骨科手法治疗对慢性肌肉骨骼疼痛患者疼痛敏化的影响：荟萃分析的伞状评价。
Effects of Orthopedic Manual Therapy on Pain Sensitization in Patients With Chronic Musculoskeletal Pain: An Umbrella Review With Meta-Meta-analysis.
机构信息
From the Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain (OM-P, AA-R); Department of Physiotherapy (EAS-R) and Musculoskeletal Pain and Motor Control Research Group (EAS-R, JF-C), Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain; Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Spain (EAS-R); Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, Spain (EAS-R, JF-C); Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing, Universidad Castilla La Mancha, Toledo, Spain (HB-A); Department of Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Rey Juan Carlos University, Madrid, Spain (AA-R, JF-C); Department of Physiotherapy, University of Valencia, Valencia, Spain (FC-M); IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy (JHV); La Paz Hospital Institute for Health Research, IdiPAZ, Madrid, Spain (JF-C); and Grupo Multidisciplinar de Investigación y Tratamiento del Dolor, Grupo de Excelencia Investigadora URJC-Banco de Santander (JF-C), Madrid, Spain.
出版信息
Am J Phys Med Rehabil. 2023 Oct 1;102(10):879-885. doi: 10.1097/PHM.0000000000002239. Epub 2023 Mar 14.
OBJECTIVE
The aim of this umbrella review with meta-meta-analysis was to assess the effectiveness of orthopedic manual therapy in isolation on pain sensitization in patients with chronic musculoskeletal pain.
DESIGN
A systematic search was performed in different databases including systematic reviews with or without meta-analysis. The outcome measures included were pressure pain threshold, temporal summation, and conditioned pain modulation. The results of the different reviews were statistically synthesized through a random-effect meta-analysis, of all standardized mean differences and the corresponding 95% confidence interval reported by each study.
RESULTS
For mechanical hyperalgesia, the meta-meta-analysis of three meta-analyses revealed a statistically significant small-moderate effect of orthopedic manual therapy, with no evidence of heterogeneity and moderate-quality evidence. In terms of temporal summation, one meta-analysis revealed a statistically significant small effect of orthopedic manual therapy intervention, with moderate heterogeneity and low quality of evidence. Finally, one review without meta-analysis found that orthopedic manual therapy improved endogenous analgesia with low-quality evidence.
CONCLUSION
Orthopedic manual therapy in isolation improved mechanical hyperalgesia with moderate-quality evidence, as well as temporal summation and conditioned pain modulation with low-quality evidence. However, its effects are limited only to immediate and short-term.
目的
本项伞式综述与元分析旨在评估孤立使用骨科手法治疗对慢性肌肉骨骼疼痛患者痛觉过敏的疗效。
设计
系统检索了包括有或无元分析的系统综述在内的不同数据库。纳入的结局指标包括压力疼痛阈值、时间总和和条件性疼痛调制。通过对每项研究报告的所有标准化均数差值及其相应的 95%置信区间进行随机效应荟萃分析，对不同综述的结果进行了统计学综合。
结果
对于机械性痛觉过敏，3 项元分析的元分析显示，骨科手法治疗具有统计学意义的小到中度效果，无异质性，且证据质量为中等。就时间总和而言，一项元分析显示，骨科手法治疗干预具有统计学意义的小效应，存在中度异质性和低质量证据。最后，一项没有元分析的综述发现，骨科手法治疗可改善内源性镇痛，但证据质量较低。
结论
孤立使用骨科手法治疗可改善机械性痛觉过敏，具有中等质量证据，同时也改善了时间总和和条件性疼痛调制，但其效果仅局限于即时和短期。
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