背景:手动疗法(MT)经常与膝关节骨关节炎的治疗结合使用,但对于这种治疗策略的确切疗效尚无共识.本系统评价和荟萃分析的目的是评估MT治疗膝骨关节炎(KOA)的疼痛缓解和安全性。
方法:在以下数据库中搜索主要英文和中文期刊上评估KOA患者MT的随机对照试验:万方,中国科技期刊数据库(VIP数据库),中国国家知识基础设施(CNKI),PubMed,Embase,WebofScience,和Cochrane图书馆数据库到2023年6月。纳入研究的方法学质量和证据质量使用Cochrane的偏倚风险2(ROB2)工具和建议评估分级。发展,和评估(等级)工具。使用Stata版本15.0软件进行数据分析。在使用Galbraith图排除可能导致异质性的研究之后,随机效应模型用于分析剩余数据并检验结果的一致性.我们使用meta回归来评估治疗期的效果,患者年龄,和性别比例对结果的影响。漏斗图和Egger检验用于评估发表偏倚。敏感性分析用于确定结果的可靠性。
结果:共25项研究,有2376名参与者,包括在这次审查中。纳入研究的总体方法学质量有限。我们的研究结果表明,MT对KOA患者的疼痛缓解结果具有积极影响。荟萃分析表明,MT在减轻疼痛方面优于常规护理(SMD=2.04,95%CI0.94,3.14,I2=96.3%;低证据质量)和运动(SMD=1.56,95%CI0.41,2.71,I2=96.3%;低证据质量)。在视觉模拟量表(VAS)评分的改善方面,MT治疗超过4周(SMD=1.56,95%CI0.41,2.71,I2=96.3%)可能优于小于或等于4周的治疗(SMD=1.24,95%CI0.56,1.95,I2=94.7%)。未报告与MT相关的严重不良事件。
结论:MT可有效减轻KOA患者的疼痛,治疗4周后可能更有效。与常规护理和运动疗法相比,MT在短期内(9周)在减少KOA疼痛方面可能更好,但其长期疗效需要仔细考虑循证结局.MT对KOA患者来说似乎是安全的,尽管临床医生应告知患者MT相关不良事件的潜在风险。
BACKGROUND: Manual therapy (MT) is frequently used in combination with management of osteoarthritis of the knee, but there is no consensus on the exact efficacy of this treatment strategy. The purpose of this systematic
review and meta-analysis was to evaluate the pain relief and safety of MT for treatment of knee osteoarthritis (KOA).
METHODS: Randomized controlled trials evaluating MT in patients with KOA in major English and Chinese journals were searched in the following databases: Wanfang, China Science and Technology Journal Database (VIP database), China National Knowledge Infrastructure (CNKI), PubMed, Embase, Web of Science, and the Cochrane Library databases through June 2023. The methodological quality and quality of evidence of the included studies were assessed using Cochrane\'s risk-of-bias 2 (ROB 2) tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Data analysis was performed using Stata version 15.0 software. After use of Galbraith plots to exclude studies that could lead to heterogeneity, random effects models were used to analyze the remaining data and test the consistency of the findings. We used meta-regression to assess the effect of treatment period, patient age, and sex ratio on outcomes. Funnel plots and Egger\'s test were used to evaluate publication bias. Sensitivity analyses were used to determine the reliability of the results.
RESULTS: A total of 25 studies, with 2376 participants, were included in this
review. The overall methodological quality of the included studies was limited. Our findings suggest that MT has a positive impact on pain relief outcomes in KOA patients. The meta-analysis showed that MT was superior to usual care (SMD = 2.04, 95% CI 0.94, 3.14, I 2 = 96.3%; low evidence quality) and exercise (SMD = 1.56, 95% CI 0.41, 2.71, I 2 = 96.3%; low evidence quality) for reducing pain. In terms of improvement in visual analogue scale (VAS) scores, MT treatment beyond 4 weeks (SMD = 1.56, 95% CI 0.41, 2.71, I 2 = 96.3%) may be superior to treatments less than or equal to 4 weeks (SMD = 1.24, 95% CI 0.56, 1.95, I 2 = 94.7%). No serious adverse events associated with MT were reported.
CONCLUSIONS: MT may be effective at reducing pain in patients with KOA and may be more effective after a 4-week treatment period. Compared with usual care and exercise therapy, MT may be superior at reducing KOA pain in the short term (9 weeks), but its long-term efficacy requires careful consideration of evidence-based outcomes. MT appears to be safe for KOA patients, though clinicians should inform patients of the potential risk of MT-related adverse events.