系统回顾和量化倒走治疗膝骨关节炎的Meta分析

Effectiveness of backward walking training on knee osteoarthritis: a systematic review and meta-analysis

背景:目前大多数研究者认为倒走可改善膝骨关节炎患者的症状,被用来进行膝骨关节炎的康复及辅助治疗,但尚缺乏循证医学证据。目的:系统地回顾和量化倒走对膝骨关节炎影响的科学证据,明确倒走对膝骨关节炎的作用。方法:在中英文电子数据库(Pub Med、CINAHL、Embase英文数据库和中国知网、万方、中国生物医学文献数据库、维普中文数据库)中进行倒走相关文献的检索,筛选随机对照实验,采用Meta分析来评估倒走对膝骨关节炎的影响。共有7篇文献,231例患者纳入研究。结果与结论:(1)Meta分析发现:倒走配合传统治疗较单纯传统治疗可更好地减轻疼痛[MD=-1.05,95%CI(-1.46,-0.63),P=0.0001]、改善膝关节功能[SMD=-0.98,95%CI(-1.33,-0.64),P<0.00001]、增强股四头肌肌力[SMD=1.07,95%CI(0.52,1.63),P=0.0002]和提高活动能力[MD=-0.41,95%CI(-0.67,0.16),P=0.001];(2)倒走与正走对膝骨关节炎WOMAC评分的影响没有明显差异[SMD=-0.43,95%CI(-0.94,-0.08),P=0.10];(3)Meta分析表明,倒走配合传统治疗比单纯传统治疗对膝骨关节炎患者有更好的临床疗效。而在传统治疗基础上配合倒走和正走对改善膝骨关节炎患者WOMAC评分的治疗效果相当,但这需要高质量大样本的随机对照试验验证。

BACKGROUND:Backward walking is mainly considered to improve the symptoms of patients with knee osteoarthritis,which is used for rehabilitation and adjuvant treatment of knee osteoarthritis,but there is no evidence for evidence-based medicine.OBJECTIVE:To systematically review and quantify the evidence for the effect of backward walking on knee osteoarthritis in order to clarify the effect of backward walking on knee osteoarthritis.METHODS:PubMed,CINAHL,EMBASE,CNKI,CBM,WanFang and VIP were searched for relevant literature.After randomized controlled trials were screened,a meta-analysis was used to evaluate the effectiveness of backward walking on knee osteoarthritis.A total of 7 articles involving 231 patients were included in the result analysis.RESULTS AND CONCLUSION:Meta-analysis found that:compared with conventional treatment alone,the combination of conventional treatment with backward walking was better in pain relief[mean difference(MD)=-1.05,95%confidence interval(CI)(-1.46,-0.63),P=0.0001],improving knee joint function[standardized mean difference(SMD)=-0.98,95%CI(-1.33,-0.64),P<0.00001],enhancing quadriceps strength[SMD=1.07,95%CI(0.52,1.63),P=0.0002]and improving timed up to go performance[MD=-0.41,95%CI(-0.67,0.16),P=0.001].However,there was no significant difference in the WOMAC score after backward and forward walking[SMD=-0.43,95%CI(-0.94,-0.08),P=0.10].Meta-analysis results indicate that the combination of backward walking with conventional treatment has better clinical efficacy than conventional treatment alone for knee osteoarthritis patients.However,on the basis of conventional treatment,backward walking has comparable effects on WOMAC scores as compared with forward walking,which needs further large-sample high-quality randomized controlled trials to be verified.