传统运动疗法干预对膝骨关节炎患者疼痛改善及关节功能影响的系统评价
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摘要
目的:系统评价传统运动疗法干预对膝骨关节炎患者疼痛改善及关节功能影响的有效性与安全性。方法:计算机综合检索国内外8个数据库,手工检索大学图书馆馆藏杂志,检索时间建库至2017年10月;全面搜寻传统运动疗法(包括太极拳、五禽戏、八段锦、易筋经)治疗膝骨关节炎的随机对照试验文献。依据Cochrane系统评价原则筛选文献、提取资料及评价文献方法学质量;通过软件Rev Man 5.3开展文献Meta分析,采用软件GRADEpro?GDT评估本研究证据质量。结果:本研究共纳入11个文献,经系统评析得出:(1)疗效评价方面:膝骨关节炎患者接受传统运动太极拳干预后,西安大略和麦克马斯特大学骨性关节炎指数量表(WOMAC)疼痛、关节僵硬以及生理功能等症状改善方面,其短期疗效均优于对照组;其他传统运动疗法干预(八段锦1篇、五禽戏1篇、易筋经1篇等),因相关见刊文献偏少,尚有待考证;(2)安全性评价方面:尚未发现严重不良事件;(3)证据分级方面:依照证据等级GRADE测评结果,本研究评估级别显示"低质量或极低质量"。结论:本系统评价证据表明,传统运动太极拳治疗膝骨关节炎疗效明确,不良反应相对偏少,能够对膝骨关节炎患者疼痛改善及关节功能影响发挥积极效应;其他传统运动疗法因纳入研究较少及文献本身局限性,有待今后开展更多设计严谨、高质量的研究予以验证。
Objective: To systematically evaluate the effectiveness and safety of the intervention effects of the traditional exercise therapy on pain and joint function in patients with knee osteoarthritis. Methods: Eight databases at home and abroad were retrieved extensively by computer, and university library collection magazines were retrieved manually, and the retrieval time was limited to October 2107. Randomized controlled trial literatures on treating knee osteoarthritis with traditional exercise therapies(including Taijiquan, Wuqinxi, Baduanjin, Yijinjing) were widely searched. Selecting literatures, extracting data, and evaluating literature methodology qualities were all based on Cochrane systematic evaluation principle. The Meta-analysis on literatures was performed using Rev Man 5.3 software, and the quality of evidence for this study was evaluated by GRADEpro?GDT software. Results: Eleven literatures were accepted, and some results was concluded.(1)In terms of therapeutic evaluation, the short term efficacy of patients with knee osteoarthritis intervened with traditional exercise Taijiquan on improving pain, joint stiffness and physiological function in Western Ontario and Mc Master Universities Osteoarthritis Index(WOMAC) scales were all better than that of the control group. The disease intervened with other traditional exercise therapies should be further verified, because of lacking related literatures(one literature on Baduanjin, one literature on Wuqinxi, one literature on Yijinjing).(2)In terms of safety evaluation, no serious adverse events were reported.(3)In terms of evidence grade, the evidence grade evaluating results in this study showed ‘low quality' or ‘very low quality' according to the GRADE evaluation. Conclusion: This system evaluating evidence shows traditional exercise Taijiquan having a remarkable efficacy on knee osteoarthritis and relative less adverse reactions, and also playing positive effects on improving pain and joint function in patients with knee osteoarthritis. Other traditional exercise therapies need to be verified in the future by more rigorous and high-quality studies, because of involving less studies and certain limitations of the study
Objective: To systematically evaluate the effectiveness and safety of the intervention effects of the traditional exercise therapy on pain and joint function in patients with knee osteoarthritis. Methods: Eight databases at home and abroad were retrieved extensively by computer, and university library collection magazines were retrieved manually, and the retrieval time was limited to October 2107. Randomized controlled trial literatures on treating knee osteoarthritis with traditional exercise therapies(including Taijiquan, Wuqinxi, Baduanjin, Yijinjing) were widely searched. Selecting literatures, extracting data, and evaluating literature methodology qualities were all based on Cochrane systematic evaluation principle. The Meta-analysis on literatures was performed using Rev Man 5.3 software, and the quality of evidence for this study was evaluated by GRADEpro?GDT software. Results: Eleven literatures were accepted, and some results was concluded.(1)In terms of therapeutic evaluation, the short term efficacy of patients with knee osteoarthritis intervened with traditional exercise Taijiquan on improving pain, joint stiffness and physiological function in Western Ontario and Mc Master Universities Osteoarthritis Index(WOMAC) scales were all better than that of the control group. The disease intervened with other traditional exercise therapies should be further verified, because of lacking related literatures(one literature on Baduanjin, one literature on Wuqinxi, one literature on Yijinjing).(2)In terms of safety evaluation, no serious adverse events were reported.(3)In terms of evidence grade, the evidence grade evaluating results in this study showed ‘low quality' or ‘very low quality' according to the GRADE evaluation. Conclusion: This system evaluating evidence shows traditional exercise Taijiquan having a remarkable efficacy on knee osteoarthritis and relative less adverse reactions, and also playing positive effects on improving pain and joint function in patients with knee osteoarthritis. Other traditional exercise therapies need to be verified in the future by more rigorous and high-quality studies, because of involving less studies and certain limitations of the study
引文
[1]宋永嘉,郑吉元,李泽佳,等.传统运动疗法在现代慢性病防治中的应用价值.中医药临床杂志,2015,27(4):462-464
[2]袁望舒,刘忠良,张海娜,等.膝骨性关节炎的运动疗法新进展.中华物理医学与康复杂志,2011,33(3):230-233
[3]刘超,王阶.中医传统运动疗法调气、调神治疗高血压病.北京中医药,2017,36(1):58-60
[4]李淑珍,郑国华,汪玉成,等.太极拳运动对脑卒中患者平衡功能影响的系统评价.康复学报,2016,26(2):57-62
[5]Lawrence R C,Felson D T,Helmick C G,et al.Estimates of the prevalence of arthritis and other rheumatic conditions in the United States:PartⅡ.Arthritis&Rheumatism,2008,58(1):26-35
[6]Tao J,Liu J,Egorova N,et al.Increased hippocampus-medial prefrontal cortex resting-state functional connectivity and memory function after Tai Chi Chuan Practice in elder adults.Front Aging Neurosci,2016,8(2):25-26
[7]Fejer R,Ruhe A.What is the prevalence of musculoskeletal problems in the elderly population in developed countries?.A systematic critical literature review.Chiropractic&Manual Therapies,2012,20(1):31-32
[8]Chen Y W,Hunt M A,Campbell K L,et al.The effect of Tai Chi on four chronic conditions-cancer,osteoarthritis,heart failure and chronic obstructive pulmonary disease:A systematic review and meta-analyses.British Journal of Sports Medicine,2016,50(7):397-407
[9]Wang X,Pi Y,Chen B,et al.Effect of traditional Chinese exercise on the quality of life and depression for chronic diseases:A metaanalysis of randomised trials.Scientific Reports,2015,5:15913
[10]Wayne P M,Berkowitz D L,Litrownik D E,et al.What do we really know about the safety of Tai Chi?.A systematic review of adverse event reports in randomized trials.Archives of Physical Medicine&Rehabilitation,2014,95(12):2470-2483
[11]Moher D,Liberati A,Tetzlaff J,et al.Preferred reporting items for systematic reviews and meta-analyses:the PRISMA statement.Ann Intern Med,2009,151(4):264-268
[12]Higgins J P T,Green S.Cochrane handbook for systematic reviews of interventions version 5.1.0(updated March 2011):The Cochrane Collaboration.2011.[2017-10-30]http://www.cochrane-handbook.org,Access 2017,October,30
[13]Gagnier J J,Boon H,Rochon P,et al.CONSORT Group.Reporting randomized,controlled trials of herbal interventions:An elaborated CONSORT statement.Ann Intern Med,2006,144(5):364-367
[14]Peters J L,Sutton A J,Jones D R,et al.Comparison of two methods to detect publication bias in meta-analysis.JAMA,2006,295(6):676-680
[15]Tsai P F,Chang J Y,Beck C,et al.A pilot cluster-randomized trial of a 20-week Tai Chi program in elders with cognitive impairment and osteoarthritic knee:Effects on pain and other health outcomes.Journal of Pain&Symptom Management,2013,45(4):660-669
[16]Wang C,Schmid C H,Hibberd P L,et al.Tai Chi is effective in treating knee osteoarthritis:A randomized controlled trial.Arthritis Care&Research,2009,61(11):1545-1553
[17]Lee H J,Park H J,Chae Y,et al.Tai Chi Qigong for the quality of life of patients with knee osteoarthritis:A pilot,randomized,waiting list controlled trial.Clinical Rehabilitation,2009,23(6):504-511
[18]Brismée J M,Paige R L,Chyu M C,et al.Group and home-based tai chi in elderly subjects with knee osteoarthritis:A randomized controlled trial.Clinical Rehabilitation,2007,21(2):99-111
[19]Song R,Lee E O,Lam P,et al.Effects of tai chi exercise on pain,balance,muscle strength,and perceived difficulties in physical functioning in older women with osteoarthritis:A randomized clinical trial.Journal of Rheumatology,2003,30(9):2039-2044
[20]Zeng R,Lin J,Wu S,et al.A randomized controlled trial:Preoperative home-based combined Tai Chi and Strength Training(TCST)to improve balance and aerobic capacity in patients with total hip arthroplasty(THA).Arch Gerontol Geriatr,2015,60(2):265-271
[21]Wortley M,Zhang S,Paquette M,et al.Effects of resistance and Tai Ji training on mobility and symptoms in knee osteoarthritis patients.Journal of Sport and Health Science,2013,2(4):209-214
[22]徐璐,唐霞珠.24式简化太极拳对老年膝关节骨性关节炎患者关节功能的影响.护理学报,2016,23(11):51-53
[23]王翠敏,孟令刚.八段锦干预老年膝骨关节炎的临床研究.中西医结合心血管病电子杂志,2016,4(31):158
[24]殷献锦,李海峰.五禽戏对女性膝关节骨关节炎患者本体感觉及平衡功能影响的研究.江汉大学学报(自然科学版),2017,45(4):355-358
[25]郑衍庆,张风华,郑黎勤.推拿功法易筋经结合艾灸治疗老年膝关节骨性关节炎的应用效果分析.齐齐哈尔医学院学报,2017,38(5):522-524
[26]胡宇才,毛静远,侯雅竹,等.参仙升脉口服液治疗缓慢性心律失常疗效及安全性系统评价与Meta分析.中华中医药杂志,2016,31(3):1059-1063
[27]曾令烽,邹元平,黄小桃,等.中医药干预对改善脑卒中后睡眠障碍疗效与安全性的系统评价.中华中医药杂志,2015,30(5):1488-1498
[28]Wu G,Liu W,Hitt J,et al.Spatial,temporal and muscle action patterns of Tai Chi gait.Journal of Electromyography&Kinesiology Official Journal of the International Society of Electrophysiological Kinesiology,2004,14(3):343-354
[29]Cheing G L,Huichan C W,Chan K M.Does four weeks of TENS and/or isometric exercise produce cumulative reduction of osteoarthritic knee pain?.Clinical Rehabilitation,2002,16(7):749-760
[30]Sowers M F,Jannausch M L,Gross M,et al.Performance-based Physical Functioning in African-American and Caucasian Women at Midlife:Considering Body Composition,Quadriceps Strength,and Knee Osteoarthritis.American Journal of Epidemiology,2006,163(10):950-958
[31]Woodburn J,Nelson K M,Siegel K L,et al.Multisegment foot motion during gait:Proof of concept in rheumatoid arthritis.Journal of Rheumatology,2004,31(10):1918-1927
[32]Axford J,Heron C,Ross F,et al.Management of knee osteoarthritis in primary care:Pain and depression are the major obstacles.Journal of Psychosomatic Research,2008,64(5):461-467
[2]袁望舒,刘忠良,张海娜,等.膝骨性关节炎的运动疗法新进展.中华物理医学与康复杂志,2011,33(3):230-233
[3]刘超,王阶.中医传统运动疗法调气、调神治疗高血压病.北京中医药,2017,36(1):58-60
[4]李淑珍,郑国华,汪玉成,等.太极拳运动对脑卒中患者平衡功能影响的系统评价.康复学报,2016,26(2):57-62
[5]Lawrence R C,Felson D T,Helmick C G,et al.Estimates of the prevalence of arthritis and other rheumatic conditions in the United States:PartⅡ.Arthritis&Rheumatism,2008,58(1):26-35
[6]Tao J,Liu J,Egorova N,et al.Increased hippocampus-medial prefrontal cortex resting-state functional connectivity and memory function after Tai Chi Chuan Practice in elder adults.Front Aging Neurosci,2016,8(2):25-26
[7]Fejer R,Ruhe A.What is the prevalence of musculoskeletal problems in the elderly population in developed countries?.A systematic critical literature review.Chiropractic&Manual Therapies,2012,20(1):31-32
[8]Chen Y W,Hunt M A,Campbell K L,et al.The effect of Tai Chi on four chronic conditions-cancer,osteoarthritis,heart failure and chronic obstructive pulmonary disease:A systematic review and meta-analyses.British Journal of Sports Medicine,2016,50(7):397-407
[9]Wang X,Pi Y,Chen B,et al.Effect of traditional Chinese exercise on the quality of life and depression for chronic diseases:A metaanalysis of randomised trials.Scientific Reports,2015,5:15913
[10]Wayne P M,Berkowitz D L,Litrownik D E,et al.What do we really know about the safety of Tai Chi?.A systematic review of adverse event reports in randomized trials.Archives of Physical Medicine&Rehabilitation,2014,95(12):2470-2483
[11]Moher D,Liberati A,Tetzlaff J,et al.Preferred reporting items for systematic reviews and meta-analyses:the PRISMA statement.Ann Intern Med,2009,151(4):264-268
[12]Higgins J P T,Green S.Cochrane handbook for systematic reviews of interventions version 5.1.0(updated March 2011):The Cochrane Collaboration.2011.[2017-10-30]http://www.cochrane-handbook.org,Access 2017,October,30
[13]Gagnier J J,Boon H,Rochon P,et al.CONSORT Group.Reporting randomized,controlled trials of herbal interventions:An elaborated CONSORT statement.Ann Intern Med,2006,144(5):364-367
[14]Peters J L,Sutton A J,Jones D R,et al.Comparison of two methods to detect publication bias in meta-analysis.JAMA,2006,295(6):676-680
[15]Tsai P F,Chang J Y,Beck C,et al.A pilot cluster-randomized trial of a 20-week Tai Chi program in elders with cognitive impairment and osteoarthritic knee:Effects on pain and other health outcomes.Journal of Pain&Symptom Management,2013,45(4):660-669
[16]Wang C,Schmid C H,Hibberd P L,et al.Tai Chi is effective in treating knee osteoarthritis:A randomized controlled trial.Arthritis Care&Research,2009,61(11):1545-1553
[17]Lee H J,Park H J,Chae Y,et al.Tai Chi Qigong for the quality of life of patients with knee osteoarthritis:A pilot,randomized,waiting list controlled trial.Clinical Rehabilitation,2009,23(6):504-511
[18]Brismée J M,Paige R L,Chyu M C,et al.Group and home-based tai chi in elderly subjects with knee osteoarthritis:A randomized controlled trial.Clinical Rehabilitation,2007,21(2):99-111
[19]Song R,Lee E O,Lam P,et al.Effects of tai chi exercise on pain,balance,muscle strength,and perceived difficulties in physical functioning in older women with osteoarthritis:A randomized clinical trial.Journal of Rheumatology,2003,30(9):2039-2044
[20]Zeng R,Lin J,Wu S,et al.A randomized controlled trial:Preoperative home-based combined Tai Chi and Strength Training(TCST)to improve balance and aerobic capacity in patients with total hip arthroplasty(THA).Arch Gerontol Geriatr,2015,60(2):265-271
[21]Wortley M,Zhang S,Paquette M,et al.Effects of resistance and Tai Ji training on mobility and symptoms in knee osteoarthritis patients.Journal of Sport and Health Science,2013,2(4):209-214
[22]徐璐,唐霞珠.24式简化太极拳对老年膝关节骨性关节炎患者关节功能的影响.护理学报,2016,23(11):51-53
[23]王翠敏,孟令刚.八段锦干预老年膝骨关节炎的临床研究.中西医结合心血管病电子杂志,2016,4(31):158
[24]殷献锦,李海峰.五禽戏对女性膝关节骨关节炎患者本体感觉及平衡功能影响的研究.江汉大学学报(自然科学版),2017,45(4):355-358
[25]郑衍庆,张风华,郑黎勤.推拿功法易筋经结合艾灸治疗老年膝关节骨性关节炎的应用效果分析.齐齐哈尔医学院学报,2017,38(5):522-524
[26]胡宇才,毛静远,侯雅竹,等.参仙升脉口服液治疗缓慢性心律失常疗效及安全性系统评价与Meta分析.中华中医药杂志,2016,31(3):1059-1063
[27]曾令烽,邹元平,黄小桃,等.中医药干预对改善脑卒中后睡眠障碍疗效与安全性的系统评价.中华中医药杂志,2015,30(5):1488-1498
[28]Wu G,Liu W,Hitt J,et al.Spatial,temporal and muscle action patterns of Tai Chi gait.Journal of Electromyography&Kinesiology Official Journal of the International Society of Electrophysiological Kinesiology,2004,14(3):343-354
[29]Cheing G L,Huichan C W,Chan K M.Does four weeks of TENS and/or isometric exercise produce cumulative reduction of osteoarthritic knee pain?.Clinical Rehabilitation,2002,16(7):749-760
[30]Sowers M F,Jannausch M L,Gross M,et al.Performance-based Physical Functioning in African-American and Caucasian Women at Midlife:Considering Body Composition,Quadriceps Strength,and Knee Osteoarthritis.American Journal of Epidemiology,2006,163(10):950-958
[31]Woodburn J,Nelson K M,Siegel K L,et al.Multisegment foot motion during gait:Proof of concept in rheumatoid arthritis.Journal of Rheumatology,2004,31(10):1918-1927
[32]Axford J,Heron C,Ross F,et al.Management of knee osteoarthritis in primary care:Pain and depression are the major obstacles.Journal of Psychosomatic Research,2008,64(5):461-467