P, Wheeler Patrick C, Fong Daniel T P
National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
Division of Orthopaedics, Trauma and Sports Medicine, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
J Orthop Translat. 2021 Feb 8;27:119-131. doi: 10.1016/j.jot.2020.11.005. eCollection 2021 Mar.
This systematic review examines the available evidence on the use of medical stretching devices to treat knee arthrofibrosis, it suggests a focus for future studies addressing limitations in current research and identifies gaps in the published literature to facilitate future works.
Articles were identified using the Cochrane Library, MEDLINE, PubMed and SCOPUS databases. Articles from peer reviewed journals investigating the effectiveness of medical stretching devices to increase range of movement when treating arthrofibrosis of the knee were included.
A total of 13 studies (558 participants) met the inclusion criteria with the devices falling into the following categories; CPM, load control or displacement control stretching devices. A statistically significant increase in range of movement was demonstrated in CPM, load-control and displacement-control studies (p < 0.001). The results show that the stretch doses applied using the CPM, load-control devices were performed over a considerably longer treatment time and involved significantly more additional physiotherapy compared to the displacement-control and patient actuated serial stretching devices.
The systematic review indicates that load-control and displacement-control devices are effective in increasing range of movement in the treatment of knee arthrofibrosis. Displacement-control devices involving patient actuated serial stretching techniques, may be more effective in increasing knee flexion than those utilising static progressive stretch.The paucity of research in this field indicates that more randomised controlled trials are required to investigate the superiority of the different types of displacement-control stretching devices and which of these would be most effective for use in clinical practice and to compare these with standard physiotherapy treatment.
本系统评价考察了使用医用拉伸装置治疗膝关节纤维性关节病的现有证据，针对当前研究的局限性提出了未来研究的重点，并确定了已发表文献中的空白，以促进未来的研究工作。
通过Cochrane图书馆、MEDLINE、PubMed和SCOPUS数据库检索文章。纳入来自同行评审期刊、研究医用拉伸装置在治疗膝关节纤维性关节病时增加活动范围有效性的文章。
共有13项研究（558名参与者）符合纳入标准，所使用的装置分为以下几类：持续被动运动（CPM）装置、负荷控制或位移控制拉伸装置。在CPM、负荷控制和位移控制研究中，活动范围有统计学意义的显著增加（p < 0.001）。结果表明，与位移控制和患者主动连续拉伸装置相比，使用CPM、负荷控制装置进行拉伸时，治疗时间长得多，且涉及的额外物理治疗显著更多。
该系统评价表明，负荷控制和位移控制装置在增加膝关节纤维性关节病治疗中的活动范围方面是有效的。涉及患者主动连续拉伸技术的位移控制装置，在增加膝关节屈曲方面可能比使用静态渐进性拉伸的装置更有效。该领域研究的匮乏表明，需要更多随机对照试验来研究不同类型位移控制拉伸装置的优越性，以及哪种装置在临床实践中最有效，并将这些与标准物理治疗进行比较。
