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运动控制训练用于持续性,非特异性下腰痛:一项系统回顾

  2017-01-19

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【文献标题】Motor Control Exercise for Persistent, Nonspecific Low Back Pain: A Systematic Review(运动控制训练用于持续性,非特异性下腰痛:一项系统回顾)

【文献来源】Macedo LG, Maher CG, Latimer J, McAuley JH. Motor control exercise for persistent, nonspecific low back pain: a systematic review. Physical Therapy 2009; 89(1): 9-25

【文献摘要】

背景:以前的系统综述已得出结论,运动控制训练对持续性腰痛的有效性尚未明确确定。

 

目的:本研究的目的是系统性地评价随机对照试验,评估运动控制训练对持续性腰痛的有效性。

 

方法:搜索时间截止至2008年6月电子数据库。提取疼痛,残疾和生活质量的结果,并将其转换为通用的0至100量表。在可能的情况下,使用Revman 4.2汇集研究。

 

结果:共纳入了14个研究。7项研究对比了运动控制训练与最小干预,或将它作为另一种治疗的补充来评估。4项研究对比了运动控制训练与手动治疗。5项研究对比了运动控制训练与另一种运动形式。1项试验对比了运动控制训练与腰椎融合术。

汇总显示,在短期随访(加权平均差= -14.3点,95%置信区间[CI] = - 20.4至-8.1),中期随访(加权平均差= -13.6点,95%CI = -22.4至-4.1)和长期随访(加权平均差= -14.4点,95%CI = -23.1至-5.7)时,运动控制训练在减轻疼痛的效果上优于最小干预,并且长期随访时减少残疾的发生(加权平均差= -10.8点,95%CI = -18.7至-2.8)。中期随访时,运动控制训练对于疼痛(加权平均差= -5.7点,95%CI = -10.7至-0.8)、残疾(加权平均差= -4.0点,95%CI = -7.6至-0.4)和生活质量结果(加权平均差= -6.0点,95%CI = -11.2至-0.8)的效用优于手法治疗,同时在短期随访中对于减少残疾的效果优于其他形式的运动(加权平均差= -5.1点,95%CI = -8.7至-1.4)。


结论:运动控制训练优于最小干预,并且长期随访中在任何时间点作为另一种疗法的补充均能够改善疼痛和残疾。运动控制训练不比手动治疗或其他形式的运动更有效。


Background: Previous systematic reviews have concluded that the effectiveness of motor control exercise for persistent low back pain has not been clearly established.


Objective: The objective of this study was to systematically review randomized controlled trials evaluating the effectiveness of motor control exercises for persistent low back pain.


Methods: Electronic databases were searched to June 2008. Pain, disability, and quality-of-life outcomes were extracted and converted to a common 0 to 100 scale. Where possible, trials were pooled using Revman 4.2.


Results: Fourteen trials were included. Seven trials compared motor control exercise with minimal intervention or evaluated it as a supplement to another treatment. Four trials compared motor control exercise with manual therapy. Five trials compared motor control exercise with another form of exercise. One trial compared motor control exercise with lumbar fusion surgery. The pooling revealed that motor control exercise was better than minimal intervention in reducing pain at short-term follow-up (weighted mean difference=−14.3 points, 95% confidence interval [CI]=−20.4 to −8.1), at intermediate follow-up (weighted mean difference=−13.6 points, 95% CI=−22.4 to −4.1), and at long-term follow-up (weighted mean difference=−14.4 points, 95% CI=−23.1 to −5.7) and in reducing disability at long-term follow-up (weighted mean difference=−10.8 points, 95% CI=−18.7 to −2.8). Motor control exercise was better than manual therapy for pain (weighted mean difference=−5.7 points, 95% CI=−10.7 to −0.8), disability (weighted mean difference=−4.0 points, 95% CI=−7.6 to −0.4), and quality-of-life outcomes (weighted mean difference=−6.0 points, 95% CI=−11.2 to −0.8) at intermediate follow-up and better than other forms of exercise in reducing disability at short-term follow-up (weighted mean difference=−5.1 points, 95% CI=−8.7 to −1.4).


Conclusions: Motor control exercise is superior to minimal intervention and confers benefit when added to another therapy for pain at all time points and for disability at long-term follow-up. Motor control exercise is not more effective than manual therapy or other forms of exercise.


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