目的:长期颈部疼痛(LNP)是物理治疗诊所经常遇到的临床疾病。LNP是一个复杂的,影响包括自主神经系统(ANS)在内的多个身体系统的多因素状况。传统上,关于物理治疗对LNP影响的研究集中在自我报告措施和疼痛量表上。心率变异性(HRV)是ANS的客观量度,允许量化治疗效果。这项系统评价旨在评估手动治疗是否会严重影响长期颈部疼痛的成年人的心率变异性。
方法:发布,Medline,CINAHL,谷歌学者,WebofScience,和Cochrane文库用于检索2010-2021年间的随机对照试验。搜索词包括:慢性颈部疼痛,颈部疼痛,颈椎疼痛,手动治疗,动员,操纵,骨病,整骨疗法或整脊疗法。心率变异性,HRV,心率变异,影响,结果,好处,影响或有效性。
结果:在查找和筛选的139篇文章中,选择了三篇全文进行全面定性综合,共有112名受试者,其中91人是女性,所有受试者的平均年龄为33.7±6.8岁。三项研究中的MT技术在改善LNP患者的HRV方面具有统计学意义;然而,技术在不同的研究中有所不同,而一项研究没有显示出任何益处。这些研究被发现是高质量的,PEDro评分≥6。
结论:尽管手动治疗改善HRV之间没有明确的因果关系,结果支持使用MT急性降低HRV.没有一种特殊的MT方法被证明是优越的,已发现MT在HRV中产生统计学上显著的变化。这些HRV变化与交感神经张力降低和主观疼痛一致。
Long-standing neck pain (LNP) is a clinical condition frequently encountered in the physical therapy clinic. LNP is a complex, multifactorial condition affecting multiple body systems including the autonomic nervous system (ANS). Traditionally, research on the impact of physical therapy on LNP has focused on self-report measures and pain scales. Heart rate variability (HRV) is an objective measure of the ANS, allowing for quantification of effects of treatment. This systematic review is intended to evaluate if manual therapy acutely affects heart rate variability in adults with long-standing neck pain.
Pubmed, Medline, CINAHL, Google Scholar, Web of Science, and Cochrane library were used to retrieve the randomized controlled trials for this review between the years 2010-2021. Search terms included: chronic neck pain, neck pain, cervical pain, manual therapy, mobilization, manipulation, osteopathy, osteopathic or chiropractic. Heart rate variability, HRV, heart rate variation, effects, outcomes, benefits, impacts or effectiveness.
Of 139 articles located and screened, three full-text articles were selected for full qualitative synthesis, with a combined population of 112 subjects, 91 of which were female, with an average age of 33.7 ± 6.8 years for all subjects. MT techniques in three studies were statistically significant in improving HRV in people with LNP; however, techniques were differed across studies, while one study showed no benefit. The studies were found to be of high quality with PEDro scores ≥6.
Although no clear cause and effect relationship can be established between improvement in HRV with manual therapy, results supported the use of MT for an acute reduction in HRV. No one particular method of MT has proven superior, MT has been found to produce a statistically significant change in HRV. These HRV changes are consistent with decreased sympathetic tone and subjective pain.