闭合式与开放式动力链运动治疗膝关节骨关节炎的疗效——一项系统评价与Meta分析

The Efficacy of Closed Versus Open Kinetic Chain Exercise in Knee Osteoarthritis-A Systematic Review and Meta-Analysis.

作者信息

Michael Harrison J, Pham Harrison D, Li Lok Sze Katrina, Semciw Adam I, Scholes Mark J, Hannington Madeline, King Matthew G

机构信息

Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.

La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.

出版信息

Physiother Res Int. 2025 Oct;30(4):e70105. doi: 10.1002/pri.70105.

DOI:10.1002/pri.70105

PMID:40890564

Abstract

BACKGROUND/PURPOSE: Despite the prevalence of knee osteoarthritis, no consensus exists in the most effective exercise type for improving patient clinical outcomes. Therefore, we conducted a systematic review to compare the effectiveness of closed and open kinetic chain exercises (CKC and OKC) in reducing pain, increasing physical function and improving quality of life (QoL) in people with knee OA.

METHODS

We searched PubMed, MEDLINE, EMBASE, CINAHL, PEDro, Scopus and Cochrane from inception to April 2024. Studies were included if they compared pain, physical function and QoL outcomes via a randomised controlled trial design in people with knee osteoarthritis. The Pedro Scale was used to assess the risk of bias, and the GRADE approach was used to determine the certainty of evidence. Outcomes were pooled in a random effects meta-analysis. 13 randomised controlled trials evaluating the efficacy of CKC versus OKC exercises in the short term (≤ 13 weeks) were included.

RESULTS

Low-certainty evidence found that CKC exercises were superior to OKC exercises in the short term for improving pain (standardised mean difference (SMD) -0.18, 95% CI -0.37 to < 0.00; p = 0.048) and self-reported physical function (SMD -0.24, 95% CI -0.44 to -0.03, p = 0.022), with very low-certainty evidence of no difference in QoL outcomes (SMD -0.25, 95% CI -0.81 to 0.30, p = 0.370).

DISCUSSION

To reduce pain and improve physical function in individuals with knee osteoarthritis in the short term, physiotherapists should prescribe CKC exercises. However, there is a paucity of information outlining the effects of these CKC versus OKC in the medium to long term.

STUDY REGISTRATION NUMBER

PROSPERO (CRD42023470739).

摘要

背景/目的：尽管膝关节骨关节炎很常见，但对于改善患者临床结局的最有效运动类型尚无共识。因此，我们进行了一项系统评价，以比较闭链运动和开链运动（CKC和OKC）在减轻膝关节骨关节炎患者疼痛、提高身体功能和改善生活质量（QoL）方面的有效性。

方法

我们检索了从数据库建立到2024年4月的PubMed、MEDLINE、EMBASE、CINAHL、PEDro、Scopus和Cochrane数据库。纳入的研究需通过随机对照试验设计比较膝关节骨关节炎患者的疼痛、身体功能和生活质量结局。使用PEDro量表评估偏倚风险，并采用GRADE方法确定证据的确定性。结局在随机效应荟萃分析中进行汇总。纳入了13项评估CKC与OKC运动短期（≤13周）疗效的随机对照试验。

结果

低确定性证据表明，短期内CKC运动在改善疼痛（标准化均数差（SMD）-0.18，95%CI -0.37至<0.00；p=0.048）和自我报告的身体功能（SMD -0.24，95%CI -0.44至-0.03，p=0.022）方面优于OKC运动，关于生活质量结局无差异的证据确定性非常低（SMD -0.25，95%CI -0.81至0.30，p=0.370）。