Fadil Ammar, Muaidi Qassim Ibrahim, Alayat Mohamed Salaheldien, AlMatrafi Nahla Ahmad, Subahi Moayad Saleh, Alshehri Mansour Abdullah
Department of Medical Rehabilitation Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia.
Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia.
PLoS One. 2025 May 2;20(5):e0322475. doi: 10.1371/journal.pone.0322475. eCollection 2025.
INTRODUCTION: The aims of this review was to investigate the effectiveness of closed kinetic chain exercise (CKCE) on pain, function, and proprioception in individuals with knee osteoarthritis (OA). METHODS: Nine databases were searched up to December 2023. Randomized controlled trials (RCTs) examining the effects of CKCE in individuals with knee OA were included. The methodological quality was assessed using the PEDro scale, and the level of evidence was evaluated with the GRADE system. A random-effects meta-analysis was conducted to assess differences between treatment groups for the primary outcomes (pain and function). Effect sizes were calculated using standardized mean differences (SMDs) with 95% confidence intervals (CIs). RESULTS: A total of 24 studies were included in the descriptive analysis, and 18 studies were included in the quantitative analysis (meta-analysis). The meta-analysis results indicated that CKCE treatment led to greater improvements in pain (SMD = -0.76; 95% CI: -1.51, -0.01) and function (SMD = -1.25; 95% CI: -1.88, -0.62) compared to no treatment. A subgroup meta-analysis showed that the combined treatment of CKCE and conventional physical therapy (CPT) resulted in greater improvements in pain (SMD = -1.18; 95% CI: -1.70, -0.67) and function (SMD = -1.27; 95% CI: -1.79, -0.75) compared to CPT alone. The risk of bias assessment revealed that two studies were of low quality, nine were of fair quality, and the remaining 13 were of high quality. The GRADE system indicated a low quality of evidence for the effects of CKCE on both pain and function. CONCLUSION: While CKCE shows promise in reducing pain and improving function in individuals with knee OA, the quality of evidence is considered low according to the GRADE system. Further high-quality RCTs with larger sample sizes are needed to confirm the effectiveness of CKCE in managing knee OA.
引言:本综述的目的是研究闭链运动(CKCE)对膝骨关节炎(OA)患者疼痛、功能和本体感觉的有效性。 方法:检索了截至2023年12月的九个数据库。纳入了研究CKCE对膝OA患者影响的随机对照试验(RCT)。使用PEDro量表评估方法学质量,并采用GRADE系统评估证据水平。进行随机效应荟萃分析以评估治疗组在主要结局(疼痛和功能)方面的差异。使用标准化均数差(SMD)及95%置信区间(CI)计算效应量。 结果:描述性分析共纳入24项研究,定量分析(荟萃分析)纳入18项研究。荟萃分析结果表明,与不治疗相比,CKCE治疗在疼痛(SMD = -0.76;95% CI:-1.51,-0.01)和功能(SMD = -1.25;95% CI:-1.88,-0.62)方面有更大改善。亚组荟萃分析显示,与单纯常规物理治疗(CPT)相比,CKCE与CPT联合治疗在疼痛(SMD = -1.18;95% CI:-1.70,-0.67)和功能(SMD = -1.27;95% CI:-1.79,-0.75)方面有更大改善。偏倚风险评估显示,两项研究质量低,九项质量一般,其余13项质量高。GRADE系统表明,CKCE对疼痛和功能影响的证据质量低。 结论:虽然CKCE在减轻膝OA患者疼痛和改善功能方面显示出前景,但根据GRADE系统,证据质量被认为较低。需要进一步开展样本量更大的高质量RCT来证实CKCE在管理膝OA方面的有效性。
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