基于不同肌肉收缩特征的下肢强化训练对膝骨关节炎的疗效：一项系统评价和网状荟萃分析
Efficacy of lower limb strengthening exercises based on different muscle contraction characteristics for knee osteoarthritis: a systematic review and network meta-analysis.
作者信息
Ding Xiaoqing, Yang Yi, Xing Ying, Jia Qingsong, Liu Qingguo, Zhang Jie
机构信息
Heilongjiang University of Chinese Medicine, Harbin, China.
School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China.
出版信息
Front Med (Lausanne). 2024 Sep 25;11:1442683. doi: 10.3389/fmed.2024.1442683. eCollection 2024.
PURPOSE
While strengthening exercises are recommended for knee osteoarthritis (KOA) treatment, the optimal type of muscle contraction remains unclear, with current research showing conflicting results. This network meta-analysis (NMA) aims to evaluate the efficacy of lower limb strengthening exercises based on different muscle contraction characteristics for KOA patients and provide clinical references.
METHODS
We conducted the NMA following the PRISMA-NMA. A comprehensive search of five databases (PubMed, Web of Science, CENTRAL, Embase, and SPORTDiscus) up to August 2024 identified randomized controlled trials (RCTs) investigating lower limb strengthening exercises in KOA patients. Control groups included receiving usual care, only providing health education, or no intervention at all. Outcomes analyzed included pain, physical function, quality of life, and muscle strength.
RESULTS
Forty-one studies (2,251 participants) were included. Twenty-eight studies used rigorous randomization; eighteen reported allocation concealment. All had high performance bias risk due to exercise interventions. Regarding efficacy, isokinetic exercise ranked highest in pain relief (SMD = 0.70, 95% CI: 0.50-0.91, SUCRA = 82.6%), function improvement (SMD = 0.75, 95% CI: 0.57-0.92, SUCRA = 96.1%), and enhancement in muscle strength (SMD = 0.56, 95% CI: 0.34-0.78, SUCRA = 90.1%). Isometric exercise ranked highest in improving quality of life (SMD = 0.80, 95% CI: 0.28-1.31, SUCRA = 90.5%). Mixed strengthening exercise ranked lowest across all outcomes. High-frequency interventions (≥5 times/week) showed superior pain relief compared with low-frequency (≤3 times/week) for isotonic, isometric, and isokinetic exercise.
CONCLUSION
This NMA suggests isokinetic exercise may be most effective for pain, function, and muscle strength in KOA patients, while isometric exercise benefits quality of life most. Mixed strengthening exercise ranked lowest across all outcomes. High-frequency interventions appear more effective than low-frequency ones. These findings support personalized KOA treatment, considering efficacy, accessibility, and patient-specific factors. Study biases, heterogeneity, and other limitations may affect result reliability. Future research should focus on high-quality studies with standardized protocols and analyze dose-response relationships to refine KOA treatment strategies.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024582525, identifier: CRD42024582525.
目的
虽然推荐进行强化锻炼来治疗膝关节骨关节炎（KOA），但最佳的肌肉收缩类型仍不明确，目前的研究结果相互矛盾。这项网状荟萃分析（NMA）旨在评估基于不同肌肉收缩特征的下肢强化锻炼对KOA患者的疗效，并提供临床参考。
方法
我们按照PRISMA-NMA进行了NMA。全面检索了截至2024年8月的五个数据库（PubMed、Web of Science、CENTRAL、Embase和SPORTDiscus），以确定调查KOA患者下肢强化锻炼的随机对照试验（RCT）。对照组包括接受常规护理、仅提供健康教育或根本不进行干预。分析的结局包括疼痛、身体功能、生活质量和肌肉力量。
结果
纳入了41项研究（2251名参与者）。28项研究采用了严格的随机化；18项报告了分配隐藏。由于运动干预，所有研究都有较高的表现偏倚风险。在疗效方面，等速运动在缓解疼痛（标准化均数差[SMD]=0.70，95%可信区间[CI]：0.50-0.91，表面排序曲线下面积[SUCRA]=82.6%）、改善功能（SMD=0.75，95%CI：0.57-0.92，SUCRA=96.1%）和增强肌肉力量（SMD=0.56，95%CI：0.34-0.78，SUCRA=90.1%）方面排名最高。等长运动在改善生活质量方面排名最高（SMD=0.80，95%CI：0.28-1.31，SUCRA=90.5%）。混合强化运动在所有结局中的排名最低。与低频（≤3次/周）的等张、等长和等速运动相比，高频干预（≥5次/周）在缓解疼痛方面表现更优。
结论
这项NMA表明，等速运动可能对KOA患者的疼痛、功能和肌肉力量最有效，而等长运动对生活质量的益处最大。混合强化运动在所有结局中的排名最低。高频干预似乎比低频干预更有效。这些发现支持考虑疗效、可及性和患者特定因素的个性化KOA治疗。研究偏倚、异质性和其他局限性可能会影响结果的可靠性。未来的研究应侧重于采用标准化方案的高质量研究，并分析剂量反应关系以完善KOA治疗策略。
系统评价注册
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024582525，标识符：CRD42024582525 。
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