移动医疗对膝骨关节炎疾病管理效果的系统评价及Meta分析

Management effect of mobile health on knee osteoarthritis:systematic review and a Meta-analysis

目的:探讨移动医疗对膝骨关节炎病人疾病管理效果。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,the Cochrane Library、Web of Science、EBSCO中关于移动医疗对膝骨关节炎影响的随机对照试验(RCT),检索时限为建库至2021年4月30日。由2名研究者独立筛选文献,按照Cochrane手册5.1版的偏倚风险评估工具对文献质量进行评价,采用RevMan 5.3进行统计分析,采用GRADEpro3.6评估证据质量等级。结果:纳入9篇英文RCT,Meta结果显示,试验组与对照组比较在减轻疼痛[短期:SMD=-0.56,95%CI(-1.02,-0.09),P=0.02;远期:SMD=-0.22,95%CI(-0.39,-0.05),P=0.01]、缓解肢体僵硬[SMD=-0.65,95%CI(-0.91,-0.39),P<0.00001]、提高身体功能[短期:SMD=-0.56,95%CI(-0.74,-0.37),P<0.00001;远期:SMD=-0.34,95%CI(-0.62,-0.05),P=0.02]方面效果更好,但试验组与对照组相比在提高生活质量方面差异无统计学意义[SMD=0.05,95%CI(-0.51,0.60),P=0.87]。结论:现有证据表明,与常规干预相比,基于移动医疗的疾病管理可以减轻膝骨关节炎病人的疼痛,改善身体功能和肢体僵硬,但总体效应量较低,证据等级不高,尚需高质量的临床研究进一步验证疗效。

Objective:To explore the management effect of mobile health in patients with knee osteoarthritis.Methods:Randomized controlled trails on the effect of mobile health on knee osteoarthritis were searched from CNKI,WanFang Data,VIP,SinoMed,PubMed,the Cochrane Library,Web of Science and EBSCO.The retrieval time was from inception to April 30,2021.Two researchers independently screened the literature,and evaluated the literature quality according to the bias risk assessment tool of Cochrane Handbook version 5.1.RevMan 5.3 was used for statistical analysis,and GRADEpro3.6 was used to evaluate the level of evidence quality.Results:9 English RCTs were included.Meta-analysis results showed that are compared with control group,the experimental group showed better effects in relieving pain[short-term:SMD=-0.56,95%CI(-1.02,-0.09),P=0.02;long-term:SMD=-0.22,95%CI(-0.39,-0.05),P=0.01],relieving limb stiffness[SMD=-0.65,95%CI(-0.91,-0.39),P<0.00001],and improving physical function[short-term:SMD=-0.56,95%CI(-0.74,-0.37),P<0.00001;long-term:SMD=-0.34,95%CI(-0.62,-0.05),P=0.02].However,there was no significant difference between the experimental group and the control group in improving the quality of life[SMD=0.05,95%CI(-0.51,0.60),P=0.87].Conclusions:Current evidence shows that compared with routine intervention,the disease management based on mobile health can reduce pain,improve physical function and limb stiffness of patients with knee osteoarthritis.However,the overall effect size is low,the level of evidence is not high,and high-quality clinical studies are needed to further verify the efficacy.