Department of Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan.
Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan.
PM R. 2024 Jan;16(1):60-84. doi: 10.1002/pmrj.13002. Epub 2023 Jul 31.
To summarize the effects of physical therapist-led interventions based on the biopsychosocial (BPS) model in spinal disorders compared to interventions with no BPS model through a systematic review and meta-analysis of randomized-controlled trials. TYPE: Systematic review and meta-analysis.
We searched the Web of Science, CENTRAL, MEDLINE, PsycINFO, CINAHL, and PEDro up to October 27, 2022.
Pain intensity and disability were primary outcomes and psychological factors were secondary outcomes in spinal disorders. The included intervention was physical therapist-led interventions based on the BPS model. The control group received no physiotherapy intervention for BPS. Pooled effects were analyzed as standardized mean differences (SMDs) and 95% confidence intervals (CIs), and the random-effects model was used for the meta-analysis. The subgroup analysis was divided into low back pain group and neck pain group. Another subgroup analysis was conducted only of the groups that had received training of the BPS model.
Fifty-seven studies with 5471 participants met the inclusion criteria. For pain intensity, there was a statistically significant effect for the BPS model led by physical therapists in the short, medium, and long terms. The SMDs with 95% CIs were -0.44 (-0.62, -0.27), -0.24 (-0.37, -0.12), and -0.17 (-0.28, -0.06), respectively. Outcomes were clinically significant, except in the long term. For disability, there was a statistically significant effect in the short, medium, and long terms. The SMDs with 95% CIs were -0.48 (-0.69, -0.27), -0.44 (-0.64, -0.25), and -0.37 (-0.58, -0.15), respectively. All periods were clinically significant. The quality of the evidence was low for all of the main outcomes for all of the terms.
Physical therapist-led interventions based on the BPS model effectively improve pain intensity and disability in patients with spinal disorders based on low-quality evidence.
通过系统评价和荟萃分析随机对照试验，总结基于生物心理社会（BPS）模型的物理治疗师主导干预措施在脊柱疾病中的效果，与无 BPS 模型的干预措施相比。类型：系统评价和荟萃分析。
我们检索了 Web of Science、CENTRAL、MEDLINE、PsycINFO、CINAHL 和 PEDro，截至 2022 年 10 月 27 日。
疼痛强度和残疾是脊柱疾病的主要结局，心理因素是次要结局。纳入的干预措施是基于 BPS 模型的物理治疗师主导的干预措施。对照组未接受 BPS 的物理治疗干预。汇总效应分析为标准化均数差（SMD）和 95%置信区间（CI），并采用随机效应模型进行荟萃分析。亚组分析分为腰痛组和颈痛组。另一个亚组分析仅针对接受 BPS 模型培训的组进行。
57 项研究共纳入 5471 名参与者。对于疼痛强度，物理治疗师主导的 BPS 模型在短期、中期和长期均有统计学意义。95%CI 的 SMD 分别为-0.44（-0.62，-0.27）、-0.24（-0.37，-0.12）和-0.17（-0.28，-0.06）。结果具有临床意义，但在长期内除外。对于残疾，短期、中期和长期均有统计学意义。95%CI 的 SMD 分别为-0.48（-0.69，-0.27）、-0.44（-0.64，-0.25）和-0.37（-0.58，-0.15）。所有时间段均具有临床意义。所有主要结局的证据质量均为低质量。
基于低质量证据，基于 BPS 模型的物理治疗师主导的干预措施可有效改善脊柱疾病患者的疼痛强度和残疾程度。
