治疗性运动对头前倾并发颈痛患者颈部功能和生活质量影响的Meta分析

doi:10.3969/j.issn.1006-9771.2023.02.010

摘要/Abstract

摘要：

目的系统分析治疗性运动对头前倾并发颈痛患者颈部功能和生活质量的效果。方法计算机检索PubMed、Web of Science、Embase、Medline、Science Direct、EBSCO、Springlink、中国知网、维普、万方数据库。文献类型为不同类型治疗性运动对头前倾并发颈痛患者颈部功能和生活质量的随机对照试验，检索时间为建库至2022年4月。由2名研究人员独立对文献进行筛选，研究人员采用Cochrane风险评估量表与物理治疗证据数据库量表进行文献质量评价，运用Revman 5.4软件进行Meta分析。结果最终纳入11篇文献，共416例患者。1a级证据证明肩胛骨稳定性训练能有效改善头前倾并发颈痛患者头前倾角度(MD = 3.62, 95%CI 2.41~4.83, P < 0.001)，减轻颈部疼痛(MD = 1.32, 95%CI 0.18~2.46, P = 0.02)。1b级证据证明肩胛骨稳定性训练可减轻功能残疾(MD = -0.92, 95%CI -1.11~-0.74, P < 0.001)；1b级证据证明颈深屈肌训练能改善头前倾角度(MD = -0.83, 95%CI -1.56~-0.10, P = 0.03)，减轻颈部疼痛(MD = 0.93, 95%CI 0.54~1.32, P < 0.001)，改善功能残疾(MD = 2.17, 95%CI 1.39~2.95, P < 0.001)。结论肩胛骨稳定性训练颈深屈肌训练均能有效改善头前倾，减轻疼痛，改善颈部功能。

关键词: 头前倾, 颈痛, 运动, 生活质量, 颈部功能, Meta分析

Abstract:

Objective To systematically analyze the effect of therapeutic exercise on neck function and quality of life in patients with neck pain and forward head posture. Methods Randomized controlled trials about the effects of exercise training on forward head posture and neck pain were searched from PubMed, Web of science, Embase, Medline, Science Direct, EBSCO, Springlink, CNKI, VIP, and Wanfang Data from database establishment to April, 2022. The literature was screened by two researchers independently. Cochrane bias risk assessment tool and Physiotherapy Evidence Database Scale were used to evaluate the quality of the included articles. Revman 5.4 software was used for meta-analysis. Results A total of 416 patients from eleven literatures were included. Level 1a evidence indicated scapula stability training could effectively improve cranial vertebral angle (MD = 3.62, 95%CI 2.41 to 4.83, P < 0.001), and relieve pain (MD = 1.32, 95%CI 0.18 to 2.46, P = 0.02). Level 1b evidence indicated scapula stability training could reduce functional disability (MD = -0.92, 95%CI -1.11 to -0.74, P < 0.001). Level 1b evidence indicated deep cervical flexor training could improve cranial vertebral angle (MD = -0.83, 95%CI -1.56 to -0.10, P = 0.03), relieve pain (MD = 0.93, 95%CI 0.54 to 1.32, P < 0.001), and improve neck functional disability (MD = 2.17, 95%CI 1.39 to 2.95, P < 0.001). Conclusion Scapula stability training and deep cervical flexor training can effectively improve cranial vertebral angle, relieve neck pain, and improve neck function.

Key words: forward head posture, neck pain, exercise, quality of life, neck function, meta-analysis

中图分类号:

R681.5

孙喜妹, 刘华, 柴良伟, 李凯洋, 马景. 治疗性运动对头前倾并发颈痛患者颈部功能和生活质量影响的Meta分析[J]. 《中国康复理论与实践》, 2023, 29(2): 214-222.

SUN Ximei, LIU Hua, CHAI Liangwei, LI Kaiyang, MA Jing. Effect of therapeutic exercise on functional disability and quality of life in patients with forward head posture and neck pain: a meta-analysis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(2): 214-222.

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参考文献 44

[1]	GRIEGEL-MORRIS P, LARSON K, MUELLER-KLAUS K, et al. Incidence of common postural abnormalities in the cervical, shoulder, and thoracic regions and their association with pain in two age groups of healthy subjects[J]. Phys Ther, 1992, 72(6): 425-431. doi: 10.1093/ptj/72.6.425
[2]	KUO Y L, TULLY E A, GALEA M P. Video analysis of sagittal spinal posture in healthy young and older adults[J]. J Manipulative Physiol Ther, 2009, 32(3): 210-215. doi: 10.1016/j.jmpt.2009.02.002
[3]	DIAB A A. The role of forward head correction in management of adolescent idiopathic scoliotic patients: a randomized controlled trial[J]. Clin Rehabil, 2012, 26(12): 1123-1132. doi: 10.1177/0269215512447085 pmid: 22801470
[4]	RUIVO R M, CARITA A I, PEZARAT-CORREIA P. The effects of training and detraining after an 8 month resistance and stretching training program on forward head and protracted shoulder postures in adolescents: randomised controlled study[J]. Man Ther, 2016, 21: 76-82. doi: 10.1016/j.math.2015.05.001
[5]	KIM D H, KIM C J, SON S M. Neck pain in adults with forward head posture: effects of craniovertebral angle and cervical range of motion[J]. Osong Public Health Res Perspect, 2018, 9(6): 309-313. doi: 10.24171/j.phrp.2018.9.6.04
[6]	LING F P, CHEVILLOTTE T, LEGLISE A, et al. Which parameters are relevant in sagittal balance analysis of the cervical spine? A literature review[J]. Eur Spine J, 2018, 27(Suppl 1): 8-15. doi: 10.1007/s00586-018-5462-y pmid: 29332239
[7]	YIP C H, CHIU T T, POON A T. The relationship between head posture and severity and disability of patients with neck pain[J]. Man Ther, 2008, 13(2): 148-154. doi: 10.1016/j.math.2006.11.002
[8]	LINDFORS P, VON THIELE U, LUNDBERG U. Work characteristics and upper extremity disorders in female dental health workers[J]. J Occup Health, 2006, 48(3): 192-197. pmid: 16788280
[9]	CHIU T T, KU W Y, LEE M H, et al. A study on the prevalence of and risk factors for neck pain among university academic staff in Hong Kong[J]. J Occup Rehabil, 2002, 12(2): 77-91. doi: 10.1023/a:1015008513575 pmid: 12014228
[10]	CÔTÉ P, VAN DER VELDE G, CASSIDY J D, et al. The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders[J]. Spine (Phila Pa 1976), 2008, 33(4 Suppl): S60-S74. doi: 10.1097/BRS.0b013e3181643ee4
[11]	GUSTAFSSON E, THOMÉE S, GRIMBY-EKMAN A, et al. Texting on mobile phones and musculoskeletal disorders in young adults: a five-year cohort study[J]. Appl Ergon, 2017, 58: 208-214. doi: S0003-6870(16)30123-5 pmid: 27633215
[12]	SILVA A G, PUNT T D, SHARPLES P, et al. Head posture and neck pain of chronic nontraumatic origin: a comparison between patients and pain-free persons[J]. Arch Phys Med Rehabil, 2009, 90(4): 669-674. doi: 10.1016/j.apmr.2008.10.018
[13]	SHEIKHHOSEINI R, SHAHRBANIAN S, SAYYADI P, et al. Effectiveness of therapeutic exercise on forward head posture: a systematic review and meta-analysis[J]. J Manipulative Physiol Ther, 2018, 41(6): 530-539. doi: 10.1016/j.jmpt.2018.02.002
[14]	VERNON H, MIOR S. The Neck Disability Index: a study of reliability and validity[J]. J Manipulative Physiol Ther, 1991, 14(7): 409-415.
[15]	JUNIPER E F, NORMAN G R, COX F M, et al. Comparison of the standard gamble, rating scale, AQLQ and SF-36 for measuring quality of life in asthma[J]. Eur Respir J, 2001, 18(1): 38-44. pmid: 11510803
[16]	YANG Y, YAN X, DENG H, et al. The efficacy of traditional acupuncture on patients with chronic neck pain: study protocol of a randomized controlled trial[J]. Trials, 2017, 18(1): 312. doi: 10.1186/s13063-017-2009-1 pmid: 28693563
[17]	谷鸿秋, 王杨, 李卫. Cochrane偏倚风险评估工具在随机对照研究Meta分析中的应用[J]. 中国循环杂志, 2014, 29(2): 147-148.
	GU H Q, WANG Y, LI W. The application of the Cochrane bias risk assessment tool in the meta-analysis of randomized controlled trials[J]. Chin Circ J, 2014, 29(2): 147-148.
[18]	ELKINS M R, MOSELEY A M, SHERRINGTON C, et al. Growth in the Physiotherapy Evidence Database (PEDro) and use of the PEDro scale[J]. Br J Sports Med, 2013, 47(4): 188-189. doi: 10.1136/bjsports-2012-091804
[19]	郑尉, 孙立冰, 郝传萍, 等. 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 W, SUN L B, HAO C P, et al. Effect of spinal manipulation therapy on chronic nonspecific neck pain: a meta-analysis[J]. Chin J Rehabil Theory Pract, 2022, 28(2): 150-164.
[20]	SACKETT D L, ROSENBERG W M. The need for evidence-based medicine[J]. J Public Health Med, 1995, 88(11): 620-624.
[21]	GUPTA B D, AGGARWAL S, GUPTA B, et al. Effect of deep cervical flexor training vs. conventional isometric training on forward head posture, pain, neck disability index in dentists suffering from chronic neck pain[J]. J Clin Diagn Res, 2013, 7(10): 2261-2264.
[22]	LEE S M, LEE C H, O'SULLIVAN D, et al. Clinical effectiveness of a Pilates treatment for forward head posture[J]. J Phys Ther Sci, 2016, 28(7): 2009-2013. doi: 10.1589/jpts.28.2009
[23]	IM B, KIM Y, CHUNG Y, et al. Effects of scapular stabilization exercise on neck posture and muscle activation in individuals with neck pain and forward head posture[J]. J Phys Ther Sci, 2016, 28(3): 951-955. doi: 10.1589/jpts.28.951 pmid: 27134391
[24]	CHUNG S, JEONG Y G. Effects of the craniocervical flexion and isometric neck exercise compared in patients with chronic neck pain: a randomized controlled trial[J]. Physiother Theory Pract, 2018, 34(12): 916-925. doi: 10.1080/09593985.2018.1430876 pmid: 29364754
[25]	FATHOLLAHNEJAD K, LETAFATKAR A, HADADNEZHAD M. The effect of manual therapy and stabilizing exercises on forward head and rounded shoulder postures: a six-week intervention with a one-month follow-up study[J]. BMC Musculoskelet Disord, 2019, 20(1): 86. doi: 10.1186/s12891-019-2438-y
[26]	LETAFATKAR A, RABIEI P, ALAMOOTI G, et al. Effect of therapeutic exercise routine on pain, disability, posture, and health status in dentists with chronic neck pain: a randomized controlled trial[J]. Int Arch Occup Environ Health, 2020, 93(3): 281-290. doi: 10.1007/s00420-019-01480-x
[27]	MEHRI A, LETAFATKAR A, KHOSROKIANI Z. Effects of corrective exercises on posture, pain, and muscle activation of patients with chronic neck pain exposed to anterior-posterior perturbation[J]. J Manipulative Physiol Ther, 2020, 43(4): 311-324. doi: 10.1016/j.jmpt.2018.11.032
[28]	SIKKA I, CHAWLA C, SETH S. Effects of deep cervical flexor training on forward head posture, neck pain, and functional status in adolescents using computer regularly[J]. Biomed Res Int, 2020, 2020: 8327565.
[29]	ABADIYAN F, HADADNEZHAD M, KHOSROKIANI Z, et al. Adding a smartphone app to global postural re-education to improve neck pain, posture, quality of life, and endurance in people with nonspecific neck pain: a randomized controlled trial[J]. Trials, 2021, 22(1): 274. doi: 10.1186/s13063-021-05214-8 pmid: 33845880
[30]	KANG N Y, IM S C, KIM K. Effects of a combination of scapular stabilization and thoracic extension exercises for office workers with forward head posture on the craniovertebral angle, respiration, pain, and disability: a randomized-controlled trial[J]. Turk J Phys Med Rehabil, 2021, 67(3): 291-299.
[31]	DAREH-DEH H R, HADADNEZHAD M, LETAFATKAR A, et al. Therapeutic routine with respiratory exercises improves posture, muscle activity, and respiratory pattern of patients with neck pain: a randomized controlled trial[J]. Sci Rep, 2022, 12(1): 4149. doi: 10.1038/s41598-022-08128-w
[32]	SAUTER S L, SCHLEIFER L M, KNUTSON S J. Work posture, workstation design, and musculoskeletal discomfort in a VDT data entry task[J]. Hum Factors, 1991, 33(2): 151-167. pmid: 1860702
[33]	THIGPEN C A, PADUA D A, MICHENER L A, et al. Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks[J]. J Electromyogr Kinesiol, 2010, 20(4): 701-709. doi: 10.1016/j.jelekin.2009.12.003
[34]	COOLS A M, DEWITTE V, LANSZWEERT F, et al. Rehabilitation of scapular muscle balance: which exercises to prescribe?[J]. Am J Sports Med, 2007, 35(10): 1744-1751. doi: 10.1177/0363546507303560 pmid: 17606671
[35]	张秦. 久坐青年肩胛骨动力异常的特征及康复方法研究[D]. 北京: 北京体育大学, 2018.
	ZHANG Q. Study on characteristics and rehabilitation of scapular dyskinesis in sedentary youth[D]. Beijing: Beijing Sport University, 2018.
[36]	AMIRI A S, MOHSENI B M, JAVANSHIR K, et al. The effect of different exercise programs on size and function of deep cervical flexor muscles in patients with chronic nonspecific neck pain: a systematic review of randomized controlled trials[J]. Am J Phys Med Rehabil, 2017, 96(8): 582-588. doi: 10.1097/PHM.0000000000000721
[37]	BLOMGREN J, STRANDELL E, JULL G, et al. Effects of deep cervical flexor training on impaired physiological functions associated with chronic neck pain: a systematic review[J]. BMC Musculoskelet Disord, 2018, 19(1): 415. doi: 10.1186/s12891-018-2324-z
[38]	IQBAL Z A, ALGHADIR A H, ANWER S. Efficacy of deep cervical flexor muscle training on neck pain, functional disability, and muscle endurance in school teachers. A clinical trial[J]. Biomed Res Int, 2021, 2021: 7190808.
[39]	张恩铭, 王安利, 李新建, 等. 女性慢性颈痛患者颈深肌肉形态特征及其与颈肩部姿势相关性研究[J]. 中国运动医学杂志, 2016, 35(9): 816-821.
	ZHANG E M, WANG A L, LI X J, et al. Morphologic characteristics of deep cervical muscles in female patients with chronic neck pain and its relationship to their neck and shoulder postures[J]. Chin J Sports Med, 2016, 35(9): 816-821.
[40]	THAVATCHAI S, RUNGTHIP P, SUREEPORN U, et al. Effect of specific deep cervical muscle exercises on functional disability, pain intensity, craniovertebral angle, and neck-muscle strength in chronic mechanical neck pain: a randomized controlled trial[J]. J Pain Res, 2019, 12: 915-925. doi: 10.2147/JPR.S190125 pmid: 30881101
[41]	JULL G A, O'LEARY S P, FALLA D L. Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test[J]. J Manipulative Physiol Ther, 2008, 31(7): 525-533. doi: 10.1016/j.jmpt.2008.08.003
[42]	VICENZINO B, COLLINS D, WRIGHT A. The initial effects of a cervical spine manipulative physiotherapy treatment on the pain and dysfunction of lateral epicondylalgia[J]. Pain, 1996, 68(1): 69-74. doi: 10.1016/S0304-3959(96)03221-6 pmid: 9252000
[43]	KANLAYANAPHOTPORN R, CHIRADEJNANT A, VACHALATHITI R. The immediate effects of mobilization technique on pain and range of motion in patients presenting with unilateral neck pain: a randomized controlled trial[J]. Arch Phys Med Rehabil, 2009, 90(2): 187-192. doi: 10.1016/j.apmr.2008.07.017
[44]	孙增鑫, 闫彦宁, 刘迎东, 等. 胸椎手法治疗在慢性非特异性颈痛患者中的应用进展[J]. 中国康复医学杂志, 2022, 37(4): 551-555.
	SUN Z X, YAN Y N, LIU Y D, et al. Progress of thoracic manipulation in patients with chronic nonspecific neck pain[J]. Chin J Rehabil Med, 2022, 37(4): 551-555.

纳入文献	n		运动干预		干预时间	结局指标
纳入文献	对照组	试验组	对照组	试验组	干预时间	CVA	VAS	NDI	生活质量
Gupta等^[21](2013)	15	15	姿势矫正	颈深屈肌训练	4周	√	√	√
Lee等^[22](2016)	14	14	拉伸练习	普拉提运动	10周	√	√	√
Im等^[23](2016)	7	8	放松练习	肩胛骨稳定性训练	4周	√	√	√	√
Chung等^[24](2018)	19	22	自我姿势矫正	颈深屈肌训练	8周		√	√
Fathollahnejad等^[25](2019)	20	40	姿势矫正	肩胛骨稳定性训练	6周	√	√	√
Letafatkar等^[26](2020)	24	24	姿势矫正	本体感觉，力量耐力练习	8周	√	√	√	√
Mehri等^[27](2020)	16	16	自我锻炼	肩颈肌肉强化训练	8周	√	√
Sikka等^[28](2020)	15	15	姿势教育	颈深屈肌训练	4周	√	√	√
Abadiyan等^[29](2021)	20	40	日常姿势矫正	拉伸紧张肌肉，训练薄弱肌肉	8周	√	√	√	√
Kang等^[30](2021)	16	16	颈椎伸展练习	肩胛骨稳定性训练	6周	√	√	√
Dareh-Deh等^[31](2022)	20	20	姿势矫正	肩胛骨稳定性训练	8周	√	√

研究	资格标准	随机分配	分配隐藏	基线相似	被试施盲	治疗师施盲	评估者施盲	被试流失率 ≤ 15%	意向性分析	组间统计比较	变异性测量	总分
Gupta等^[21](2013)	√	√		√				√		√	√	5
Lee等^[22](2016)	√	√		√	√		√	√	√	√	√	8
Im等^[23](2016)	√	√		√				√		√	√	5
Chung等^[24](2018)	√	√	√	√				√			√	5
Fathollahnejad等^[25](2019)	√	√	√		√	√	√	√		√	√	8
Letafatkar等^[26](2020)	√	√	√	√	√	√	√	√	√	√		9
Mehri等^[27](2020)	√	√		√	√		√	√	√	√	√	8
Sikka等^[28](2020)	√	√	√	√	√	√	√	√		√		8
Abadiyan等^[29](2021)	√	√	√	√	√		√	√		√	√	8
Kang等^[30](2021)	√	√	√	√				√		√		5
Dareh-Deh等^[31](2022)	√	√	√		√	√	√	√		√	√	8