Department of Nursing, Shanxi Provincial People's Hospital, Taiyuan, China.
School of Nursing, Shanxi Medical University, Taiyuan, China.
Am J Nephrol. 2023;54(1-2):35-41. doi: 10.1159/000530219. Epub 2023 Mar 30.
Chronic kidney disease is estimated to become the fifth leading cause of death globally by 2040. Due to the high incidence of fatigue in patients with end-stage renal disease without reliable pharmacological treatments, more and more studies on non-pharmacological interventions to improve physical function appear; which might be the best approach remains unknown. This study aimed to compare and rank the efficacy of all known non-pharmacological interventions on improving physical function from multiple outcomes for adults with end-stage renal disease.
This systematic review and network meta-analysis included searches of PubMed, Embase, CINAHL, and Cochrane Library from inception to September 1, 2022, for randomized controlled trials of non-pharmacological interventions to improve physical function in adults with end-stage renal disease. Literature screening, data extraction, and quality appraisal were performed systematically by two independent reviewers. The frequentist random-effect network meta-analysis was adopted to pool the evidence from five outcomes, namely, 6-min walk test, handgrip strength, knee extension strength, physical component summary, and mental component summary, respectively.
A total of 1,921 citations were identified by this search, of which 44 eligible trials enrolled 2,250 participants, and 16 interventions were identified. All subsequent figures refer to comparisons with usual care. For increasing walking distance, the combined resistance and aerobic exercise with virtual reality or music were the most effective interventions, with a mean difference plus 95% confidence interval of 90.69 (8.92-172.46) and 92.59 (23.13-162.06), respectively. Resistance exercise with blood flow restriction (8.13, 0.09-16.17) was the best treatment to improve handgrip strength. Combined resistance and aerobic exercise (11.93, 3.63-20.29) and whole-body vibration (6.46, 1.71-11.20) were associated with improving knee extension strength. For life quality, all treatment effects did not show statistically significant differences.
It was found via network meta-analysis that combined resistance and aerobic exercise is the most effective intervention. Besides, if virtual reality or music is added to the training, there will be better results. Resistance exercise with blood flow restriction and whole-body vibration might be good alternative treatments for improving muscle strength. None of the interventions improved quality of life, suggesting a need for alternative interventions in this regard. The results of this study contribute evidence-based data to decision-making.
据估计，到 2040 年，慢性肾脏病将成为全球第五大死亡原因。由于终末期肾病患者疲劳发生率高，且缺乏可靠的药物治疗方法，越来越多的研究关注改善身体功能的非药物干预措施；但哪种方法效果最好仍不清楚。本研究旨在比较和排名所有已知非药物干预措施对改善终末期肾病成人身体功能的疗效，评估多种结局指标。
本系统评价和网络荟萃分析纳入了从建库至 2022 年 9 月 1 日，PubMed、Embase、CINAHL 和 Cochrane Library 中关于改善终末期肾病成人身体功能的非药物干预的随机对照试验。两名独立评审员系统地进行文献筛选、数据提取和质量评估。采用经典随机效应网络荟萃分析汇总来自 5 个结局（6 分钟步行测试、握力、膝关节伸展力量、身体成分综合评分和心理成分综合评分）的证据。
本次检索共确定了 1921 条引文，其中 44 项合格试验纳入了 2250 名参与者，共确定了 16 种干预措施。所有后续图表均指与常规护理相比。为了增加步行距离，结合抗阻和有氧运动与虚拟现实或音乐的干预措施最有效，平均差值加 95%置信区间分别为 90.69（8.92-172.46）和 92.59（23.13-162.06）。血流限制的抗阻运动（8.13，0.09-16.17）是改善握力的最佳治疗方法。结合抗阻和有氧运动（11.93，3.63-20.29）和全身振动（6.46，1.71-11.20）与改善膝关节伸展力量有关。对于生活质量，所有治疗效果均无统计学差异。
通过网络荟萃分析发现，结合抗阻和有氧运动是最有效的干预措施。此外，如果在训练中加入虚拟现实或音乐，效果会更好。血流限制的抗阻运动和全身振动可能是改善肌肉力量的良好替代治疗方法。没有一种干预措施能提高生活质量，这表明在这方面需要替代干预措施。本研究结果为决策提供了基于证据的数据。
