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补肾活血法治疗膝骨关节炎随机对照试验中结局指标的现状

[Status of outcome measures in randomized controlled trials of kidney-tonifying and blood-activating method in treatment of knee osteoarthritis].

作者信息

Chen Ji-Xin, Zhou Qin-Xin, Yu Wei-Jie, Guo Tian-Ci, Niu Pu-Yu, Ye Yun-Tian, Liu Ai-Feng

机构信息

First Teaching Hospital of Tianjin University of Traditional Chinese Medicine Tianjin 300381, China National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion Tianjin 300381, China.

Shaoxing Traditional Chinese Medicine Hospital Shaoxing 312000, China.

出版信息

Zhongguo Zhong Yao Za Zhi. 2024 Mar;49(6):1661-1672. doi: 10.19540/j.cnki.cjcmm.20231123.501.

Abstract

This study assesses the status of outcome measures in the randomized controlled trial(RCT) involving the kidney-tonif-ying and blood-activating method for treating knee osteoarthritis(KOA), aiming to establish a theoretical foundation for the development of a core set of outcome measures in traditional Chinese medicine(TCM) treatment of KOA. The relevant articles were retrieved from CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Cochrane Library, and Web of Science, in addition to ClinicalTrials.gov and the China Clinical Trial Registration Center, with the time interval from inception to August 2023. The RCT of treating KOA with the kidney-tonifying and blood-activating method was included. Two assessors independently conducted literature screening, data collection, and qualitative analysis to compile the outcome measure results. A total of 350 RCTs were included, involving 165 outcome measures with the total frequency of 1 462. These outcome measures were categorized into six domains: symptom and sign measures(23) with the frequency of 718(49.1%), TCM symptom and syndrome measures(3) with the frequency of 53(3.6%), physical examination measures(130) with the frequency of 506(34.6%), quality of life measures(4) with the frequency of 20(1.3%), long-term efficacy measures(2) with the frequency of 6(0.4%), and safety measures(3) with the frequency of 159(10.9%). Additionally, 53 studies used TCM syndrome and symptom scores as indicators of efficacy, employing eight distinct measurement tools. The RCTs involving the kidney-tonifying and blood-activating method for treating KOA had a variety of problems, such as unclear prio-ritization of outcome measures, diversity in measurement tools, absence of standardized assessment criteria for specific measures, and non-standardized usage. These problems affected the research quality and reliability. Hence, it is advisable to draw upon international expertise, improve research design, and merge TCM efficacy characteristics with clinical research to establish a core set of KOA outcome measures aligned with TCM principles.

摘要

本研究评估补肾活血法治疗膝骨关节炎(KOA)的随机对照试验(RCT)中结局指标的现状,旨在为制定中医治疗KOA的核心结局指标集奠定理论基础。除ClinicalTrials.gov和中国临床试验注册中心外,还从中国知网、万方、维普、中国生物医学文献数据库、PubMed、EMbase、Cochrane图书馆和Web of Science检索相关文章,时间跨度从建库至2023年8月。纳入补肾活血法治疗KOA的RCT。两名评估者独立进行文献筛选、数据收集和定性分析,以汇总结局指标结果。共纳入350项RCT,涉及165个结局指标,总频次为1462次。这些结局指标分为六个领域:症状和体征指标(23个),频次为718次(49.1%);中医症状和证候指标(3个),频次为53次(3.6%);体格检查指标(130个),频次为506次(34.6%);生活质量指标(4个),频次为20次(1.3%);远期疗效指标(2个),频次为6次(0.4%);安全性指标(3个),频次为159次(10.9%)。此外,53项研究将中医证候和症状评分作为疗效指标,采用了8种不同的测量工具。补肾活血法治疗KOA的RCT存在多种问题,如结局指标的优先级不明确、测量工具多样、特定指标缺乏标准化评估标准以及使用不规范等。这些问题影响了研究质量和可靠性。因此,建议借鉴国际经验,改进研究设计,将中医疗效特点与临床研究相结合,建立符合中医原则的KOA核心结局指标集。

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