脊柱手法治疗对慢性非特异性颈痛干预效果的Meta分析

Effect of spinal manipulation therapy on chronic nonspecific neck pain:a meta-analysis

目的运用世界卫生组织国际健康分类家族(WHO-FICs)的架构和知识体系,评价脊柱手法治疗(SMT)对慢性非特异性颈痛(CNSNP)的干预效果。方法检索PubMed、Web of Science、Cochrane Library、EMBASE、EBSCO、CBM和CNKI等中、英文数据库中有关SMT干预CNSNP的随机对照试验,检索时限为建库至2021年12月31日。至少两名研究者独立提取数据,采用Cochrane风险评估量表与物理治疗证据数据库量表进行纳入文献质量评价,分别采用Revman 5.4软件和Stata 16.0软件进行Meta分析和发表偏倚分析。结果最终纳入15篇文献,共1067例患者。在身体功能方面,与对照组相比,SMT可降低患者疼痛视觉模拟评分(MD=-0.85,95%CI-1.06~-0.63,P<0.001)和数字疼痛评分(MD=-0.92,95%CI-1.29~-0.55,P<0.001),提高压力疼痛阈值(SMD=0.67,95%CI 0.47~0.86,P<0.001)、颈椎关节屈/伸(SMD=0.51,95%CI0.33~0.68,P<0.001)和旋转(SMD=0.20,95%CI 0.01~0.38,P=0.04)活动度以及颈部肌肉肌电振幅均方根(MD=2.17,95%CI 0.06~4.29,P=0.04),对颈椎侧屈活动度(SMD=0.19,95%CI-0.00~0.38,P=0.06)、最大肌力(SMD=-0.18,95%CI-0.84~0.49,P=0.60)和肌耐力(SMD=0.18,95%CI-0.39~0.75,P=0.53)的干预效果不显著;在活动和参与方面,SMT能够显著降低颈椎功能障碍程度(MD=-0.96,95%CI-1.55~-0.38,P=0.001),对健康状态的改善效果无显著性(SMD=0.08,95%CI-0.03~0.20,P=0.15)。结论SMT有助于改善CNSNP患者的疼痛程度、疼痛敏感性、颈椎关节活动度和功能障碍程度,而在提高肌肉功能、本体感觉和健康状态方面的疗效尚不明确。

Objective To evaluate the effects of spinal manipulation therapy(SMT)on chronic nonspecific neck pain(CNSNP)by using World Health Organization Family International Classifications(WHO-FICs).Methods Randomized controlled trials(RCTs)about the effects of SMT on CNSNP were searched from PubMed,Web of Science,Cochrane Library,EMBASE,EBSCO,CBM and CNKI from database establishment to December31 st,2021.At least two researchers extracted the data.Cochrane bias risk assessment tool and Physiotherapy Evidence Database Scale were used to evaluate the quality of the included articles.Revman 5.4 software and Stata16.0 software were used for meta-analyses and publication bias analysis respectively.Results A total of 15 RCTs that represented 1067 participants were evaluated.In terms of body functions,compared with the control group,SMT significantly reduced Visual Analog Score for pain(MD=-0.85,95%CI-1.06 to-0.63,P<0.00001)and Numerical Rating Scale(MD=-0.92,95%CI-1.29 to-0.55,P<0.001),increased pressure pain thresholds(SMD=0.67,95%CI 0.47 to 0.86,P<0.001),cervical range of motion(ROM)of flexion/extension(SMD=0.51,95%CI 0.33 to 0.68,P<0.001)and rotation(SMD=0.20,95%CI 0.01 to 0.38,P=0.04),improved root mean square of cervical muscles electromygraphy(MD=2.17,95%CI 0.06 to 4.29,P=0.04),but not significantly in cervical ROM of lateral flexion(SMD=0.19,95%CI-0.00 to 0.38,P=0.06),cervical strength(SMD=-0.18,95%CI-0.84 to 0.49,P=0.60)and endurance(SMD=0.18,95%CI-0.39 to0.75,P=0.53).In term of activities and participation,SMT significantly improved cervical disability(MD=-0.96,95%CI-1.55 to-0.38,P=0.001),but not significantly in health status of patients with CNSNP(SMD=0.08,95%CI-0.03 to 0.20,P=0.15).Conclusion SMT could improve pain intensity,pain sensitivity,cervical ROM and disability in patients with CNSNP,but its efficacy on muscle function,proprioception and health status is unclear.