下肢挽救性手术后肉瘤运动干预的治疗有效性和效果：系统评价。
Therapeutic validity and effectiveness of exercise interventions after lower limb-salvage surgery for sarcoma: a systematic review.
机构信息
Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
出版信息
BMC Musculoskelet Disord. 2023 Mar 23;24(1):216. doi: 10.1186/s12891-023-06315-y.
BACKGROUND
An increasing number of patients are surviving sarcoma after lower limb-salvage surgery (LSS) and are left with functional limitations. This systematic review aimed to determine the therapeutic validity and effectiveness of exercise interventions after lower limb-salvage surgery (LSS) for sarcoma.
METHODS
A systematic review was conducted using formal narrative synthesis of intervention studies (with and without control group) identified through PubMed, Embase, Cochrane Library, CINAHL, and PEDro databases. Studies were included if participants were treated with LSS for unilateral lower limb sarcoma and followed an exercise intervention using active exercise, physical training, or rehabilitation before and/or after surgery. This review's outcome measures were interventions' therapeutic validity, assessed using the CONTENT scale (0 to 9); methodological quality, identified using the Downs & Black checklist (0 to 28); interventions' effectiveness, assessed based on differences in outcome measures between intervention and control groups; and certainty of evidence, classified according to the GRADE approach.
RESULTS
Seven studies involving 214 participants were included. None of the included interventions were therapeutically valid (median 5, range 1-5). All but one study were of at least fair methodological quality (median 18, range 14-21). There was very low-quality evidence that exercise interventions resulted in increased knee range of motion (MD 10-15°) or compliance (MD 30%), and reduced functionality scores (MD -5%) compared to usual care.
CONCLUSIONS
We found overall low therapeutic validity of interventions, performed in overall low-quality studies. Combined with the very low certainty of evidence, the results prevent drawing valid conclusions on the interventions' effectiveness. Future studies should aim for uniformity among their methodological approaches and outcome measures, using the CONTENT scale as a template to avert insufficient reporting.
TRIAL REGISTRATION
PROSPERO CRD42021244635.
背景
越来越多的患者在接受保肢手术后（LSS）后幸存下来，但仍存在功能受限。本系统评价旨在确定保肢手术后（LSS）治疗肉瘤的运动干预的治疗有效性和效果。
方法
通过对 PubMed、Embase、Cochrane 图书馆、CINAHL 和 PEDro 数据库中具有和不具有对照组的干预研究进行正式的叙述性综合，进行了系统评价。如果参与者因单侧下肢肉瘤接受 LSS 治疗，并在手术前后接受主动运动、物理训练或康复运动的干预，则将研究纳入本研究。本综述的结局指标为干预的治疗有效性，使用 CONTENT 量表（0-9）评估；方法学质量，使用 Downs & Black 清单（0-28）识别；根据干预组和对照组之间的结果指标差异评估干预的有效性；根据 GRADE 方法进行证据确定性分类。
结果
纳入了 7 项涉及 214 名参与者的研究。没有一项纳入的干预措施具有治疗有效性（中位数 5，范围 1-5）。除了一项研究外，其余所有研究的方法学质量均至少为良好（中位数 18，范围 14-21）。有非常低质量的证据表明，与常规护理相比，运动干预可增加膝关节活动范围（MD 10-15°）或依从性（MD 30%），并降低功能评分（MD-5%）。
结论
我们发现干预措施的总体治疗有效性较低，且研究质量也较低。综合考虑证据确定性非常低的情况，结果无法得出干预措施有效性的有效结论。未来的研究应旨在使方法学方法和结局指标统一，并使用 CONTENT 量表作为模板避免报告不足。
登记号
PROSPERO CRD42021244635。
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