J Orthop Sports Phys Ther. 2024 Jun;54(6):391-399. doi: 10.2519/jospt.2024.12126.
We aimed to quantify the proportion not attributable to the specific effects (PCE) of physical therapy interventions for musculoskeletal pain. Intervention systematic review with meta-analysis. We searched Ovid, MEDLINE, EMBASE, CINAHL, Scopus, PEDro, Cochrane Controlled Trials Registry, and SPORTDiscus databases from inception to April 2023. Randomized placebo-controlled trials evaluating the effect of physical therapy interventions on musculoskeletal pain. Risk of bias was evaluated using the Cochrane risk-of-bias tool for randomized trials (RoB 2). The proportion of physical therapy interventions effect that was not explained by the specific effect of the intervention was calculated, using the proportion not attributable to the specific effects (PCE) metric, and a quantitative summary of the data from the studies was conducted using the random-effects inverse-variance model (Hartung-Knapp-Sidik-Jonkman method). Sixty-eight studies were included in the systematic review (participants: n = 5238), and 54 placebo-controlled trials informed our meta-analysis (participants: n = 3793). Physical therapy interventions included soft tissue techniques, mobilization, manipulation, taping, exercise therapy, and dry needling. Placebo interventions included manual, nonmanual interventions, or both. The proportion not attributable to the specific effects of mobilization accounted for 88% of the immediate overall treatment effect for pain intensity (PCE = 0.88, 95% confidence interval [CI]: 0.57, 1.20). In exercise therapy, this proportion accounted for 46% of the overall treatment effect for pain intensity (PCE = 0.46, 95% CI: 0.41, 0.52). The PCE in manipulation excelled in short-term pain relief (PCE = 0.81, 95% CI: 0.62, 1.01) and in mobilization in long-term effects (PCE = 0.86, 95% CI: 0.76, 0.96). In taping, the PCE accounted for 64% of disability improvement (PCE = 0.64, 95% CI: 0.48, 0.80). The outcomes of physical therapy interventions for musculoskeletal pain were significantly influenced by factors not attributable to the specific effects of the interventions. Boosting these factors consciously to enhance therapeutic outcomes represents an ethical opportunity that could benefit patients. .
我们旨在量化物理治疗干预对肌肉骨骼疼痛的特定效果之外的部分（PCE）比例。干预系统评价与荟萃分析。我们从开始到 2023 年 4 月在 Ovid、MEDLINE、EMBASE、CINAHL、Scopus、PEDro、Cochrane 对照试验注册中心和 SPORTDiscus 数据库中进行了搜索。评估物理治疗干预对肌肉骨骼疼痛影响的随机安慰剂对照试验。使用 Cochrane 随机试验风险偏倚工具（RoB 2）评估偏倚风险。使用比例未归因于特定效应（PCE）指标计算物理治疗干预效果中无法用干预的特定效应解释的部分，并使用随机效应逆方差模型（Hartung-Knapp-Sidik-Jonkman 方法）对研究数据进行定量总结。系统评价纳入 68 项研究（参与者：n = 5238），54 项安慰剂对照试验为我们的荟萃分析提供信息（参与者：n = 3793）。物理治疗干预包括软组织技术、松动、推拿、贴扎、运动疗法和干针。安慰剂干预包括手动、非手动干预或两者兼有。松动的特定效果之外的部分占疼痛强度即时总治疗效果的 88%（PCE = 0.88，95%置信区间[CI]：0.57，1.20）。在运动疗法中，这一比例占疼痛强度总治疗效果的 46%（PCE = 0.46，95% CI：0.41，0.52）。推拿的 PCE 在短期疼痛缓解方面表现出色（PCE = 0.81，95% CI：0.62，1.01），而在长期效果方面，松动的 PCE 表现出色（PCE = 0.86，95% CI：0.76，0.96）。在贴扎方面，PCE 占残疾改善的 64%（PCE = 0.64，95% CI：0.48，0.80）。肌肉骨骼疼痛的物理治疗干预的结果受到无法归因于干预特定效果的因素的显著影响。有意识地增强这些因素以提高治疗效果代表了一种可以使患者受益的伦理机会。
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