不同物理疗法对膝关节骨性关节炎疼痛缓解效果的meta分析

Effects of different physical therapies on pain relief in patients with knee osteoarthritis:a network meta-analysis

目的使用网状meta分析方式评价不同物理疗法对膝关节骨性关节炎(KOA)患者疼痛缓解的效果。方法计算机检索万方、中国知网(CNKI)、维普(VIP)、PubMed、Google Scholar、Embase、The Cochrane Library和Scopus数据库,检索不同物理疗法对KOA患者疼痛缓解的随机对照研究(RCT),检索时间从建库至2020年12月。纳入文献风险评估使用Cochrane手册推荐的RCT偏倚风险评估工具,数据的收集和整理提取及分析分别由2位研究者独立完成,对所得的数据通过Stata15.0软件进行分析与绘图。结果共纳入36个RCT,共计2123例患者,涉及的物理疗法共9种。网状meta分析结果显示:与使用安慰剂比较,低能量激光、高能量激光、运动疗法更能缓解疼痛,差异有统计学意义(P<0.05);与低能量激光、经皮神经电刺激、干扰电流、超短波、运动疗法、超声波、使用楔形鞋和膝部支具比较,高能量激光更能缓解疼痛,差异有统计学意义(P<0.05)。采用累积排序概率曲线下面积(SUCRA)进行排序,不同物理疗法的疼痛缓解效果从优到劣依次为:高能量激光、低能量激光、运动疗法、膝部支具、干扰电流、超短波、楔形鞋、经皮神经电刺激、超声波。结论激光疗法和运动疗法对KOA患者疼痛缓解最有效。

Objective To evaluate the effects of different physical therapies on pain relief in patients with knee osteoarthritis(KOA)using the network meta-analysis method.Methods Randomized controlled trials(RCT)of different physical therapies for pain relief in KOA patients were searched using WanFang,China National Knowledge Infrastructure(CNKI),VIP,PubMed,Google Scholar,Embase,the Cochrane Library and Scopus databases.The search time ranged from database creation to December 2020.The Cochrane Handbook was used to evaluate the methodological quality.The data collection,sorting,extraction and analysis of the data were completed independently by two researchers,and the data obtained were analyzed and graphed by Stata 15.0 software.Results A total of 36 RCTs were included,involving 2123 patients and 9 types of physical therapy.The results of network meta-analysis showed that compared with placebo,low-energy laser,high-energy laser,and exercise therapy were more effective in relieving pain,and the differences were statistically significant(P<0.05);Compared with low-energy laser and transcutaneous electrical nerve stimulation,interference current,ultrashort wave,sports,ultrasound,wedge shoes and knee brace,high-energy laser treatment was more effective in relieving pain with statistically significant differences(P<0.05).The pain relief effects of various physical therapies were ranked by the cumulative ranking probability curve area(SUCRA),the effects of different physical therapies from good to bad were as follows:high-energy laser,low-energy laser,exercise therapy,knee brace,interference current,shortwave therapy,wedge shoes,transcutaneous electrical nerve stimulation,ultrasound.Conclusion The results of SUCRA show that laser therapy and exercise therapy are the most effective for pain relief in patients with KOA.