运动干预纤维肌痛综合征有效性的Meta分析

Effectiveness of exercise interventions for fibromyalgia syndrome:a Meta-analysis

目的:运动干预是纤维肌痛的主要治疗方法之一,但对于不同运动方式的选择尚无一致结论。文章运用网状Meta分析方法综合定量评价不同运动方式干预纤维肌痛综合征的效果。方法:计算机检索PubMed、EMbase、Scoups、The Cochrane Library、Web of Science、中国知网、万方和中国生物医学文献数据库的相关文献,检索时限为各数据库建库至2023年6月。结局指标包括纤维肌痛影响问卷(FIQ)评分、目测类比评分、生活质量、睡眠质量及抑郁共5个连续性变量,采用Cochrane偏倚风险评估工具对纳入的文献进行质量评价,应用RevMan 5.4软件对数据进行效应量合并、亚组分析和敏感性分析,使用Stata 17软件对数据进行网状Meta分析。结果:①最终纳入13篇文献,包括14项随机对照试验,整体文献方法学质量较高。②传统Meta分析结果显示:与对照组相比,运动疗法可显著改善纤维肌痛综合征患者的纤维肌痛影响问卷评分(SMD=-0.67,95%CI:-0.83至-0.50,P<0.01)、目测类比评分(SMD=-0.72,95%CI:-0.90至-0.54,P<0.01)、生活质量(SMD=1.03,95%CI:0.45-1.61,P=0.0005)、睡眠质量(SMD=-0.62,95%CI:-0.98至-0.25,P=0.001)、抑郁(SMD=-0.63,95%CI:-1.09至-0.18,P=0.007)。③网状Meta分析结果显示:对纤维肌痛影响问卷评分干预效果最优的运动方式概率排序为:身心运动(86.5)>抗阻运动(70.5)>有氧运动(41.7);对目测类比评分干预效果最优的运动方式概率排序为:抗阻运动(85.3)>身心运动(74.3)>有氧运动(34.5)。结论:现有的随机对照试验证据证实,运动疗法能显著改善纤维肌痛综合征患者的纤维肌痛运动能力、生活质量、睡眠质量和抑郁状态,身心运动和抗阻运动是减轻纤维肌痛综合征患者纤维肌痛最有效的运动方式。

OBJECTIVE:Exercise intervention is one of the main treatments for fibromyalgia,but there is no consistent conclusion on the choice of different exercise modalities.In this article,a network Meta-analysis was used to comprehensively and quantitatively evaluate the effects of different exercise modalities on fibromyalgia syndrome.METHODS:PubMed,EMbase,Scoups,The Cochrane Library,Web of Science,CNKI,WanFang Database,and China Biomedical Literature Database were searched for relevant literature,with a search timeframe from the establishment of each database to June 2023.The outcome indicators included five continuous variables,including fibromyalgia impact questionnaire-revised(FIQ)scores,visual analogue scale(VAS)scores,quality of life,quality of sleep,and depression.The Cochrane Risk of Bias Assessment Tool was used to evaluate the quality of the included literature.RevMan 5.4 software was used to perform effect sizes,subgroup analyses,and sensitivity analyses of the data.Stata 17 software was used to perform reticulation and network Meta-analysis of the data.RESULTS:A total of 13 articles with 14 randomized controlled trials were finally included.The overall methodological quality of the literature was high.The results of traditional Meta-analysis showed that,compared with the control group,exercise therapy significantly improved the FIQ score[standardized mean difference(SMD)=-0.67,95%confidence interval(CI):-0.83 to-0.50,P<0.01],VAS score(SMD=-0.72,95%CI:-0.90 to-0.54,P<0.01),quality of life(SMD=1.03,95%CI:0.45 to 1.61,P=0.0005),sleep quality(SMD=-0.62,95%CI:-0.98 to-0.25,P=0.001),and depression(SMD=-0.63,95%CI:-1.09 to-0.18,P=0.007).Network Meta-analysis showed that the probability of optimal intervention effect of exercise modalities on FIQ scores was ranked as:mind-body exercise(86.5)>resistance exercise(70.5)>aerobic exercise(41.7);the probability of optimal intervention effect of exercise modalities on VAS scores was ranked as:resistance exercise(85.3)>mind-body exercise(74.3)>aerobic exercise(34.5).CONCLUSION:Exercise therapy significantly improves FIQ scores,VAS scores,quality of life,sleep quality,and depression in patients with fibromyalgia syndrome.Mind-body exercise and resistance exercise are the most effective exercise modalities to reduce FIQ scores and VAS scores in patients with fibromyalgia syndrome.