《中国康复理论与实践》

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (7): 778-788.doi: 10.3969/j.issn.1006-9771.2024.07.005

• 循证研究 • 上一篇    下一篇

ICF框架下运动疗法对慢性非特异性颈痛效果的Meta分析

温艳飞, 杨露, 班玥, Ykabaru Daniela BERBESI NORIEGA, 张郝琪, 王丽(), 刘华()   

  1. 首都体育学院，北京市 100191
  • 收稿日期:2024-05-24 修回日期:2024-06-18 出版日期:2024-07-25 发布日期:2024-08-07
  • 通讯作者: 刘华，E-mail： liuhua@cupes.edu.cn； 王丽，E-mail： wangli@cupes.edu.cn
  • 作者简介:温艳飞(2001-)，女，汉族，山东聊城市人，硕士研究生，主要研究方向：运动损伤的预防与康复。
  • 基金资助:
    北京高校"优质本科课程"项目(145122005/004);北京高等教育"本科教学改革创新项目"(145122002/007);内涵发展-科研-科技强校支持计划项目(155223021);内涵发展-运动科学与健康学院"一融双高"双创项目(515124001);内涵发展-?肌肉骨骼康复学?(515124004)

Effect of exercise therapy on chronic nonspecific neck pain: a meta-analysis based on ICF

WEN Yanfei, YANG Lu, BAN Yue, Ykabaru Daniela BERBESI NORIEGA, ZHANG Haoqi, WANG Li(), LIU Hua()   

  1. Capital University of Physical Education and Sports, Beijing 100191, China
  • Received:2024-05-24 Revised:2024-06-18 Published:2024-07-25 Online:2024-08-07
  • Contact: LIU Hua, E-mail: liuhua@cupes.edu.cn; WANG Li, E-mail: wangli@cupes.edu.cn
  • Supported by:
    Quality Undergraduate Program in Beijing Universities(145122005/004);Beijing Higher Education Undergraduate Teaching Reform and Innovation Project(145122002/007);Inner Connotation Development-Research-Science and Technology Stronger Schools Supporting Program(155223021);Inner Connotation Development-School of Kinesiology and Health Dual Creation Project(515124001);Inner Connotation Development-Musculoskeletal Rehabilitation(515124004)

RichHTML

PDF (PC)

摘要：

目的 基于《国际功能、残疾和健康分类》(ICF)框架，系统评价运动疗法对慢性非特异性颈痛(CNSNP)患者身体结构、功能、活动和参与等方面的干预效果。
方法 构建PICO架构，系统检索CBM、万方、维普、中国知网、Cochrane Library、Embase、PubMed和Web of Science等中、英文数据库，纳入有关运动疗法干预CNSNP患者的随机对照试验，时间范围为建库至2024年3月。采用Cochrane偏倚风险评估工具和物理治疗证据数据库(PEDro)量表对纳入文献进行质量评价，采用GRADE对结局指标进行证据质量评价，采用RevMan 5.3进行数据合并和分析，采用Stata 18.0进行偏倚风险评估。
结果 最终纳入11篇文献，共668例患者。PEDro量表评分5~8分。运动疗法类型包括肌力训练、稳定性训练、本体感觉训练、瑜伽和普拉提等；对照组包括空白对照、物理因子治疗和健康教育。运动疗法可显著增加患者颅椎角(SMD = 0.84, 95%CI 0.42~1.26, P < 0.001)，降低疼痛视觉模拟量表评分(SMD = -2.05, 95%CI -2.58~-1.52, P < 0.001)，提高压力疼痛阈值(MD = 112.27, 95%CI 75.03~149.50, P < 0.001)，提高颈椎前屈(SMD = 1.24, 95%CI 0.34~2.15, P = 0.007)、侧屈(SMD = 1.52, 95%CI 0.40~2.65, P = 0.008)关节活动度，提高颈深屈肌耐力(SMD = 1.02, 95%CI 0.10~1.94, P = 0.03)，改善颈椎关节位置觉(SMD = -1.00, 95%CI -1.47~-0.53, P < 0.001)，但对于改善后屈(SMD = 0.85, 95%CI -1.04~2.75, P = 0.38)、旋转(SMD = 1.65, 95%CI -0.35~3.65, P = 0.11)关节活动度的效果不显著；运动疗法还能降低患者颈椎功能障碍指数评分(MD = -11.88, 95%CI -16.09~-7.68, P < 0.001)，对健康调查简表评分效果不显著(MD = 19.04, 95%CI -3.00~41.08, P = 0.09)。
结论 运动疗法可以改善CNSNP患者的异常姿势、疼痛、前屈和侧屈运动、颈屈肌耐力和关节位置觉，改善功能障碍，但对提高颈部后屈和旋转运动，改善生活质量方面仍需进一步的研究。

关键词: 慢性非特异性颈痛, 运动, 国际功能、残疾和健康分类, Meta分析

Abstract:

Objective To systematically evaluate the effect of exercise therapy on body structure, function, and activity and participation in patients with chronic nonspecific neck pain (CNSNP) based on the International Classification of Functioning, Disability and Health (ICF) framework.
Methods A PICO framework was constructed, and randomized controlled trials (RCTs) on the intervention of different types of exercise therapy for patients with CNSNP were retrieved from databases of CBM, Wanfang data, VIP, CNKI, Cochrane Library, Embase, PubMed and Web of Science, from the establishment to March, 2024. The quality of the literature was evaluated with Cochrane Risk of Bias Tool and Physiotherapy Evidence Database (PEDro) scale, and the evidence quality of the outcome indicators was evaluated using GRADE. Data were synthesized and analyzed using RevMan 5.3, and the risk of bias was evaluated using Stata 18.0.
Results A total of eleven RCTs involving 668 subjects were included. The scores of PEDro scale were five to eight. The types of interventions included muscle strength training, stability training, proprioception training, Yoga and Pilates. The control groups received placebo, physical factor therapy and health education. Exercise therapy could increase the craniovertebral angle (SMD = 0.84, 95%CI 0.42 to 1.26, P < 0.001), reduce the Visual Analogue Scale score (SMD = -2.05, 95%CI -2.58 to -1.52, P < 0.001), increase the pressure pain threshold (MD = 112.27, 95%CI 75.03 to 149.50, P < 0.001), increase the range of motion of cervical forward (SMD = 1.24, 95%CI 0.34 to 2.15, P = 0.007) and lateral (SMD = 1.52, 95%CI 0.40 to 2.65, P = 0.008) flexion, and improve the endurance of the deep cervical flexors (SMD = 1.02, 95%CI 0.10 to 1.94, P = 0.03) and position sense of the cervical spine (SMD = -1.00, 95%CI -1.47 to -0.53, P < 0.001); however, it was not significant in improving the range of motion of backward flexion (SMD = 0.85, 95%CI -1.04 to 2.75, P = 0.38) and rotation (SMD = 1.65, 95%CI -0.35 to 3.65, P = 0.11). Exercise therapy could also reduce the Neck Disability Index score (MD = -11.88, 95%CI -16.09 to -7.68, P < 0.001), and it was no significant in the Short-Form-36 score (MD = 19.04, 95%CI -3.00 to 41.08, P = 0.09).
Conclusion Exercise therapy can improve head posture, pain, motion of forward flexion and lateral flexion, endurance of the cervical flexors and joint position sense, and the overall function in patients with CNSNP. However, further researches are needed to verify the effects on cervical backward flexion and rotation, and quality of life.

Key words: chronic nonspecific neck pain, exercise, International Classification of Functioning, Disability and Health, meta-analysis

中图分类号: