脊柱手法治疗对慢性非特异性颈痛干预效果的Meta分析

doi:10.3969/j.issn.1006-9771.2022.02.004

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (2): 150-164.doi: 10.3969/j.issn.1006-9771.2022.02.004

脊柱手法治疗对慢性非特异性颈痛干预效果的Meta分析

郑尉¹,孙立冰¹,郝传萍²(),黄文琪¹,尤婧¹,郭彦桦¹

1.天津体育学院,天津市 301617
2.北京联合大学特殊教育学院,北京市 100075

收稿日期:2022-02-07 修回日期:2022-02-14 出版日期:2022-02-25 发布日期:2022-03-09
通讯作者: 郝传萍 E-mail:tjtchuanping@buu.edu.cn
作者简介:郑尉(1985-),女,汉族,河北沧州市人,博士,讲师,硕士生导师,主要研究方向：脊柱手法治疗,运动损伤防护。
基金资助:
1.天津市自然科学基金项目(18JCQNJC83000);2.天津市教委科研计划项目(2020KJ101)

Effect of spinal manipulation therapy on chronic nonspecific neck pain: a meta-analysis

ZHENG Wei¹,SUN Libing¹,HAO Chuanping²(),HUANG Wenqi¹,YOU Jing¹,GUO Yanhua¹

1. Tianjin University of Sport, Tianjin 301617, China
2. Special Education College, Beijing Union University, Beijing 100075, China

Received:2022-02-07 Revised:2022-02-14 Published:2022-02-25 Online:2022-03-09
Contact: HAO Chuanping E-mail:tjtchuanping@buu.edu.cn
Supported by:
Natural Science Fund of Tianjin(18JCQNJC83000);Scientific Research Project of Tianjin Education Commission(2020KJ101)

摘要/Abstract

摘要：

目的运用世界卫生组织国际健康分类家族(WHO-FICs)的架构和知识体系,评价脊柱手法治疗(SMT)对慢性非特异性颈痛(CNSNP)的干预效果。方法检索PubMed、Web of Science、Cochrane Library、EMBASE、EBSCO、CBM和CNKI等中、英文数据库中有关SMT干预CNSNP的随机对照试验,检索时限为建库至2021年12月31日。至少两名研究者独立提取数据,采用Cochrane风险评估量表与物理治疗证据数据库量表进行纳入文献质量评价,分别采用Revman 5.4软件和Stata 16.0软件进行Meta分析和发表偏倚分析。结果最终纳入15篇文献,共1 067例患者。在身体功能方面,与对照组相比,SMT可降低患者疼痛视觉模拟评分(MD = -0.85, 95%CI -1.06~-0.63, P < 0.001)和数字疼痛评分(MD = -0.92, 95%CI -1.29~-0.55, P < 0.001),提高压力疼痛阈值(SMD = 0.67, 95%CI 0.47~0.86, P < 0.001)、颈椎关节屈/伸(SMD = 0.51, 95%CI 0.33~0.68, P < 0.001)和旋转(SMD = 0.20, 95%CI 0.01~0.38, P = 0.04)活动度以及颈部肌肉肌电振幅均方根(MD = 2.17, 95%CI 0.06~4.29, P = 0.04),对颈椎侧屈活动度(SMD = 0.19, 95%CI -0.00~0.38, P = 0.06)、最大肌力(SMD = -0.18, 95%CI -0.84~0.49, P = 0.60)和肌耐力(SMD = 0.18, 95%CI -0.39~0.75, P = 0.53)的干预效果不显著;在活动和参与方面,SMT能够显著降低颈椎功能障碍程度(MD = -0.96, 95%CI -1.55~-0.38, P = 0.001),对健康状态的改善效果无显著性(SMD = 0.08, 95%CI -0.03~0.20, P = 0.15)。结论 SMT有助于改善CNSNP患者的疼痛程度、疼痛敏感性、颈椎关节活动度和功能障碍程度,而在提高肌肉功能、本体感觉和健康状态方面的疗效尚不明确。

关键词: 慢性非特异性颈痛, 脊柱手法治疗, 世界卫生组织国际健康分类家族, Meta分析

Abstract:

Objective To evaluate the effects of spinal manipulation therapy (SMT) on chronic nonspecific neck pain (CNSNP) by using World Health Organization Family International Classifications (WHO-FICs). Methods Randomized controlled trials (RCTs) about the effects of SMT on CNSNP were searched from PubMed, Web of Science, Cochrane Library, EMBASE, EBSCO, CBM and CNKI from database establishment to December 31st, 2021. At least two researchers extracted the data. Cochrane bias risk assessment tool and Physiotherapy Evidence Database Scale were used to evaluate the quality of the included articles. Revman 5.4 software and Stata 16.0 software were used for meta-analyses and publication bias analysis respectively. Results A total of 15 RCTs that represented 1 067 participants were evaluated. In terms of body functions, compared with the control group, SMT significantly reduced Visual Analog Score for pain (MD = -0.85, 95%CI -1.06 to -0.63, P < 0.00001) and Numerical Rating Scale (MD = -0.92, 95%CI -1.29 to -0.55, P < 0.001), increased pressure pain thresholds (SMD = 0.67, 95%CI 0.47 to 0.86, P < 0.001), cervical range of motion (ROM) of flexion/extension (SMD = 0.51, 95%CI 0.33 to 0.68, P < 0.001) and rotation (SMD = 0.20, 95%CI 0.01 to 0.38, P = 0.04), improved root mean square of cervical muscles electromygraphy (MD = 2.17, 95%CI 0.06 to 4.29, P = 0.04), but not significantly in cervical ROM of lateral flexion (SMD = 0.19, 95%CI -0.00 to 0.38, P = 0.06), cervical strength (SMD = -0.18, 95%CI -0.84 to 0.49, P = 0.60) and endurance (SMD = 0.18, 95%CI -0.39 to 0.75, P = 0.53). In term of activities and participation, SMT significantly improved cervical disability (MD = -0.96, 95%CI -1.55 to -0.38, P = 0.001), but not significantly in health status of patients with CNSNP (SMD = 0.08, 95%CI -0.03 to 0.20, P = 0.15). Conclusion SMT could improve pain intensity, pain sensitivity, cervical ROM and disability in patients with CNSNP, but its efficacy on muscle function, proprioception and health status is unclear.

Key words: nonspecific chronic neck pain, spinal manipulation therapy, World Health Organization Family International Classifications, meta-analysis

中图分类号:

R681.5

郑尉,孙立冰,郝传萍,黄文琪,尤婧,郭彦桦. 脊柱手法治疗对慢性非特异性颈痛干预效果的Meta分析[J]. 《中国康复理论与实践》, 2022, 28(2): 150-164.

ZHENG Wei,SUN Libing,HAO Chuanping,HUANG Wenqi,YOU Jing,GUO Yanhua. Effect of spinal manipulation therapy on chronic nonspecific neck pain: a meta-analysis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(2): 150-164.

图/表 20

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纳入文献干预措施的基本特征"

纳入文献	干预措施			疗程	评定时间	主要ICF类目	结局指标	不良反应
纳入文献	试验组	SMT对应ICHI编码	对照组	疗程	评定时间	主要ICF类目	结局指标	不良反应
罗慧等^[18](2021)	SMT(4R技术)	MBA.PA.ZZ	中、高频电治疗	每次20 min/次,每周2次,共2周	干预前、干预2周后	b2801、b710、b730、d899	①④⑦⑨⑩	无
Aki等^[19](2020)	SMT(diversified技术)	MBG.PA.ZZ	干针疗法	每周2次,共4周	干预前、干预4周后	b2801、b710、d899	①④⑦	无
Akhter等^[20](2014)	SMT(HVLA技术)+ET	MBA.PA.ZZ	ET	SMT：每周2次,共3周 ET：每天2次,每周7 d,共3周	干预前、干预3周后	b2801、d899	①④	无
Galindez-Ibarbengoetxea等^[21](2018)	SMT(HVLA技术)	MAJ.PA.ZZ、MBA.PA.ZZ或MBG.PA.ZZ	HE	SMT：单次 HE：每天10~20 min,共7 d	干预前、干预1周后	b2801、b710、b730、d899	①③④⑦⑨	无
Lee等^[22](2016)	SMT(HVLA技术)+DCF训练	MBG.PA.ZZ	DCF训练	每次35 min,每周3次,共10周	干预前、干预10周后	b2801、b710、b740	①④⑦⑧?	无
Martel等^[23](2011)	SMT(HVLA技术)	MBA.PA.ZZ或MBG.PA.ZZ	空白对照	共10~15次,共5~6周	干预前、干预5~6周后	b2801、b710、d899、d5702	①④⑥⑦	无
Murphy等^[24](2010)	前4周：SMT(HVLA技术) 后8周：SMT(HVLA技术)+ET	MBA.PA.ZZ或MBG.PA.ZZ	前4周：空白对照后8周：ET	SMT：每周1~2次 ET：每周3次,共8周	干预前、干预4周和12周后	b2801、d899	①④	无
Palmgren等^[25](2006)	SMT(HVLA技术)+HE	MBA.PA.ZZ或MBG.PA.ZZ	HE	共3~5次,共5周	干预前、干预5周后	b710	⑦	无
Valera-Calero等^[26](2019)	SMT(HVLA技术)	MBA.PA.ZZ	组1：关节松动组2：假治疗	单次	干预前、单次干预后	b2801、b710、b599、d899	①③④⑦	无
García-Pérez-Juana等^[27](2018)	组1：右侧SMT(HVLA技术) 组2：左侧SMT(HVLA技术)	MBA.PA.ZZ	假治疗	单次	干预前、单次干预和干预1周后	b2801、d899、d429	②③④?	无
Bronfort等^[15](2004)	组1：SMT(HVLA技术)+ET 组2：SMT(HVLA技术)	MBA.PA.ZZ或MBG.PA.ZZ	ET	每次1 h,共20次,共20周	干预前,干预11周后	b2801、b730、b740、d899、d5702	②④⑤⑧?	无
Evans等^[28](2012)	SMT(HVLA技术)+ET	MBA.PA.ZZ或MBG.PA.ZZ	ET	每次15~20 min,共20次,共12周	干预前,干预12周后	b2801、d899、d5702	②④⑤	无
Lau等^[29](2011)	SMT(A-P技术)+IRR	MBG.PA.ZZ	IRR	每周2次,共4周	干预前,干预4周后	b2801、b710、s710	②⑤⑦?	无
Maiers等^[30](2014)	SMT(diversified技术)+HE	MBA.PA.ZZ	HE	共20次,共12周	干预前,干预12周后	b2801、d899、d5702	②④⑤	无
Mansilla-Ferragut等^[31](2009)	SMT(HVLA技术)	MAJ.PA.ZZ	安慰剂治疗	单次	干预前,干预5min后	b2801	③	无

表4

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ICHI β-2编码	治疗部位	动作	方法	ICHI描述符	索引词
MAJ.PA.ZZ	MAJ(头颈部关节)	PA(手法治疗)	ZZ(其他和非特指的方法)	头颈部手法治疗	颞下颌关节手法治疗
MBA.PA.ZZ	MBA(颈椎)			颈椎手法治疗	-
MBG.PA.ZZ	MBG(胸椎)			胸椎手法治疗	-

ICF结构	ICF维度	ICF类目	评价领域	评定工具/指标
身体层面	身体结构	s710 头颈部结构	X线等影像学检查、姿势评估	颈椎序列、椎间隙、节段不稳定程度、CVA等
	身体功能	b2801 身体某部位疼痛	疼痛	VAS、NRS、PPTs
		b710 关节活动功能	关节活动度	颈椎ROM
		b730 肌肉力量功能	肌力	最大肌力测试、表面肌电图时域指标
		b740 肌肉耐力功能	肌耐力	肌耐力测试、表面肌电图频域指标
		d429 改变和保持身体姿势	本体感觉	关节位置觉
个体层面	活动和参与	d5702 保持个体健康	自理	SF-36、SF-12
个体层面	活动和参与	d899 主要生活领域,未特指的	功能障碍程度	NDI

纳入文献	国家	n		年龄/岁		病程/月
纳入文献	国家	试验组	对照组	试验组	对照组	试验组	对照组
罗慧等^[18](2021)	中国	15	15	36.7±4.5	38.5±3.4	10.9±2.1	9.7±2.5
Aki等^[19](2020)	土耳其	20	20	37.30±7.35	37.55±8.20	> 3	> 3
Akhter等^[20](2014)	巴基斯坦	31	31	38.1	39.5	4.12	4.78
Galindez-Ibarbengoetxea等^[21](2018)	西班牙	13	14	32.15±1.87	34.35±1.71	> 3	> 3
Lee等^[22](2016)	韩国	16	15	18~60	18~60	> 3	> 3
Martel等^[23](2011)	加拿大	36	29	36.8±10.5	43.3±10.9	> 3	> 3
Murphy等^[24](2010)	加拿大	8	7	43±8	44±10	108±108	84±60
Palmgren等^[25](2006)	瑞典	18	19	32.7±8.2	31.2±9.0	> 3	> 3
Valera-Calero等^[26](2019)	西班牙	28	组1：28 组2：27	35.64±8.11	组1：37.25±10.54 组2：36.96±8.89	> 3	> 3
García-Pérez-Juana等^[27](2018)	西班牙	组1：18 组2：18	18	组1：35±10 组2：38±7	39±7	组1：39.6±13.2 组2：39.6±10.8	42±13.2
Bronfort等^[15](2004)	加拿大	组1：55 组2：56	49	组1：5±10.5 组2：4.3±11.0	43.6±10.5	组1：78 组2：66	60
Evans等^[28](2012)	美国	86	84	44.1±11.6	48.7±9.6	105.6±97.2	124.8±115.2
Lau等^[29](2011)	中国	57	54	44.17±9.27	43.78±9.25	> 3	> 3
Maiers等^[30](2014)	美国	73	72	71.7±5.2	72.7±5.3	78	60
Mansilla-Ferragut等^[31](2009)	西班牙	18	19	36±7	34±8	≥ 6	≥ 6

脊柱手法治疗对慢性非特异性颈痛干预效果的Meta分析

Effect of spinal manipulation therapy on chronic nonspecific neck pain: a meta-analysis

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纳入研究	随机序列产生	随机化隐藏	盲法	撤出与退出	总分	质量
罗慧等^[18](2021)	2	1	0	1	4	高
Aki等^[19](2020)	2	1	0	1	4	高
Akhter等^[20](2014)	2	1	0	1	4	高
Galindez-Ibarbengoetxea等^[21](2018)	2	2	1	1	6	高
Lee等^[22](2016)	1	1	1	0	3	低
Martel等^[23](2011)	2	2	0	1	5	高
Murphy等^[24](2010)	1	1	0	1	3	低
Palmgren等^[25](2006)	2	2	0	1	5	高
Valera-Calero等^[26](2019)	2	2	2	1	7	高
García-Pérez-Juana等^[27](2018)	2	2	2	1	7	高
Bronfort等^[15](2004)	2	2	0	1	5	高
Evans等^[28](2012)	2	2	0	1	5	高
Lau等^[29](2011)	2	2	0	1	5	高
Maiers等^[30](2014)	2	2	0	1	5	高
Mansilla-Ferragut等^[31](2009)	2	1	2	1	6	高