非药物干预方法治疗患者颈肩痛效果的网状Meta分析

Treatment effect of non-pharmacological interventions in patients with neck and shoulder pain:a network Meta-analysis

目的:采用网状Meta分析评价不同非药物干预方法治疗患者颈肩痛的效果。方法:计算机检索PubMed、The Cochrane Library、Web of Science、Embase、CNKI、WanFang Data和CBM数据库,检索时间均为建库至2020年7月。依据研究目的和纳入排除标准,由两名研究员独立对检索到的文献进行筛选和资料提取与质量评价。结果:纳入15篇研究,共1?185例患者,涉及8种非药物干预措施,包括常规护理、针刺、理疗、普拉提、瑜伽、推拿、VR治疗和运动疗法。网状Meta分析结果显示,在治疗颈肩痛患者疼痛效果中,8种非药物干预措施相互比较,差异均有统计学意义(P<0.05),根据累积排序概率曲线下面积(SUCRA)值大小对不同干预措施进行排序,排序结果从优到劣依次为理疗、VR治疗、针刺、常规护理、运动疗法、推拿、瑜伽、普拉提;在治疗颈肩痛患者颈椎功能障碍的效果中,运动疗法与瑜伽、普拉提、针刺比较,差异具有统计学意义(P<0.05),根据SUCRA值大小对不同干预措施进行排序,排序结果从优到劣依次为运动疗法、理疗、常规护理、推拿、瑜伽、普拉提、针刺。结论:在治疗颈肩痛患者的疼痛、颈椎功能障碍时,理疗和运动疗法成为最优疗法的可能性最大,研究显示其疗效好,未来临床实践中,护士可优先考虑应用理疗和运动疗法。

Objective:To evaluate the effectiveness of non-pharmacological interventions on neck and shoulder pain relief.Methods:A systematic search of the online databases included PubMed,The Cochrane Library,Web of Science,Embase,CBM,CNKI and WanFang Data was conducted from the inception of database to July 2020.Based on the inclusion and exclusion criteria,two reviewers independently screened the literature,extracted related data,and assessed the risk of bias of the included studies.Results:A total of 15 studies(n=1185)were identified,involving 8 non-pharmacological interventions which include routine care,acupuncture,physical therapy,Pilates,yoga,massage,VR therapy and exercise therapy.The network Meta-analysis results showed that the effects of the eight non-pharmacological interventions in releasing neck and shoulder pain were statistically significant(P<0.05).According to the Surface Under the Cumulative Ranking(SUCRA),the probability ranking in a descending order is identified as physical therapy,VR therapy,acupuncture,routine care,exercise therapy,massage,yoga,Pilates.In examining the effect of improving cervical spine dysfunction in patients with neck and shoulder pain,the difference between exercise therapy and yoga,Pilates,and acupuncture is statistically significant(P<0.05);and based on the SUCRA,the probability ranking in descending order is exercise therapy,physical therapy,routine care,massage,yoga,Pilates,acupuncture.Conclusion:In releasing pain and cervical spine dysfunction in patients with neck and shoulder pain,physical therapy and exercise therapy are identified as the most advantaged methods according to our analysis,with their curative effect showing good applicability.In the future,nurses may give priority to the application of physical therapy and exercise therapy in clinical practice.