Therapies Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK; Population Health Research Institute, St George's, University of London, London, UK.
Population Health Research Institute, St George's, University of London, London, UK.
J Pain. 2022 Jun;23(6):929-957. doi: 10.1016/j.jpain.2021.11.004. Epub 2021 Nov 29.
This systematic review and meta-analysis investigated the effectiveness of physical activity (PA) and sedentary behavior (SB) interventions on PA and SB levels in people with persistent musculoskeletal pain. We explored the effectiveness of behavior change techniques (BCTs), the use of behavior change theory and non-PA/SB outcomes. Randomized controlled trials of PA or SB interventions for people with persistent musculoskeletal pain were eligible. Twenty-three studies were included. Quality of evidence was assessed using the GRADE approach. Meta-analysis demonstrated a small effect for PA post-intervention (Hedge's g = .321, CI .136-.507, P = .001, very low-quality evidence). There was no effect for longer-term follow-up PA (low quality evidence) or SB outcomes (very low-quality evidence). There was a small effect for studies with low risk-of-bias at longer-term follow-up PA. Self-report PA outcomes, PA and education interventions, non-self-selected PA, a combination of supervised and unsupervised PA and a combination of individual and group-based interventions had larger effects. Heterogeneity was moderate to considerable. Risk-of-bias, assessed using Cochrane risk-of-bias tool (version two), was generally low. Five promising BCTs were identified: "adding objects to the environment," "goal setting (outcome)," "action planning," "monitoring outcome(s) of behaviour by others without feedback" and "feedback on outcome(s) of behaviour." In conclusion, there is evidence for a modest benefit for PA interventions immediately post-intervention, however the quality of evidence is very low. There was no evidence for longer-term follow-up PA or SB. Higher quality studies of PA and SB interventions that use objective measures are needed. PROSPERO registration: CRD42020180260. PERSPECTIVE: This review investigated the effects of physical activity and sedentary behavior interventions on physical activity and sedentary behavior levels in people with persistent musculoskeletal pain. Current evidence shows a modest benefit for interventions on physical activity post-intervention but not at longer-term follow-up or on sedentary behavior at any time-point, however quality of evidence is low to very low.
本系统评价和荟萃分析研究了体力活动 (PA) 和久坐行为 (SB) 干预措施对持续性肌肉骨骼疼痛患者 PA 和 SB 水平的有效性。我们探讨了行为改变技术 (BCT) 的有效性、行为改变理论的使用以及非 PA/SB 结果。纳入了针对持续性肌肉骨骼疼痛患者的 PA 或 SB 干预措施的随机对照试验。共有 23 项研究纳入。使用 GRADE 方法评估证据质量。荟萃分析显示干预后 PA 有小的效果（Hedge's g=0.321，CI 0.136-0.507，P=0.001，低质量证据）。在更长时间的随访中，PA 没有效果（低质量证据）或 SB 结果（低质量证据）。在长期随访的 PA 中低偏倚风险的研究中，效果较小。自我报告的 PA 结果、PA 和教育干预、非自我选择的 PA、监督和非监督 PA 的结合以及个体和基于小组的干预的结合具有更大的效果。异质性中等至较大。使用 Cochrane 偏倚风险工具（第二版）评估的偏倚风险通常较低。确定了 5 种有希望的 BCT：“向环境中添加物体”、“设定目标（结果）”、“行动计划”、“由他人监测行为结果而无需反馈”和“反馈行为结果”。结论：干预后立即进行 PA 干预有适度的益处，但证据质量非常低。在长期随访中，PA 或 SB 没有证据。需要进行更高质量的 PA 和 SB 干预研究，使用客观测量方法。PROSPERO 注册：CRD42020180260。观点：本综述调查了体力活动和久坐行为干预对持续性肌肉骨骼疼痛患者体力活动和久坐行为水平的影响。目前的证据表明，干预对干预后体力活动有适度的益处，但在长期随访或任何时间点的久坐行为均无益处，但是证据质量为低至非常低。
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