University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
University of New Mexico, Albuquerque.
Arthritis Care Res (Hoboken). 2022 Jan;74(1):59-69. doi: 10.1002/acr.24737. Epub 2021 Dec 22.
To systematically review evidence of rehabilitation interventions for improving outcomes in systemic sclerosis (SSc) and to evaluate evidence quality.
Several electronic databases were searched to identify studies in which rehabilitation professionals delivered, supervised, or participated in interventions for individuals with SSc. Randomized controlled trials (RCTs) or non-randomized trials, one-arm trials, and prospective quasi-experimental studies with interventions were included if they had ≥10 participants. Quality appraisal was conducted by 2 independent raters using the Physiotherapy Evidence Database (PEDro) Scale.
A total of 16 good or excellent quality studies (15 RCTs, 1 prospective quasi-experimental study) were included. Most rehabilitation interventions focused on hands/upper extremities, followed by multicomponent, orofacial, and directed self-management. Sample sizes varied between 20-267 participants (median 38). In 50% of studies, participants in intervention groups significantly improved compared to controls. Most studies demonstrated within-group improvements in intervention groups. Interventions varied in content, delivery, length, and dose and outcome measures collected.
Existing evidence provides some support for rehabilitation in SSc, such as interventions that focus on hand and upper extremity outcomes or are multicomponent, although there is high study heterogeneity. The evidence base would benefit from interventions testing similar replicable components, use of common outcome measures, and incorporation of delivery modes that enable larger sample sizes. There are challenges in recruiting participants due to the rarity of SSc and high disease burden, as participants' involvement in rehabilitation studies requires active participation over time. Intervention studies designed to reduce participation barriers may facilitate translation of effective interventions into practice.
系统回顾康复干预措施改善系统性硬化症（SSc）患者结局的证据，并评估证据质量。
检索了多个电子数据库，以确定由康复专业人员提供、监督或参与 SSc 患者干预措施的研究。纳入了随机对照试验（RCT）或非随机试验、单臂试验和有干预措施的前瞻性准实验研究，如果这些研究的参与者≥10 人且具有以下特征：质量评估由 2 名独立评估员使用物理治疗证据数据库（PEDro）量表进行。
共纳入 16 项质量较好或优秀的研究（15 项 RCT，1 项前瞻性准实验研究）。大多数康复干预措施集中于手部/上肢，其次是多组分、口腔面部和自我管理。参与者人数在 20-267 人之间（中位数 38 人）。在 50%的研究中，干预组的参与者与对照组相比显著改善。大多数研究表明干预组的患者在组内得到了改善。干预措施在内容、提供方式、时长和剂量以及收集的结局指标方面存在差异。
现有证据为 SSc 的康复提供了一定的支持，例如关注手部和上肢结局或多组分的干预措施，但研究之间存在高度异质性。干预措施的研究应受益于测试类似可复制的组成部分、使用共同的结局指标以及纳入能够扩大样本量的提供模式。由于 SSc 的罕见性和高疾病负担，招募参与者存在挑战，因为参与者参与康复研究需要随着时间的推移积极参与。旨在减少参与障碍的干预研究可能有助于将有效的干预措施转化为实践。
