J Orthop Sports Phys Ther. 2024 Jun;54(6):361-376. doi: 10.2519/jospt.2024.12216.
To evaluate the effectiveness of remote rehabilitation interventions for people living with chronic musculoskeletal pain and depression. A systematic review with network meta-analysis (NMA) of randomized controlled trials. We searched the Cochrane Central Register of Controlled Trials, CINAHL, EMBASE, LILACS MEDLINE, PSYNDEX, and PsycINFO databases from inception to May 2023. Randomized controlled trials that evaluated the effectiveness of remote rehabilitation interventions in people with chronic musculoskeletal pain and depression. We used Bayesian random-effects models for the NMA. Effect estimates were comparisons between rehabilitation interventions and waitlist. We performed a sensitivity analysis based on bias in the randomization process, large trials (>100 patients per arm) and musculoskeletal condition. Fifty-eight randomized controlled trials involving 10 278 participants (median sample size: 137; interquartile range [IQR]: 77-236) were included. Interactive voice response cognitive behavioral therapy (CBT; standardized mean difference [SMD] -0.66, 95% credible interval [CrI] -1.17 to -0.16), CBT in person (SMD -0.50, 95% CrI -0.97 to -0.04), and mobile app CBT plus exercise (SMD -0.37, 95% CrI -0.69 to -0.02) were superior to waitlist at 12-week follow-up for reducing pain (> 98% probability of superiority). For depression outcomes, Internet-delivered CBT and telecare were superior to waitlist at 12-week follow-up (SMD -0.51, 95% CrI -0.87 to -0.13) (> 99% probability of superiority). For pain outcomes, the certainty of evidence ranged from low to moderate. For depression outcomes, the certainty of evidence ranged from very low to moderate. The proportion of dropouts attributed to adverse events was unclear. No intervention was associated with higher odds of dropout. Interactive voice response CBT and mobile app CBT plus exercise showed similar treatment effects with in-person CBT on pain reduction among people living with chronic musculoskeletal pain and depression had over 98% probability of superiority than waitlist control at 12-week follow-up. Internet-delivered CBT and telecare had over 99% probability of superiority than waitlist control for improving depression outcomes at 12-week follow-up. .
评价远程康复干预措施对慢性肌肉骨骼疼痛和抑郁患者的有效性。一项针对随机对照试验的系统评价和网络荟萃分析（NMA）。我们从 Cochrane 对照试验中心注册库、CINAHL、EMBASE、LILACS MEDLINE、PSYNDEX 和 PsycINFO 数据库中检索了从建库到 2023 年 5 月的文献。评价远程康复干预措施对慢性肌肉骨骼疼痛和抑郁患者有效性的随机对照试验。我们使用贝叶斯随机效应模型进行 NMA。效应估计值为康复干预措施与候补组之间的比较。我们根据随机分组过程中的偏倚、大型试验（每组 >100 名患者）和肌肉骨骼状况进行了敏感性分析。纳入 58 项随机对照试验，共涉及 10278 名参与者（中位数样本量：137；四分位距 [IQR]：77-236）。交互式语音响应认知行为疗法（CBT；标准化均数差 [SMD] -0.66，95%可信区间 [CrI] -1.17 至 -0.16）、面对面 CBT（SMD -0.50，95% CrI -0.97 至 -0.04）和移动应用程序 CBT 加运动（SMD -0.37，95% CrI -0.69 至 -0.02）在 12 周随访时优于候补组，可降低疼痛（>98%可能性优于候补组）。对于抑郁结局，互联网提供的 CBT 和远程护理在 12 周随访时优于候补组（SMD -0.51，95% CrI -0.87 至 -0.13）（>99%可能性优于候补组）。对于疼痛结局，证据的确定性从低到中等。对于抑郁结局，证据的确定性从极低到中等。归因于不良事件的辍学比例尚不清楚。没有干预措施与较高的辍学率相关。交互式语音响应 CBT 和移动应用程序 CBT 加运动在降低慢性肌肉骨骼疼痛和抑郁患者的疼痛方面与面对面 CBT 具有相似的治疗效果，在 12 周随访时，与候补组相比，有超过 98%的可能性具有优势。互联网提供的 CBT 和远程护理在 12 周随访时，改善抑郁结局的可能性超过 99%，优于候补组。。
