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自我管理治疗膝骨关节炎的系统评价和随机对照试验的荟萃分析。

Self-Management for Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

机构信息

The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China.

Guangzhou University of Chinese Medicine, Guangzhou 510006, China.

出版信息

Pain Res Manag. 2022 Mar 2;2022:2681240. doi: 10.1155/2022/2681240. eCollection 2022.

DOI:10.1155/2022/2681240
PMID:35281344
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8906975/
Abstract

BACKGROUND: Knee osteoarthritis (KOA) is a high incidence chronic joint disease that seriously affects patients' quality of life, and current treatment methods have limited efficacy. Self-management may be an effective strategy for KOA, and clinicians have been showing increased interest recently. However, the effectiveness of self-management for KOA remains controversial. PURPOSE: This study aims to systematically evaluate the effectiveness of self-management for KOA. METHODS: We screened articles published in MEDLINE, Cochrane Library, EMBASE, and Web of Science until September 17, 2021. The main outcomes included pain, knee function, stiffness, WOMAC (total), physical function, arthritis self-efficacy (ASE-pain), arthritis self-efficacy (ASE-other symptoms), mental health, and quality of life. RESULTS: Thirteen randomized controlled trials (RCTs) were finally included ( = 1610). Meta-analysis showed differences in pain, knee function, stiffness, ASE-pain, ASE-other symptoms, mental health, and quality of life between the self-management and control groups. Of the nine outcomes evaluated, four were highly heterogeneous, and the quality of evidence ranged from very low to moderate. CONCLUSION: The meta-analysis results showed that self-management might help improve the pain, knee function, stiffness, ASE, mental health, and quality of life in patients with KOA. However, it has no significant effect on WOMAC (total) and physical function. Considering that this study has some limitations, we cannot draw clear conclusions based on the results of this study. Nevertheless, we offer much needed insight and encourage more rigorously designed and implemented RCTs in the future to substantiate our conclusions.

摘要

背景：膝骨关节炎（KOA）是一种高发病率的慢性关节疾病，严重影响患者的生活质量，目前的治疗方法疗效有限。自我管理可能是 KOA 的一种有效策略，临床医生最近对此表现出了越来越大的兴趣。然而，自我管理对 KOA 的有效性仍存在争议。

目的：本研究旨在系统评价自我管理对 KOA 的疗效。

方法：我们检索了 MEDLINE、Cochrane 图书馆、EMBASE 和 Web of Science 中截至 2021 年 9 月 17 日发表的文章。主要结局指标包括疼痛、膝关节功能、僵硬、WOMAC（总分）、躯体功能、关节炎自我效能（ASE-疼痛）、关节炎自我效能（ASE-其他症状）、心理健康和生活质量。

结果：最终纳入了 13 项随机对照试验（RCT）（ = 1610 例）。Meta 分析显示，自我管理组与对照组在疼痛、膝关节功能、僵硬、ASE-疼痛、ASE-其他症状、心理健康和生活质量方面存在差异。在评估的 9 个结局中，有 4 个存在高度异质性，证据质量从极低到中等。

结论：Meta 分析结果表明，自我管理可能有助于改善 KOA 患者的疼痛、膝关节功能、僵硬、ASE、心理健康和生活质量。然而，它对 WOMAC（总分）和躯体功能没有显著影响。考虑到本研究存在一些局限性，我们不能根据研究结果得出明确的结论。尽管如此，我们提供了急需的见解，并鼓励未来进行更严格设计和实施的 RCT，以证实我们的结论。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c66/8906975/38acfb9dce9c/PRM2022-2681240.011.jpg
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本文引用的文献

[1]
Improved function and strength in patients with knee osteoarthritis as a result of adding a two-day educational program to usual care. Prospective randomized trial.

Osteoarthr Cartil Open. 2021-1-19

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Duration of Symptom Relief and Early Trajectory of Adverse Events for Oral Nonsteroidal Antiinflammatory Drugs in Knee Osteoarthritis: A Systematic Review and Meta-Analysis.

Arthritis Care Res (Hoboken). 2020-4-14

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