膝关节置换术后门诊康复与家庭康复的有效性和安全性Meta分析

Efficacy and safety of outpatient rehabilitation and home rehabilitation after knee replacement:a Meta-analysis

目的比较门诊康复与家庭康复对膝关节置换术后膝关节功能恢复的效果。方法计算机检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Embase、Cochrane Library、Web of Science,纳入有关膝关节置换术术后门诊康复与家庭康复比较的随机对照试验(randomized controlled trial,RCT)。检索时限为建库至2021年7月。由2名研究者对所得文献依据纳入与排除标准进行筛查,提取资料,评价文献质量,采用RevMan 5.3软件进行Meta分析。结果共纳入15项RCT研究,共2492例患者。Meta分析结果显示,膝关节置换术后1~1.5、3、6、12个月时,门诊康复与家庭康复后患者的关节活动范围、骨关节炎指数评分、膝关节损伤和骨关节炎结局评分、牛津大学膝关节评分、膝关节功能评分等结果变化的差异均无统计学意义(P>0.05),且两组在不良反应、生活质量和满意度方面的差异均无统计学意义(P>0.05),但家庭康复组所支付的医疗费用较低。结论膝关节置换术术后1年内家庭康复与门诊康复能取得相似的康复效果,且安全性良好,另外,家庭康复可降低医疗费用。

Objective To compare and analyze the effects of outpatient rehabilitation and home rehabilitation after knee replacement.Methods A systematic search of CNKI,Wanfang,VIP,CBM,PubMed,Embase,Cochrane Library,and Web of Science databases was carried out to collect randomized controlled trials on outpatient rehabilitation and home rehabilitation after knee replacement from inception to July,2021.2 reviewers independently screened the literature according to inclusion and exclusion criteria,extracted data and assessed the risk of bias of included studies.Meta-analysis was then performed by RevMan 5.3 software.Results Totally 15 RCTs involving 2492 patients were included.The results of Meta-analysis showed that there were no statistically significant difference in the changes of Range of Motion(ROM),Western Ontario and McMaster Universities Arthritis Index(WOMAC),Knee Injury and Osteoarthritis Outcome Score(KOOS),Oxford Knee Score(OKS)and Keen Society Score(KSS)between outpatient rehabilitation and home rehabilitation at 1~1.5 months,3 months,6 months and 12 months after knee replacement(P>0.05).Meanwhile,there were no statistically significant difference in the occurrence of adverse reactions,quality of life and satisfaction of patients between 2 groups(P>0.05).However,home rehabilitation required lower medical cost than outpatient rehabilitation.Conclusion Home rehabilitation has the same effect on knee function recovery as outpatient rehabilitation,and it is safe while saving medical costs within 1 year after knee replacement.