Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China.
Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
BMJ Open. 2022 Feb 9;12(2):e051608. doi: 10.1136/bmjopen-2021-051608.
Are physical therapy or orthopaedic equipment efficacious in reducing the biomechanical risk factors in people with tibiofemoral osteoarthritis (OA)? Is there a better therapeutic intervention than others to improve these outcomes?
Systematic review with network meta-analysis (NMA) of randomised trials.
PubMed, Web of Science, Cochrane Library, Embase and MEDLINE were searched through January 2021.
We included randomised controlled trials exploring the benefits of using physical therapy or orthopaedic equipment in reducing the biomechanical risk factors which included knee adduction moment (KAM) and knee adduction angular impulse (KAAI) in individuals with tibiofemoral OA.
Two authors extracted data independently and assessed risk of bias. We conducted an NMA to compare multiple interventions, including both direct and indirect evidences. Heterogeneity was assessed (sensitivity analysis) and quantified (I statistic). Grading of Recommendations Assessment, Development and Evaluation assessed the certainty of the evidence.
Eighteen randomised controlled trials, including 944 participants, met the inclusion criteria, of which 14 trials could be included in the NMA. Based on the collective probability of being the overall best therapy for reducing the first peak KAM, lateral wedge insoles (LWI) plus knee brace was closely followed by gait retraining, and knee brace only. Although no significant difference was observed among the eight interventions, variable-stiffness shoes and neuromuscular exercise exhibited an increase in the first peak KAM compared with the control condition group. And based on the collective probability of being the overall best therapy for reducing KAAI, gait retraining was followed by LWI only, and lower limb exercise.
The results of our study support the use of LWI plus knee brace for reducing the first peak KAM. Gait retraining did not rank highest but it influenced both KAM and KAAI and therefore it was the most recommended therapy for reducing the biomechanical risk factors.
物理治疗或矫形设备是否能降低膝骨关节炎（OA）患者的生物力学危险因素？是否有比其他方法更好的治疗干预措施来改善这些结果？
系统评价与网络荟萃分析（NMA）的随机试验。
通过 2021 年 1 月对 PubMed、Web of Science、Cochrane 图书馆、Embase 和 MEDLINE 进行了检索。
我们纳入了探索使用物理治疗或矫形设备降低生物力学危险因素（包括膝内收力矩（KAM）和膝内收角冲量（KAAI））的益处的随机对照试验，这些危险因素包括膝骨关节炎患者。
两名作者独立提取数据并评估偏倚风险。我们进行了 NMA 来比较多种干预措施，包括直接和间接证据。评估了异质性（敏感性分析）并进行了量化（I 统计）。推荐评估、制定和评估等级评估证据的确定性。
符合纳入标准的 18 项随机对照试验共纳入 944 名参与者，其中 14 项试验可纳入 NMA。基于降低第一峰值 KAM 的整体最佳治疗方法的综合概率，外侧楔形鞋垫（LWI）加膝部支具紧随其后的是步态再训练，而仅使用膝部支具。虽然八种干预措施之间没有显著差异，但与对照组相比，可变刚度鞋和神经肌肉锻炼表现出第一峰值 KAM 的增加。并且基于降低 KAAI 的整体最佳治疗方法的综合概率，紧随其后的是仅 LWI 加膝部支具，以及下肢运动。
我们的研究结果支持使用 LWI 加膝部支具来降低第一峰值 KAM。步态再训练并不是排名最高的，但它影响了 KAM 和 KAAI，因此它是降低生物力学危险因素的最推荐的治疗方法。
