Abstract：
OBJECTIVE: To quantify the dose-response relationship between overall and specific exercise modalities and pain, in patients with nonspecific chronic low back pain (LBP). DESIGN: Systematic review with Bayesian network meta-analysis. LITERATURE SEARCH: We searched the Medline, Embase, Web of Science, Cochrane Library, Scopus, and SPORTDiscus databases from inception to June 2023. STUDY SELECTION CRITERIA: We included randomized controlled trials of exercise interventions in adults with nonspecific chronic LBP and at least 1 pain outcome reported at the main trial end point. DATA SYNTHESIS: A random-effects network meta-analysis was conducted. We assessed risk of bias using the Cochrane Risk of Bias Tool 2.0, and used the GRADE approach to judge the certainty of evidence for each outcome. RESULTS: Eighty-two trials were included (n = 5033 participants). We found a nonlinear dose-response relationship between total exercise and pain in patients with nonspecific chronic LBP. The maximum significant response was observed at 920 MET minutes (standardized mean difference = -1.74; 95% credible intervals: -2.43, -1.04). The minimal clinically important difference for achieving meaningful pain improvement was 520 MET minutes per week. The dose to achieve minimal clinically important difference varied by type of exercise; Pilates was the most effective. The certainty of the evidence was very low to moderate for all outcomes. CONCLUSION: The dose-response relationship of different exercise modalities to improve pain in patients with nonspecific chronic LBP had a U-shaped trajectory and low- to moderate-certainty evidence. The clinical effect was most pronounced with Pilates exercise. J Orthop Sports Phys Ther 2024;54(5):1-13. Epub 8 March 2024. doi:10.2519/jospt.2024.12153.
摘要：
目的：量化总体和特定运动方式与疼痛之间的剂量反应关系，非特异性慢性下腰痛（LBP）患者。设计：系统评价与贝叶斯网络Meta分析（NMA）。我们搜索了Medline,Embase,WebofScience,科克伦图书馆,Scopus,和SPORTDiscus数据库从成立到2023年6月。研究选择标准：我们纳入了非特异性慢性LBP成人运动干预的随机对照试验（RCT），并在主要试验终点报告了至少一种疼痛结局。数据综合：进行随机效应NMA。我们使用Cochrane偏差风险工具2.0评估偏差风险，并使用GRADE方法判断每个结果的证据确定性。结果：纳入了82项试验（n=5,033名参与者）。我们发现非特异性慢性LBP患者的总运动与疼痛之间存在非线性剂量反应关系。在920MET-min时观察到最大显著响应(标准化平均差=-1.74;95%可信间隔:[-2.43,-1.04])。实现有意义的疼痛改善的最小临床重要差异（MCID）为每周520METs-min。达到MCID的剂量因运动类型而异；普拉提最有效。对于所有结果，证据的确定性非常低至中等。结论：不同运动方式改善非特异性慢性LBP患者疼痛的量效关系具有U型运动轨迹和低至中度确定性证据。普拉提运动的临床效果最为明显。
