目的:评估非药物治疗的有效性,保守治疗女性慢性盆腔疼痛(CPP)。
方法:对电子数据库的系统搜索(Amed,CINAHL,PsycINFO,运动讨论,Medline,PubMed,Embase,和Cochrane中央受控试验登记册)于2023年1月进行,并于2023年12月进行了更新。
方法:随机对照试验(RCT)比较非药物,对惰性的保守治疗(例如,安慰剂,常规护理)或非保守(例如,外科,药物)治疗包括在内。本综述感兴趣的保守治疗是:多模式物理治疗,主要是心理方法,针灸,和其他基于组织的单一疗法(例如,电物理试剂,手动拉伸)。
方法:所有研究数据都是汇总的,并对纳入的研究进行分析.对疼痛的影响;性措施;心理和身体功能;健康相关的生活质量;症状严重程度/困扰;盆底肌肉功能和形态计量学;感知改善;和不良事件进行分析。使用干预后评分对包括类似干预措施和结果的数据进行荟萃分析(随机效应模型)。计算标准化平均差(SMD)。提供了无法包含在荟萃分析中的结果的叙述性总结。用PEDro量表评估证据的质量,用建议分级评估证据的确定性,评估,发展,和评估(等级)标准。
结果:在检索到的5776项研究中,纳入38项RCTs,包括2168名女性(平均年龄35.1±8.6)。荟萃分析显示,在短期(SMD-1.69,95%CI-2.54,-0.85;高确定性)和中期(SMD-1.82,95%CI-3.13,-0.52;中等确定性),与惰性或非保守治疗相比,多模式物理治疗导致疼痛强度降低。而主要的心理方法导致疼痛强度无差异(SMD-0.18,95%CI-0.56,0.20;中度确定性),性功能略有差异(SMD-0.28,95%CI-0.52,-0.04;中度确定性).关于针灸对疼痛强度影响的荟萃分析的证据水平(SMD1.08,95%CI-1.38,3.54,支持对照治疗的无统计学意义的结果)排除了任何确定性陈述。有限数量的试验调查了个体基于组织的单一疗法,提供有限的证据。
结论:这项系统综述的荟萃分析显示,多模式物理治疗对CPP女性有效,证据具有很高的确定性。
OBJECTIVE: To evaluate the effectiveness of non-pharmacological, conservative therapies for women with chronic pelvic pain (CPP).
METHODS: A systematic search of electronic databases (Amed, CINAHL, PsycINFO, SportDiscuss, Medline, PubMed, Embase, and Cochrane Central Register of Controlled Trials) was performed in January 2023, and updated in December 2023.
METHODS: Randomized controlled trials (RCTs) comparing a non-pharmacological, conservative therapy to inert (e.g., placebo, usual care) or non-conservative (e.g., surgical, pharmacological) treatment were included. Conservative therapies of interest to this review were: multimodal physical therapy, predominantly psychological approaches, acupuncture, and other tissue-based monotherapies (e.g., electrophysical agents, manual stretching).
METHODS: All study data were aggregated, and analyses of the included studies were performed. Effects on pain; sexual measures; psychological and physical function; health-related quality of life; symptom severity/bother; pelvic floor muscle function and morphometry; perceived improvement; and adverse events were analyzed. Meta-analyses (random effects model) were conducted using post-intervention scores for data that included similar interventions and outcomes. Standardized mean differences (SMD) were calculated. A narrative summary of findings that could not be included in the meta-analysis is provided. The quality of the evidence was assessed with the PEDro scale and the certainty of evidence with Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria.
RESULTS: Of 5776 retrieved studies, 38 RCTs including 2168 women (mean age 35.1±8.6) were included. Meta-analyses revealed that multimodal physical therapy resulted in lower pain intensity compared to inert or non-conservative treatments in both the short (SMD -1.69, 95% CI -2.54,-0.85; high certainty) and intermediate-terms (SMD -1.82, 95% CI -3.13, -0.52; moderate certainty), while predominantly psychological approaches resulted in no difference in pain intensity (SMD -0.18, 95% CI -0.56, 0.20; moderate certainty) and a slight difference in sexual function (SMD -0.28, 95% CI -0.52,-0.04; moderate certainty). The level of evidence regarding the meta-analysis of the effects of acupuncture on pain intensity (SMD 1.08, 95% CI -1.38, 3.54, non-statistically significant results in favor of control treatment) precluded any statement of certainty. A limited number of trials investigated individual tissue-based monotherapies, providing a restricted body of evidence.
CONCLUSIONS: This systematic review with meta-analysis revealed that multimodal physical therapy is effective in women with CPP with a high certainty of evidence.