Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Eur Spine J. 2022 Jun;31(6):1370-1390. doi: 10.1007/s00586-022-07222-x. Epub 2022 May 5.
To determine the efficacy of physiotherapy approaches used in the treatment of LSS and compare their delivery characteristics.
A systematic search was conducted using MEDLINE/PubMed, EMBASE, Scopus, PEDro, CINAHL and Web of Science databases, from inception until March 2021. Inclusion criteria were clinical diagnosis of LSS confirmed through imaging techniques, RCTs written in English comparing physiotherapy interventions among them or versus placebo or usual care without restrictions on treatment and follow-up duration, outcomes related to pain, physical function, disability and quality of life. Two independent reviewers assessed records for eligibility and methodological quality (PEDro scale) and extracted participants' characteristics, interventions details and outcome measures at each timepoint. Pooled or un-pooled findings were reported as mean difference with 95% confidence interval, depending on heterogeneity. Evidence quality was rated using the GRADE approach.
Twelve studies (944 patients, mean PEDro score 7.6, range 5-9) were included. Three weeks of weight-supported walking improved pain and disability, while 8 weeks of aquatic exercises improved pain and walking tolerance (very low evidence). Six weeks of cycling reduced disability compared to weight-supported walking (low evidence). Six weeks of manual therapy plus exercise was not superior to supervised exercises (low evidence), but improved pain, walking tolerance, disability and quality of life compared to home/group exercises (moderate to very low evidence). Very low evidence supported 2 weeks of electromagnetic fields, whereas TENS (low evidence) and ultrasounds (very low evidence) revealed no effects.
These findings may assist clinicians in delivering effective physiotherapy interventions in LSS patients.
确定治疗腰椎管狭窄症（LSS）时使用的物理治疗方法的疗效，并比较其实施特点。
系统检索 MEDLINE/PubMed、EMBASE、Scopus、PEDro、CINAHL 和 Web of Science 数据库，检索时间截至 2021 年 3 月。纳入标准为经影像学技术确诊的 LSS 患者，临床对照试验（RCT），比较其中物理治疗干预与安慰剂或常规护理的疗效，不限制治疗和随访时间，结局指标与疼痛、身体功能、残疾和生活质量相关。两名独立的评审员评估文献的入选资格和方法学质量（PEDro 量表），并提取每个时间点的参与者特征、干预措施细节和结局测量值。根据异质性，以均数差（MD）及其 95%置信区间（CI）报告合并或非合并的结果。使用 GRADE 方法评估证据质量。
共纳入 12 项研究（944 例患者，PEDro 评分中位数为 7.6 分，范围为 5-9 分）。3 周的负重步行训练可改善疼痛和残疾，8 周的水中运动可改善疼痛和步行耐力（极低质量证据）。与负重步行训练相比，6 周的自行车运动可降低残疾（低质量证据）。6 周的手法治疗加运动疗法并不优于监督运动疗法（低质量证据），但与家庭/团体运动疗法相比，可改善疼痛、步行耐力、残疾和生活质量（中等到极低质量证据）。有非常低质量证据支持电磁疗法 2 周，TENS（低质量证据）和超声（极低质量证据）没有效果。
这些结果可能有助于临床医生为 LSS 患者提供有效的物理治疗干预措施。
