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运动治疗腰椎管狭窄症:一项随机对照试验的系统评价和干预成分分析。

Exercise treatments for lumbar spinal stenosis: A systematic review and intervention component analysis of randomised controlled trials.

机构信息

Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine, University of Leeds, UK.

Leeds Community Healthcare Musculoskeletal and Rehabilitation Services, Leeds Community Healthcare NHS Trust, UK.

出版信息

Clin Rehabil. 2024 Mar;38(3):361-374. doi: 10.1177/02692155231201048. Epub 2023 Sep 16.


DOI:10.1177/02692155231201048
PMID:37715644
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10829420/
Abstract

OBJECTIVE: To analyse the components used in exercise interventions for people with symptoms of neurogenic claudication due to lumbar spinal stenosis and identify components associated with successful interventions. DATA SOURCES: Eligible papers published up to April 2023 from MEDLINE, EMBASE, CINAHL, PEDro, CENTRAL, Web of Science, and trial registry websites. REVIEW METHODS: Literature searches were performed by an Information Specialist. We searched for randomised trials evaluating exercise interventions for people with neurogenic claudication symptoms (the primary symptom of lumbar spinal stenosis). Two authors independently performed study selection, data extraction, and quality assessments using the Cochrane Risk of Bias tool Version 2 and the TIDieR checklist for intervention reporting. Details of intervention components were extracted, tabulated, and synthesised using an intervention component analysis approach. RESULTS: We found thirteen trials reporting 23 exercise interventions delivered to 1440 participants. These featured 60 different components. Most exercise interventions included supervision and flexion-based exercises. Balance exercises were rarely included. Exercise components featured more frequently in successful interventions included stretches, strength or trunk muscle exercises, fitness exercises, especially cycling, and psychologically informed approaches. Interpretation is limited by low study numbers and heterogeneity. No conclusions could be drawn about exercise supervision or dose. DISCUSSION: Exercise interventions for people with neurogenic claudication typically feature multiple components. Common features such as supervision, lumbar flexion, and aerobic fitness exercises and also less common features such as stretches, strengthening exercises, and psychologically informed approaches warrant consideration for inclusion when designing and optimising exercise interventions for people with lumbar spinal stenosis.

摘要

目的:分析针对腰椎椎管狭窄症引起的神经源性跛行症状患者的运动干预措施中使用的组成部分,并确定与成功干预相关的组成部分。

资料来源:截至 2023 年 4 月,从 MEDLINE、EMBASE、CINAHL、PEDro、CENTRAL、Web of Science 和试验注册网站中筛选出符合条件的文献。

综述方法:由一名信息专家进行文献检索。我们检索了评估针对神经源性跛行症状(腰椎椎管狭窄的主要症状)患者的运动干预措施的随机试验。两名作者独立使用 Cochrane 偏倚风险工具 2 版和 TIDieR 干预报告清单进行研究选择、数据提取和质量评估。提取、列表和综合干预组成部分的详细信息,使用干预组成部分分析方法。

结果:我们发现了 13 项试验,共报告了 23 项针对 1440 名参与者的运动干预措施。这些措施包含 60 种不同的组成部分。大多数运动干预措施包括监督和基于弯曲的运动。很少包含平衡运动。在成功的干预措施中更常出现的运动组成部分包括伸展运动、力量或躯干肌肉运动、健身运动,特别是骑自行车运动,以及心理信息方法。由于研究数量少且存在异质性,因此解释受到限制。对于运动监督或剂量,无法得出结论。

讨论:针对神经源性跛行患者的运动干预措施通常具有多种组成部分。常见的特征,如监督、腰椎弯曲和有氧健身运动,以及不太常见的特征,如伸展运动、强化运动和心理信息方法,在为腰椎椎管狭窄症患者设计和优化运动干预措施时值得考虑。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a51/10829420/e2694127c34c/10.1177_02692155231201048-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a51/10829420/e2694127c34c/10.1177_02692155231201048-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a51/10829420/e2694127c34c/10.1177_02692155231201048-fig1.jpg

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引用本文的文献

[1]
Letter to editor: Lumbar spine stenosis: current concept of management.

Asian Spine J. 2025-8

[2]
Response to the letter to the editor: Lumbar spine stenosis: current concept of management.

Asian Spine J. 2025-8

[3]
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[4]
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本文引用的文献

[1]
Efficacy and characteristics of physiotherapy interventions in patients with lumbar spinal stenosis: a systematic review.

Eur Spine J. 2022-6

[2]
The Clinical Effectiveness of a Physiotherapy Delivered Physical and Psychological Group Intervention for Older Adults With Neurogenic Claudication: The BOOST Randomized Controlled Trial.

J Gerontol A Biol Sci Med Sci. 2022-8-12

[3]
Non-operative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic review.

BMJ Open. 2022-1-19

[4]
Management of lumbar spinal stenosis: a systematic review and meta-analysis of rehabilitation, surgical, injection, and medication interventions.

Physiother Theory Pract. 2023-2

[5]
A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance.

BMJ. 2021-9-30

[6]
Effectiveness of Conservative Nonpharmacologic Therapies for Pain, Disability, Physical Capacity, and Physical Activity Behavior in Patients With Degenerative Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis.

Arch Phys Med Rehabil. 2021-11

[7]
The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.

BMJ. 2021-3-29

[8]
Supervised physical therapy versus unsupervised exercise for patients with lumbar spinal stenosis: 1-year follow-up of a randomized controlled trial.

Clin Rehabil. 2021-7

[9]
Effect of a Multimodal Movement Intervention in Patients With Neurogenic Claudication Based on Lumbar Spinal Stenosis and/or Degenerative Spondylolisthesis-A Pilot Study.

Front Med (Lausanne). 2020-12-8

[10]
Exercise interventions for older adults: A systematic review of meta-analyses.

J Sport Health Sci. 2021-1

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