目的:采用局部练习来激活,火车,或恢复特定肌肉的功能,它们通常被认为是治疗患有腰痛的个体的一部分。所以,本系统综述和荟萃分析旨在评估特定运动对非特异性下腰痛(LBP)一般人群的疗效.
方法:我们在MEDLINE/PubMed中进行了电子搜索,Scopus,WebofScience(WoS),和谷歌学者从1990年1月到2021年6月。最初,确定了47,740条记录。删除重复项之后,留下了32,138条记录。在审阅标题和摘要之后,选择了262篇论文进行全面评估。其中,208项研究被排除在外,导致54项试验符合本研究的纳入标准.此外,这些试验中有46项是随机对照试验,并进一步进行了荟萃分析。我们纳入了研究运动疗法有效性的试验,包括深躯干肌肉的等距激活,加强练习,稳定演习,伸展运动,LBP患者的本体感觉神经肌肉促进运动(PNF)。主要结果是疼痛强度,使用视觉模拟量表(VAS)和数字疼痛评定量表(NPRS)等工具进行测量。次要结果是残疾,通过RolandMorris残疾问卷(RMDQ)和Oswestry残疾指数(ODI)等工具进行评估。使用Verhagen工具评估合格研究的质量,并使用GRADE方法评估证据水平。
结果:基于Verhagen工具,46项试验(85.2%)被归类为方法学质量低,而8项研究(14.8%)被认为具有中等方法学质量。荟萃分析表明,较小的功效有利于深躯干肌肉的等距激活(-0.37,95%CI:-0.88至0.13),中等疗效有利于稳定运动(-0.53,95%CI:-1.13至0.08),通过VAS或NPRS工具评估,PNF锻炼对减轻疼痛强度的功效很大(-0.91,95%CI:-1.62至-0.2)。此外,荟萃分析显示,对躯干深肌肉的等距激活具有中等疗效(-0.61,CI:-1.02至-0.19),以及PNF锻炼在改善残疾方面的巨大功效(-1.26,95%CI:-1.81至-0.72),使用RMDQ或ODI问卷进行评估。证据的确定性程度,根据等级方法确定,非常低到低。
结论:这些发现强调了纳入局部治疗锻炼作为管理非特异性LBP的基本方面的重要性。临床医生应考虑利用针对个体患者需求的局部治疗锻炼。此外,进一步研究最佳运动疗法,锻炼的最佳剂量,持续时间,长期依从性是必要的,以提高非特异性LBP运动干预的精确性和疗效.
OBJECTIVE: Localized exercises are employed to activate, train, or restore the function of particular muscles and they are usually considered as part of treating individuals suffering low back pain. So, this systematic
review and meta-analysis aimed to assess the efficacy of specific exercises in general population with non-specific low back pain (LBP).
METHODS: We conducted electronic searches in MEDLINE/PubMed, Scopus, Web of Science (WoS), and Google scholar from January 1990 to June 2021. Initially, 47,740 records were identified. Following the removal of duplicates, 32,138 records were left. After reviewing titles and abstracts, 262 papers were chosen for thorough assessment. Among these, 208 studies were excluded, resulting in 54 trials meeting the inclusion criteria for this study. Additionally, 46 of these trials were randomized controlled trials and were further evaluated for the meta-analysis. We included trials investigating the effectiveness of exercise therapy, including isometric activation of deep trunk muscles, strengthening exercises, stabilization exercises, stretching exercises, and proprioceptive neuromuscular facilitation exercises (PNF) in LBP patients. The primary outcome was pain intensity, measured using tools such as the visual analogue scale (VAS) and numeric pain rating scale (NPRS). The secondary outcome was disability, assessed through instruments such as the Roland Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI). The quality of the eligible studies was assessed using the Verhagen tool, and the level of evidence was evaluated using the GRADE approach.
RESULTS: Based on the Verhagen tool, 46 trials (85.2%) were categorized as having low methodological quality, while 8 studies (14.8%) were considered to have medium methodological quality. The meta-analysis indicated a small efficacy in favor of isometric activation of deep trunk muscles (-0.37, 95% CI: -0.88 to 0.13), a moderate efficacy in favor of stabilization exercises (-0.53, 95% CI: -1.13 to 0.08), and a large efficacy in favor of PNF exercises (-0.91, 95% CI: -1.62 to -0.2) for reducing pain intensity as assessed by VAS or NPRS tools. Moreover, the meta-analysis revealed a moderate efficacy for isometric activation of deep trunk muscles (-0.61, CI: -1.02 to -0.19), and a large efficacy for PNF exercises (-1.26, 95% CI: -1.81 to -0.72) in improving disability, assessed using RMDQ or ODI questionnaires. The level of certainty in the evidence, as determined by the GRADE approach, was very low to low.
CONCLUSIONS: These findings emphasize the importance of incorporating localized therapeutic exercises as a fundamental aspect of managing non-specific LBP. Clinicians should consider utilizing localized therapeutic exercise tailored to individual patient needs. Furthermore, further research investigating optimal exercise therapy, optimal dose of the exercises, durations, and long-term adherence is warranted to enhance the precision and efficacy of exercise-based interventions for non-specific LBP.