心理知情实践与行为分级活动对癌症幸存者的影响：系统评价和荟萃分析。
The effect of psychologically informed practice with behavioural graded activity in cancer survivors: systematic review and meta-analysis.
机构信息
Research Foundation - Flanders (FWO), Brussels, Belgium.
Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
出版信息
J Cancer Surviv. 2024 Jun;18(3):854-899. doi: 10.1007/s11764-022-01270-4. Epub 2023 Jan 26.
PURPOSE
This systematic review and meta-analysis aimed to determine the effectiveness of psychologically informed practice (PIP) with behavioural graded activity (BGA) compared to (1) waitlist controls (WLC), (2) other interventions (OI), (3) PIP alone or (4) BGA alone in cancer patients and survivors (CPaS).
METHODS
PubMed, Web of Science and Embase were screened for randomised controlled trials encompassing BGA + PIP in CPaS. Effect sizes were inventoried for outcomes regarding physical activity (PA), quality of life (QoL) and debilitating symptoms (DS), which were assessed at four time points: post-intervention (PI), follow-up F1 (1 to 3 months), F2 (4 to 6 months) and F3 (> 6 months). The quality of the evidence was classified by the GRADE approach.
RESULTS
Thirty-three studies were found eligible, comprising 4330 participants. Significant effects with low heterogeneity of PIP + BGA comparing to WLC were found for anxiety (SMD - 1.29 [-1.71; - 0.86]), depression (SMD - 0.79 [- 1.10; - 0.48]), functional impairment (SMD - 0.72 [- 0.95; - 0.50]), PA (self-reported: (SMD - 0.58 [- 0.84; - 0.32]) and objectively measured: (SMD - 0.51 [- 0.90; - 0.13])) and social impairment (SMD - 0.33 [- 0.58; - 0.08]). When comparing PIP + BGA to OI, fatigue (SMD - 0.35 [- 0.51; - 0.20]) and PA (SMD - 0.26 [- 0.41; - 0.11]) at PI, and fatigue (SMD - 0.34 [- 0.58; - 0.10]) at F1 were found significant with low heterogeneity. No significant effects were observed in the meta-analyses of studies comparing PIP + BGA to BGA or PIP alone.
CONCLUSIONS
PIP with BGA has a favourable effect on DS, PA and QoL in CPaS when compared to non-behavioural interventions such as WLC, usual care and education. However, further research is needed on 'how' and 'when' PIP + BGA should be provided in cancer rehabilitation.
IMPLICATIONS FOR CANCER SURVIVORS
PIP + BGA has the potential to facilitate CPaS to reach the recommended amount of PA and reduce DS.
目的
本系统评价和荟萃分析旨在确定心理知情实践（PIP）与行为分级活动（BGA）相结合在癌症患者和幸存者（CPaS）中与（1）等待对照（WLC）、（2）其他干预措施（OI）、（3）单独的 PIP 或（4）单独的 BGA 相比的有效性。
方法
在 CPaS 中筛选了包含 BGA + PIP 的随机对照试验，以检索 PubMed、Web of Science 和 Embase。为四个时间点的身体活动（PA）、生活质量（QoL）和致残症状（DS）的结果汇总了效应大小：干预后（PI）、随访 F1（1-3 个月）、F2（4-6 个月）和 F3（>6 个月）。证据质量按 GRADE 方法进行分类。
结果
发现 33 项研究符合条件，共纳入 4330 名参与者。与 WLC 相比，PIP + BGA 具有显著效果，且异质性较低，包括焦虑（SMD -1.29 [-1.71；-0.86]）、抑郁（SMD -0.79 [-1.10；-0.48]）、功能障碍（SMD -0.72 [-0.95；-0.50]）、PA（自我报告：（SMD -0.58 [-0.84；-0.32]）和客观测量：（SMD -0.51 [-0.90；-0.13]））和社会障碍（SMD -0.33 [-0.58；-0.08]）。当将 PIP + BGA 与 OI 进行比较时，PI 时疲劳（SMD -0.35 [-0.51；-0.20]）和 PA（SMD -0.26 [-0.41；-0.11]），以及 F1 时疲劳（SMD -0.34 [-0.58；-0.10]）差异具有统计学意义且异质性较低。在将 PIP + BGA 与 BGA 或 PIP 单独比较的研究的荟萃分析中，未观察到显著效果。
结论
与非行为干预（如 WLC、常规护理和教育）相比，PIP 联合 BGA 对 CPaS 的 DS、PA 和 QoL 具有有利影响。然而，需要进一步研究在癌症康复中应该如何以及何时提供 PIP + BGA。
意义
PIP + BGA 有可能帮助 CPaS 达到推荐的 PA 量并减少 DS。
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