Calvo Sandra, González Cristina, Lapuente-Hernández Diego, Cuenca-Zaldívar Juan Nicolás, Herrero Pablo, Gil-Calvo Marina
iHealthy Research Group, Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain; iHealthy Research Group, IIS Aragon, Zaragoza, Spain.
iHealthy Research Group, Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.
Sleep Med. 2023 Nov;111:70-81. doi: 10.1016/j.sleep.2023.09.008. Epub 2023 Sep 12.
Chronic pain exerts an enormous personal and economic burden, with sleep disturbances being one of the most reported problems by adults with chronic pain. The aim of this study was to analyse whether different physical therapy interventions could lead to improvements in sleep quality and pain intensity in individuals with chronic pain, as well as if there is any association. A systematic review and a univariate and multivariate meta-analysis were carried out according to the PRISMA guidelines. A search in PubMed, Scopus and Web of Science databases was performed. Six randomised controlled trials were included in the review and four of them were included in the meta-analysis; all of them with a moderate to high methodological quality. Data from adult participants with chronic pain after different physical therapy interventions was extracted. For the meta-analysis, the Insomnia Severity Index and the Numerical Rating Scale were considered. Results from the qualitative and quantitative analysis showed that most of the physical therapy interventions included had higher improvements in the intervention group than in the control group, although the effect size was not statistically significant (univariate for sleep quality: -0.08 [-0.34, 0.18], p = 0.46; univariate for pain intensity: -0.47 [-1.24, 0.30], p = 0.18; multivariate for both outcomes: -0.27). More studies are still needed to determine which physical therapy interventions are effective to improve sleep in people with chronic pain and if there are patients with specific characteristics who may benefit more than others.
慢性疼痛带来了巨大的个人和经济负担，睡眠障碍是慢性疼痛成年人报告最多的问题之一。本研究的目的是分析不同的物理治疗干预措施是否能改善慢性疼痛患者的睡眠质量和疼痛强度，以及它们之间是否存在关联。根据PRISMA指南进行了系统评价以及单变量和多变量荟萃分析。在PubMed、Scopus和科学网数据库中进行了检索。该评价纳入了六项随机对照试验，其中四项纳入了荟萃分析；所有试验的方法学质量均为中到高。提取了不同物理治疗干预后成年慢性疼痛患者的数据。对于荟萃分析，采用了失眠严重程度指数和数字评分量表。定性和定量分析结果表明，尽管效应量无统计学意义（睡眠质量单变量分析：-0.08 [-0.34, 0.18]，p = 0.46；疼痛强度单变量分析：-0.47 [-1.24, 0.30]，p = 0.18；两个结局的多变量分析：-0.27），但大多数纳入的物理治疗干预措施在干预组中的改善程度高于对照组。仍需要更多研究来确定哪些物理治疗干预措施能有效改善慢性疼痛患者的睡眠，以及是否有特定特征的患者比其他患者受益更多。
