肩袖损伤非手术治疗效果中情景效应比例的Meta分析

Proportion of contextual effect of non-surgical treatments for rotator cuff injuries:a meta-analysis

目的 评估肩袖损伤的非手术治疗的总体治疗效应以及情景效应比例(PCE)。方法 从PubMed、Embase、Cochrane Library、Web of Science、CINAHL、中国知网和万方数据库检索从建库至2020年10月关于肩袖损伤非手术治疗的随机对照试验(RCT)。由2名研究者独立进行文献筛选、资料提取和质量评价,采用STATA 15.0软件进行Meta分析。结果 纳入40项研究,2 976例患者。疼痛总PCE为0.61 (95%CI 0.54~0.69)。各项治疗的PCE由大到小依次为皮质类固醇注射治疗、体外冲击波治疗、口服非甾体抗炎药、手法治疗、透明质酸注射治疗、富血小板血浆注射治疗、激光治疗、非甾体抗炎药注射治疗、针刺治疗。功能和活动范围的总PCE分别为0.69(95%CI 0.61~0.77)和0.62 (95%CI 0.48~0.81)。盲法、在发达国家开展的研究、较长的治疗疗程均能增加疼痛的PCE。结论 肩袖损伤非手术治疗效果中,61%与情景效应有关,较高的PCE可能是导致临床实践与临床研究结论不一致的原因。

Objective To estimate the total effect size and the proportion of contextual effect(PCE) of non-surgical treatments for rotator cuff injury.Methods Randomized controlled trial(RCT) on non-surgical treatments for rotator cuff injuries was retrieved from PubMed,Embase,Cochrane Library,Web of Science,CINAHL,CNKI,and Wanfang Data from the establishment to October,2020.Two researchers conducted independent literature screening,data extraction and quality evaluation,and used STATA 15.0 software for meta-analyses.Results Forty studies involving 2 976 participants were included.The total PCE of pain was 0.61(95% CI 0.54 to 0.69).PCE of treatments from the largest to the smallest were corticosteroid injection,extracorporeal shockwave therapy,oral non-steroidal anti-inflammatory drugs(NSAIDs),manual therapy,hyaluronic acid injection therapy,platelet-rich plasma injection therapy,laser therapy,NSAIDs injection therapy,and acupuncture therapy.Total PCE for function and range of motion was 0.69(95% CI 0.61 to 0.77) and 0.62(95% CI 0.48 to 0.81),respectively.Blinding,studies in developed countries,and longer courses of treatment increased the PCE of pain.Conclusion Up to 61% of PCE for the non-surgical treatments for rotator cuff injuries means instable research.A higher proportion of PCE may be the cause of inconsistencies between clinical practice and clinical research conclusions.