目的:为了解决患者的非特异性下腰痛(NSLBP),找到最有效的解决方案,并定量综合运动控制训练(MCT)与普拉提相比的总体效果,麦肯齐方法,和物理治疗(PT)在疼痛和身体功能。
方法:四种干预类型的随机对照试验(RCT)(MCT,普拉提,麦肯齐方法,和PT)的LBP是通过搜索PubMed收集的,WebofScience,EBSCOhost(Cochrane中央受控试验登记册),和Scopus数据库从数据库建立到2023年9月30日。使用修订的Cochrane偏差风险工具(RoB2.0)评估纳入研究的偏差风险。以实验组和对照组的疼痛和身体功能为结果指标,按照干预方法进行亚组分析,计算标准化均差(SMD)和95%置信区间(CI).
结果:总共25个RCT,包括1253名病人,包括在内。Meta分析显示MCT能有效缓解疼痛[SMD=-0.65,95%CI(-1.00,-0.29),p<0.01]和改善的身体功能[SMD=-0.76,95%CI(-1.22,-0.31),p<0.01]与其他3种干预方式比较。亚组分析提示MCT可减轻疼痛[SMD=-0.92,95%CI(-1.34,-0.50),p<0.01]并改善身体功能[SMD=-1.15,95%CI(-1.72,-0.57),p<0.01]与PT相比,但与普拉提相比无统计学意义[疼痛:SMD=0.13,95%CI(-0.56,0.83),p=0.71;身体机能:SMD=0.10,95%CI(-0.72,0.91),p=0.81]和麦肯齐方法[疼痛:SMD=-0.03,95%CI(-0.75,0.68),p=0.93;身体功能:SMD=-0.03,95%CI(-1.00,0.94),p=0.95]。
结论:MCT能有效缓解NSLBP患者的疼痛,改善躯体功能。与PT相比,LBP更有效,虽然MCT和普拉提之间没有检测到差异,以及麦肯齐方法。因此,MCT,普拉提,应鼓励McKenzie方法作为NSLBP康复的运动干预措施。
OBJECTIVE: To tackle non-specific low back pain (NSLBP) among patients and find the most effective solution and to quantitatively synthesize the overall effect of motor control training (MCT) compared with Pilates, McKenzie method, and physical therapy (PT) in pain and physical function.
METHODS: Randomized controlled trials (RCTs) of four types of intervention (MCT, Pilates, McKenzie method, and PT) for LBP were collected by searching PubMed, Web of Science, EBSCOhost (Cochrane Central Register of Controlled Trials), and Scopus databases from the establishment of the database to September 30, 2023. The risk of bias was evaluated for included studies using the Revised Cochrane Risk of Bias tool for randomized trials (RoB 2.0). Taking pain and physical function in the experimental and control groups as outcome indicators, subgroup analysis was performed according to the intervention method to calculate the standardized mean difference (SMD) and 95% confidence interval (CI).
RESULTS: A total of 25 RCTs, including 1253 patients, were included. Meta-analysis showed that MCT effectively relieved pain [SMD = -0.65, 95% CI (- 1.00, - 0.29), p < 0.01] and improved physical function [SMD = -0.76, 95% CI (- 1.22, - 0.31), p < 0.01] comparing with other 3 types of intervention. Subgroup analysis suggested that MCT could alleviate pain [SMD = -0.92, 95% CI (- 1.34, - 0.50), p < 0.01] and improve physical function [SMD = -1.15, 95% CI (- 1.72, - 0.57), p < 0.01] compared with PT, but it had no statistical significance compared with Pilates [pain: SMD = 0.13, 95% CI (- 0.56, 0.83), p = 0.71; physical function: SMD = 0.10, 95% CI (- 0.72, 0.91), p = 0.81] and the McKenzie method [pain: SMD = -0.03, 95% CI (- 0.75, 0.68), p = 0.93; physical function: SMD = -0.03, 95% CI (- 1.00, 0.94), p = 0.95].
CONCLUSIONS: MCT can effectively relieve pain and improve physical function in patients with NSLBP. It is more effective compared with PT for LBP, while no differences were detected between MCT and Pilates, as well as McKenzie method. Therefore, MCT, Pilates, and the McKenzie method should be encouraged as exercise interventions for NSLBP rehabilitation.