中国传统功法治疗膝骨关节炎的网状Meta分析

Network Meta-analysis of Traditional Chinese Exercises in Treating Knee Osteoarthritis

目的:采用网状Meta分析法评价中国传统功法(CTE)治疗膝骨关节炎(KOA)的效果。方法:检索PubMed、Web of Science、Embase、Cochrane Library、国家知识基础设施数据库(CNKI)、中文科技期刊数据库(CCD)中国学术期刊数据库(CSPD)和中国生物医学文献数据库(SinoMed)中发表的CTE治疗KOA的随机对照试验(Randomized Controlled Trials,RCT),检索时间截至2022年8月。结局指标包括骨关节炎指数(WOMAC)、VAS。用Cochrane偏倚风险评估工具ROB2对纳入文献进行偏倚风险评估。用Revman5.4对文献进行质量评价,制作文献风险偏倚图;用Stata16.0进行Meta分析,当结局指标纳入文献数量≥10,绘制“比较-校正”漏斗图并进行egger检验,确定发表偏倚和小样本效应。结果:共纳入13篇文献,包括5种CTE:太极、易筋经、八段锦、五禽戏、站桩功。结果显示纳入文献整体质量较高。网状Meta分析结果显示:在缓解僵硬和疼痛方面,五禽戏效果最好;在改善功能活动方面,易筋经效果最好。在缓解僵硬方面:与太极拳相比,五禽戏的效果更好(MD=-64.69,95%CI为-107.07~-22.31,P<0.05),五禽戏的效果最好。纳入文献均未报道CTE的安全性。结论:基于现有证据,CTE治疗KOA的效果优于传统康复训练,其中五禽戏和易筋经的效果优于其他CTE。

Objective:To evaluate the effectiveness of traditional Chinese exercises in the treatment of knee osteoarthritis(KOA)by network meta-analysis.Methods:PubMed,Web of Science,Embase,Cochrane Library,China National Knowledge Infrastructure(CNKI),VIP,Wanfang Data,and SinoMed were searched for the randomized controlled trials(RCTs)of traditional Chinese exercises in the treatment of KOA that were published before August 2022.The outcome indicators included the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)and the Visual Analogue Scale(VAS)score.The Cochrane′s risk of bias assessment tool ROB2 was used to assess the risk of bias of the included articles.Revman5.4 was used to evaluate the article quality and establish the risk of bias diagram.The network meta-analysis was performed in Stata16.0.When more than 10 articles were included,a comparation-adjusted funnel plot was established and Egger′s test was carried out to assess the publication bias.Results:A total of 13 articles were included,involving 5 traditional Chinese exercises:Taiji,Yijinjing,Baduanjin,Wuqinxi,and Zhanzhuang Qigong.The results showed that the overall quality of the included articles was high.The results of network meta-analysis showed that Wuqinxi was the best traditional Chinese exercise in relieving stiffness and pain.In terms of improving functional activities,Yijinjing was the most effective.In terms of relieving stiffness,Wuqinxi had better effect than Taiji(MD=-64.69,95%CI of-107.07 to-22.31,P<0.05).None of the included articles reported the safety of traditional Chinese exercises.Conclusion:Based on the existing evidence,traditional Chinese exercises outperformed conventional rehabilitation training in the treatment of KOA.Among them,Wuqinxi and Yijinjing demonstrated better effects.