Osborne Daniel, Jadhakhan Ferozkhan, Falla Deborah
Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
Faculty of Health, Education and Life Sciences, City South Campus, Birmingham City University, Birmingham, United Kingdom.
PLoS One. 2024 May 3;19(5):e0303166. doi: 10.1371/journal.pone.0303166. eCollection 2024.
Previous systematic reviews have identified the benefits of exercise for chronic neck pain on subjective reports of pain, but not with objective measures such as quantitative sensory testing (QST). A systematic review was conducted to identify the effects of neck specific exercise on QST measures in adults with chronic neck pain to synthesise existing literature and provide clinical recommendations.
The study protocol was registered prospectively with PROSPERO (PROSPERO CRD42021297383). For both randomised and non-randomised trials, the following databases and trial registries were searched: AMED, CINAHL, Embase, Google Scholar, Medline, PEDro, PubMed, Scopus, SPORTDiscus, Science Citation Index and Social Science Citation Index from Web of Science Core Collection, clinicaltrials.gov, GreyOpen, and ISRCTN registry. These searches were conducted from inception to February 2022 and were updated until September 2023. Reference lists of eligible studies were screened. Study selection was performed independently by two reviewers, with data extraction and quality appraisal completed by one reviewer and independently ratified by a second reviewer. Due to high heterogeneity, narrative synthesis was performed with results grouped by exercise type.
Three trials were included. Risk of bias was rated as moderate and the certainty of evidence as low or moderate for all studies. All exercise groups demonstrated statistically significant improvement at an intermediate-term follow-up, with progressive resistance training combined with graded physical training demonstrating the highest certainty of evidence. Fixed resistance training demonstrated statistically significant improvement in QST measures at a short-term assessment.
Fixed resistance training is effective for short-term changes in pain sensitivity based on low-quality evidence, whilst moderate-quality evidence supports progressive resistance training combined with graded physical training for intermediate-term changes in pain sensitivity.
以往的系统评价已确定运动对慢性颈部疼痛在主观疼痛报告方面有益，但在诸如定量感觉测试（QST）等客观测量方面并非如此。本系统评价旨在确定针对慢性颈部疼痛成人的颈部特定运动对QST测量的影响，以综合现有文献并提供临床建议。
该研究方案已在国际前瞻性系统评价注册库（PROSPERO，注册号CRD42021297383）进行前瞻性注册。对于随机和非随机试验，检索了以下数据库和试验注册库：医学与健康领域数据库（AMED）、护理学与健康领域数据库（CINAHL）、荷兰医学文摘数据库（Embase）、谷歌学术、医学期刊数据库（Medline）、循证医学数据库（PEDro）、医学文献数据库（PubMed）、Scopus数据库、体育与运动科学数据库（SPORTDiscus）、科学引文索引（Science Citation Index）和社会科学引文索引（Social Science Citation Index）（来自科学网核心合集）、美国国立医学图书馆临床试验注册库（clinicaltrials.gov）、GreyOpen数据库以及国际标准随机对照试验编号注册库（ISRCTN registry）。这些检索从建库至2022年2月进行，并更新至2023年9月。对符合条件的研究的参考文献列表进行了筛选。研究选择由两名评审员独立进行，数据提取和质量评估由一名评审员完成，并由另一名评审员独立核准。由于异质性较高，采用叙述性综合分析，结果按运动类型分组。
纳入了三项试验。所有研究的偏倚风险被评为中等，证据确定性为低或中等。所有运动组在中期随访时均显示出统计学上的显著改善，渐进性抗阻训练结合分级体育训练显示出最高的证据确定性。固定抗阻训练在短期评估中显示出QST测量有统计学上的显著改善。
基于低质量证据，固定抗阻训练对疼痛敏感性的短期变化有效，而中等质量证据支持渐进性抗阻训练结合分级体育训练对疼痛敏感性的中期变化有效。
