Quicke J G, Runhaar J, van der Windt D A, Healey E L, Foster N E, Holden M A
Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, United Kingdom.
Department of General Practice, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands.
Osteoarthr Cartil Open. 2020 Nov 4;2(4):100113. doi: 10.1016/j.ocarto.2020.100113. eCollection 2020 Dec.
OBJECTIVE: 1) To identify potential moderators of the effect of therapeutic exercise explored in randomised controlled trials (RCTs) of knee and hip osteoarthritis (OA); 2) summarise the extent, strength and quality of evidence reported for moderators. DESIGN: Systematic review (PROSPERO CRD42019148074). Inclusion criteria: a) RCTs with sub-group analyses investigating potential moderator variables; b) participants with knee and/or hip OA; c) therapeutic exercise interventions compared to either no exercise control or alternative exercise intervention(s), and; d) measuring pain or physical function outcomes. Included RCTs' risk of bias and sub-group analysis quality were assessed. Data were extracted on sub-group analyses (methods and potential moderators), outcomes (pain and function) and sub-group findings (associated statistics of potential moderator∗intervention effects). Findings were analysed using narrative synthesis. RESULTS: 14 RCTs were included; 13 knee OA RCTs (n = 2743 participants) explored 23 potential moderators and 1 hip OA RCT (n = 203) explored 6 potential moderators. Sub-group analysis quality was mixed. Knee varus malalignment was the only moderator of therapeutic exercise compared to non-exercise control in 1 RCT (WOMAC-pain adjusted difference 12.7 in the neutral alignment sub-group and 1.8 in the malaligned sub-group, interaction term: p = 0.02). Varus thrust, knee laxity/instability, obesity and cardiac problems all moderated the effect of therapeutic exercise on pain or function compared to different comparison exercise. CONCLUSIONS: Therapeutic exercise may be effective for reducing pain in people with knee OA and neutral alignment but not for those with varus malalignment. The exercise moderator literature is limited. More robust evidence is required to inform sub-group exercise selection.
目的:1)确定在膝关节和髋关节骨关节炎(OA)的随机对照试验(RCT)中探索的治疗性运动效果的潜在调节因素;2)总结所报告的调节因素的证据范围、强度和质量。 设计:系统评价(PROSPERO CRD42019148074)。纳入标准:a)进行亚组分析以研究潜在调节变量的随机对照试验;b)患有膝关节和/或髋关节OA的参与者;c)将治疗性运动干预与无运动对照或替代运动干预进行比较,以及d)测量疼痛或身体功能结局。评估纳入的随机对照试验的偏倚风险和亚组分析质量。提取关于亚组分析(方法和潜在调节因素)、结局(疼痛和功能)以及亚组结果(潜在调节因素*干预效果的相关统计数据)的数据。使用叙述性综合分析结果。 结果:纳入14项随机对照试验;13项膝关节OA随机对照试验(n = 2743名参与者)探索了23个潜在调节因素,1项髋关节OA随机对照试验(n = 203)探索了6个潜在调节因素。亚组分析质量参差不齐。在1项随机对照试验中,与非运动对照相比,膝内翻畸形是治疗性运动的唯一调节因素(WOMAC疼痛调整差异在中立位亚组中为12.7,在畸形亚组中为1.8,交互项:p = 0.02)。与不同的对照运动相比,内翻推力、膝关节松弛/不稳定、肥胖和心脏问题均调节了治疗性运动对疼痛或功能的影响。 结论:治疗性运动可能对膝关节OA且中立位的患者减轻疼痛有效,但对膝内翻畸形患者无效。运动调节因素的文献有限。需要更有力的证据来指导亚组运动选择。
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