Beckerman H, Bouter L M, van der Heijden G J, de Bie R A, Koes B W
Department of Rehabilitation Medicine, Free University Hospital, Amsterdam, The Netherlands.
Br J Gen Pract. 1993 Feb;43(367):73-7.
In order to summarize the available clinical evidence for the efficacy of physiotherapy, 400 randomized clinical trials were identified from the literature. Studies were found by using bibliographic databases, citation tracking, and correspondence with researchers in the field. Focusing on disorders of the musculoskeletal system, a number of criterion based meta-analyses were performed on 180 trials in order to summarize the available evidence. For each randomized clinical trial in each meta-analysis a methodological score was calculated using a set of explicit criteria and weighting factors applied by two or three independent reviewers who were blinded as to the outcomes, the journal and the authors of the publication. In each meta-analysis the randomized clinical trials were ordered hierarchically depending on their score for methodological quality. Meta-analyses were performed for spinal manipulation, exercise therapy, traction, ultrasound, and laser therapy, and for disorders of the back, neck, shoulder and knee. In general, the methodological quality of the studies appeared to be low, and the efficacy of physiotherapy was shown to be convincing for only a few indications and treatments. On the other hand, because of the prevalence of serious methodological flaws, it cannot be concluded that physiotherapy has no effect.
为了总结物理治疗疗效的现有临床证据，从文献中筛选出400项随机临床试验。通过使用文献数据库、引文追踪以及与该领域研究人员通信来查找研究。聚焦于肌肉骨骼系统疾病，对180项试验进行了多项基于标准的荟萃分析，以总结现有证据。对于每项荟萃分析中的每项随机临床试验，由两到三名对结果、期刊和出版物作者不知情的独立评审员，使用一套明确的标准和加权因子计算方法学评分。在每项荟萃分析中，随机临床试验根据其方法学质量得分进行分层排序。对脊柱推拿、运动疗法、牵引、超声和激光疗法以及背部、颈部、肩部和膝部疾病进行了荟萃分析。总体而言，研究的方法学质量似乎较低，仅在少数适应症和治疗方法中，物理治疗的疗效具有说服力。另一方面，由于存在严重的方法学缺陷，不能得出物理治疗无效的结论。
