Rodríguez-Almagro Daniel, Del Moral-García María, López-Ruiz María Del Carmen, Cortés-Pérez Irene, Obrero-Gaitán Esteban, Lomas-Vega Rafael
Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain.
Department of Health Sciences, University of Jaén, Jaén, Spain.
Front Physiol. 2023 Apr 12;14:1170621. doi: 10.3389/fphys.2023.1170621. eCollection 2023.
The aim of our meta-analysis was to compile the available evidence to evaluate the effect of physical exercise-based therapy (PEBT) on pain, impact of the disease, quality of life (QoL) and anxiety in patients with fibromyalgia syndrome (FMS), to determine the effect of different modes of physical exercise-based therapy, and the most effective dose of physical exercise-based therapy for improving each outcome. A systematic review and meta-analysis was carried out. The PubMed (MEDLINE), SCOPUS, Web of Science, CINAHL Complete and Physiotherapy Evidence Database (PEDro) databases were searched up to November 2022. Randomized controlled trials (RCTs) comparing the effects of physical exercise-based therapy and other treatments on pain, the impact of the disease, QoL and/or anxiety in patients with FMS were included. The standardized mean difference (SMD) and a 95% CI were estimated for all the outcome measures using random effect models. Three reviewers independently extracted data and assessed the risk of bias using the PEDro scale. Sixty-eight RCTs involving 5,474 participants were included. Selection, detection and performance biases were the most identified. In comparison to other therapies, at immediate assessment, physical exercise-based therapy was effective at improving pain [SMD-0.62 (95%CI, -0.78 to -0.46)], the impact of the disease [SMD-0.52 (95%CI, -0.67 to -0.36)], the physical [SMD 0.51 (95%CI, 0.33 to 0.69)] and mental dimensions of QoL [SMD 0.48 (95%CI, 0.29 to 0.67)], and the anxiety [SMD-0.36 (95%CI, -0.49 to -0.25)]. The most effective dose of physical exercise-based therapy for reducing pain was 21-40 sessions [SMD-0.83 (95%CI, 1.1--0.56)], 3 sessions/week [SMD-0.82 (95%CI, -1.2--0.48)] and 61-90 min per session [SMD-1.08 (95%CI, -1.55--0.62)]. The effect of PEBT on pain reduction was maintained up to 12 weeks [SMD-0.74 (95%CI, -1.03--0.45)]. Among patients with FMS, PEBT (including circuit-based exercises or exercise movement techniques) is effective at reducing pain, the impact of the disease and anxiety as well as increasing QoL. PROSPERO https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021232013.
我们进行荟萃分析的目的是汇总现有证据，以评估基于体育锻炼的疗法（PEBT）对纤维肌痛综合征（FMS）患者的疼痛、疾病影响、生活质量（QoL）和焦虑的影响，确定不同模式的基于体育锻炼的疗法的效果，以及基于体育锻炼的疗法改善各项结局的最有效剂量。我们开展了一项系统评价和荟萃分析。截至2022年11月，我们检索了PubMed（MEDLINE）、SCOPUS、Web of Science、CINAHL Complete和物理治疗证据数据库（PEDro）。纳入了比较基于体育锻炼的疗法与其他治疗对FMS患者疼痛、疾病影响、QoL和/或焦虑影响的随机对照试验（RCT）。使用随机效应模型对所有结局指标估计标准化均数差（SMD）和95%置信区间（CI）。三位评价者独立提取数据，并使用PEDro量表评估偏倚风险。纳入了68项涉及5474名参与者的RCT。选择、检测和实施偏倚是最常发现的偏倚。与其他疗法相比，在即时评估时，基于体育锻炼的疗法在改善疼痛[SMD -0.62（95%CI，-0.78至-0.46）]、疾病影响[SMD -0.52（95%CI，-0.67至-0.36）]、QoL的身体维度[SMD 0.51（95%CI，0.33至0.69）]和心理维度[SMD 0.48（95%CI，0.29至0.67）]以及焦虑[SMD -0.36（95%CI，-0.49至-0.25）]方面有效。基于体育锻炼的疗法减轻疼痛的最有效剂量为21 - 40节[SMD -0.83（95%CI，1.1--0.56）]、每周3节[SMD -0.82（95%CI，-1.2--0.48）]和每节61 - 90分钟[SMD -1.08（95%CI，-1.55--0.62）]。PEBT对减轻疼痛的效果可持续至12周[SMD -0.74（95%CI，-1.03--0.45）]。在FMS患者中，PEBT（包括循环训练或运动技术）在减轻疼痛、疾病影响和焦虑以及提高QoL方面有效。PROSPERO https://www.crd.york.ac.uk/PROSPERO/，标识符CRD42021232013。
