目的:推荐非手术治疗骨关节炎(OA)。然而,干预措施如何改变疼痛和身体功能尚不清楚.因此,本范围审查的目的是1)确定对疼痛和身体功能的非手术干预的潜在介质已经被评估,2)根据干预总结发现,接头,和结果。
方法:我们搜索了Medline,Embase,CINAHL,Cochrane中央控制试验登记册,和Scopus数据库。如果他们对一项随机对照试验进行调解分析,评估非手术干预任何关节OA,则纳入研究。结果是疼痛和身体功能。
结果:九项膝关节OA研究,评估饮食加运动,锻炼,卸鞋,针灸期间的高期望沟通,并确定了基于电话的减肥加运动。除了减肥和自我效能感,推定介质(膝关节肌肉灌注/伸肌力量/内收力矩,全身性炎症生物标志物,身体活动,饮食摄入量,和疼痛信念)通过单项研究进行评估。10位介体部分介导干预(饮食加运动,锻炼,高期望沟通)对疼痛和身体功能的影响。八个介质是常见的疼痛和功能(减轻体重,增加膝盖伸肌力量,和自我效能感的提高)。持续膝关节屈肌灌注部分介导运动对疼痛的影响,膝关节疼痛缓解部分介导运动对功能的影响。
结论:在膝关节OA中,一些证据表明,1)饮食和运动的好处是通过体重的变化来调节的,全身性炎症,和自我效能感;2)运动是通过膝关节肌肉力量和自我效能感的变化来介导的;3)高期望的沟通方式是通过自我效能感的变化来介导的。
Nonsurgical interventions are recommended for osteoarthritis (OA). However, how interventions change pain and physical function is unclear. Therefore, the objectives of this scoping
review were to 1) identify what potential mediators of nonsurgical interventions on pain and physical function have been evaluated and 2) summarize the findings according to intervention, joint, and outcome.
We searched Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, and Scopus databases. Studies were included if they conducted a mediation analysis on a randomized controlled trial evaluating a nonsurgical intervention on OA of any joint. Outcomes were pain and physical function.
Nine knee OA studies, evaluating diet plus exercise, exercise, unloading shoes, high-expectation communication during acupuncture, and telephone-based weight loss plus exercise were identified. Except for weight loss and self-efficacy, putative mediators (knee muscle perfusion/extensor strength/adduction moment, systemic inflammatory biomarkers, physical activity, dietary intake, and pain beliefs) were evaluated by single studies. Ten mediators partially mediated intervention (diet plus exercise, exercise, high-expectation communication) effects on pain and physical function. Eight mediators were common to pain and function (reduced weight, increased knee extensor strength, and increased self-efficacy). Constant knee flexor muscle perfusion partially mediated exercise effects on pain, and knee pain relief partially mediated exercise effects on function.
In knee OA, some evidence suggests that the benefits of 1) diet and exercise are mediated through changes in body weight, systemic inflammation, and self-efficacy; 2) exercise is mediated through changes in knee muscle strength and self-efficacy; and 3) high-expectation communication style is mediated through changes in self-efficacy.