Abstract：
BACKGROUND: Natural history of disease refers to the progression of a disease process in an individual over time, in the absence of treatment. Understanding natural history of tendinopathies is key for clinicians to make accurate prognostic predictions and design effective intervention studies.
OBJECTIVE: To quantify the natural history of the main tendinopathies regarding pain and function and to compare outcomes between untreated individuals and those receiving treatment.
METHODS: A systematic literature search was conducted until February 2023, across PubMed, Cochrane, Embase and Scopus databases. Selection criteria included randomized controlled trials (RCTs) with a \"wait-and-see\" group and cohort studies with ≥3 months of follow-up reporting on pain and function-related outcomes. Standardized mean differences (SMDs) of \"wait-and-see\" groups were pooled using a random-effects inverse-variance model. Risk of bias was assessed using Cochrane Risk-of-Bias (RoB2), and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach.
RESULTS: Six RCTs were included, encompassing 518 subjects with tendinopathy. Pooled results demonstrated significant pain (SMD = 0.30, 95%CI: 0.19-0.41) and physical function improvement (SMD = 0.38, 95%CI: 0.28-0.48). These estimates remained consistent regardless of age or follow-up duration. In rotator cuff tendinopathy, untreated individuals improved but did not fully recover at one year, with similar outcomes to other interventions (e.g., surgery). Subjects with lateral elbow, patellar and achilles tendinopathies when untreated, did not fully resolve symptoms within 12-16 weeks.
CONCLUSIONS: This review provides limited conclusions about natural history of tendinopathies. Future studies should incorporate true no-intervention groups to accurately reflect tendinopathy\'s natural progression.
OBJECTIVE: To quantify the natural history of the main tendinopathies regarding pain and function and to compare outcomes between untreated individuals and those receiving treatment.
METHODS: A systematic literature search was conducted until February 2023, across PubMed, Cochrane, Embase and Scopus databases. Selection criteria included randomized controlled trials (RCTs) with a \"wait-and-see\" group and cohort studies with ≥3 months of follow-up reporting on pain and function-related outcomes. Standardized mean differences (SMDs) of \"wait-and-see\" groups were pooled using a random-effects inverse-variance model. Risk of bias was assessed using Cochrane Risk-of-Bias (RoB2), and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach.
RESULTS: Six RCTs were included, encompassing 518 subjects with tendinopathy. Pooled results demonstrated significant pain (SMD = 0.30, 95%CI: 0.19-0.41) and physical function improvement (SMD = 0.38, 95%CI: 0.28-0.48). These estimates remained consistent regardless of age or follow-up duration. In rotator cuff tendinopathy, untreated individuals improved but did not fully recover at one year, with similar outcomes to other interventions (e.g., surgery). Subjects with lateral elbow, patellar and achilles tendinopathies when untreated, did not fully resolve symptoms within 12-16 weeks.
CONCLUSIONS: This review provides limited conclusions about natural history of tendinopathies. Future studies should incorporate true no-intervention groups to accurately reflect tendinopathy\'s natural progression.
摘要：
背景：疾病的自然史是指个体疾病过程随时间的进展，在没有治疗的情况下。了解肌腱病的自然史是临床医生做出准确预后预测和设计有效干预研究的关键。
目的：量化有关疼痛和功能的主要肌腱病变的自然史，并比较未治疗者和接受治疗者之间的结局。
方法：在PubMed进行了系统的文献检索，直到2023年2月，科克伦,Embase和Scopus数据库。选择标准包括随机对照试验（RCTs）和“等待观察”组和队列研究，随访报告≥3个月的疼痛和功能相关结局。使用随机效应逆方差模型将“等待观察”组的标准化平均差（SMD）汇总。使用Cochrane偏差风险（RoB2）评估偏差风险，并使用建议分级评估证据质量，评估,发展,和评价方法。
结果：包括六个RCT，包括518名患有肌腱病的受试者。汇总结果显示显著疼痛(SMD=0.30,95CI:0.19-0.41)和身体功能改善(SMD=0.38,95CI:0.28-0.48)。无论年龄或随访时间如何，这些估计都保持一致。在肩袖肌腱病中，未经治疗的个体有所改善，但在一年后没有完全康复，与其他干预措施的结果相似(例如，手术）。受试者有外侧肘，髌骨和跟腱病未经治疗时，在12-16周内未完全缓解症状。
结论：这篇综述提供了关于肌腱病自然史的有限结论。未来的研究应纳入真正的无干预组，以准确反映肌腱病的自然进展。
目的：量化有关疼痛和功能的主要肌腱病变的自然史，并比较未治疗者和接受治疗者之间的结局。
方法：在PubMed进行了系统的文献检索，直到2023年2月，科克伦,Embase和Scopus数据库。选择标准包括随机对照试验（RCTs）和“等待观察”组和队列研究，随访报告≥3个月的疼痛和功能相关结局。使用随机效应逆方差模型将“等待观察”组的标准化平均差（SMD）汇总。使用Cochrane偏差风险（RoB2）评估偏差风险，并使用建议分级评估证据质量，评估,发展,和评价方法。
结果：包括六个RCT，包括518名患有肌腱病的受试者。汇总结果显示显著疼痛(SMD=0.30,95CI:0.19-0.41)和身体功能改善(SMD=0.38,95CI:0.28-0.48)。无论年龄或随访时间如何，这些估计都保持一致。在肩袖肌腱病中，未经治疗的个体有所改善，但在一年后没有完全康复，与其他干预措施的结果相似(例如，手术）。受试者有外侧肘，髌骨和跟腱病未经治疗时，在12-16周内未完全缓解症状。
结论：这篇综述提供了关于肌腱病自然史的有限结论。未来的研究应纳入真正的无干预组，以准确反映肌腱病的自然进展。
