背景:慢性颈痛(CNP)是一种常见的公共卫生问题,会影响日常生活活动和生活质量。颈部和肩胛骨之间存在生物力学相互依存关系。研究表明,肩胛骨功能可能与慢性颈部疼痛有关。因此,我们评估了肩胛骨靶向治疗对CNP患者颈部疼痛和功能的影响。
方法:数据库,包括MEDLINE(通过PubMed),EMBASE(通过Ovid),奥维德,WebofScience,还有Scopus,在2023年7月16日之前,系统地搜索了在英语中发表的关于CNP治疗肩胛骨的随机对照试验。
结果:从8个随机对照试验中纳入了313名参与者。与对照组相比,肩胛骨治疗组的干预在疼痛强度方面表现出更大的改善(标准化平均差异(SMD)=2.55;95%CI=0.97至4.13;P=0.002),适度的证据。疼痛强度的亚组分析显示性别之间存在显着差异,只有女性人群(SMD=6.23,95%CI=4.80~7.65)表现出比两性人群(SMD=1.07,95%CI=0.57~1.56)更好的结果(p<0.00001)。然而,中度证据表明肩胛骨治疗后颈部残疾无改善(颈部残疾指数或北威克公园颈部疼痛问卷的SMD为0.24[-0.14,0.62])。肩胛骨治疗对压力疼痛阈值(PPT)没有影响。由于文章中的支持有限,无法最终评估颈部肌肉的颈部活动范围(CROM)和肌电图活动,需要进一步研究。然而,肩胛骨治疗后,患者的头部向前姿势似乎得到纠正。
结论:肩胛骨疗法有利于减轻CNP患者的疼痛强度,尤其是女性。头部向前的姿势也可以通过肩胛骨治疗来纠正。然而,肩胛骨治疗可能对PPT或颈部残疾没有影响。然而,肩胛骨治疗是否能改善CNPs患者的CROM和颈肌激活,目前尚未确定,需要进一步研究.
BACKGROUND: Chronic neck pain (CNP) is a common public health problem that affects daily living activities and quality of life. There is biomechanical interdependence between the neck and scapula. Studies have shown that shoulder blade function might be related to chronic neck pain. We therefore evaluated the effects of scapular targeted therapy on neck pain and function in patients with CNP.
METHODS: Databases, including MEDLINE (via PubMed), EMBASE (via Ovid), Ovid, Web of Science, and Scopus, were systematically searched for randomized controlled trials published in English investigating treatment of the scapula for CNP before July 16, 2023.
RESULTS: A total of 313 participants were included from 8 RCTs. Compared with those in the control group, the intervention in the scapular treatment group exhibited greater improvement in pain intensity (standardized mean difference (SMD) = 2.55; 95% CI = 0.97 to 4.13; P = 0.002), with moderate evidence. Subgroup analysis for pain intensity revealed a significant difference between the sexes, with only the female population (SMD = 6.23, 95% CI = 4.80 to 7.65) showing better outcomes than those with both sexes (SMD = 1.07, 95% CI = 0.57 to 1.56) (p < 0.00001). However, moderate evidence demonstrated no improvement in neck disability after scapular treatment (SMD of 0.24[-0.14, 0.62] of Neck Disability Index or Northwick Park Neck Pain Questionnaire). No effect of scapular treatment was shown on the pressure pain threshold (PPT). The cervical range of motion (CROM) and electromyographic activity of neck muscles could not be conclusively evaluated due to limited support in the articles, and further study was needed. However, the patient\'s head forward posture appeared to be corrected after scapular treatment.
CONCLUSIONS: Scapular therapy was beneficial for relieving pain intensity in patients with CNP, especially in women. Head forward posture might also be corrected with scapular therapy. However, scapular therapy may have no effect on the PPT or neck disability. However, whether scapular therapy could improve CROM and cervical muscle activation in patients with CNPs had not been determined and needed further study.