肩袖损伤非手术治疗效果中情景效应比例的Meta分析

doi:10.3969/j.issn.1006-9771.2022.09.006

Abstract

Abstract:

Objective To estimate the total effect size and the proportion of contextual effect (PCE) of non-surgical treatments for rotator cuff injury.
Methods Randomized controlled trial (RCT) on non-surgical treatments for rotator cuff injuries was retrieved from PubMed, Embase, Cochrane Library, Web of Science, CINAHL, CNKI, and Wanfang Data from the establishment to October, 2020. Two researchers conducted independent literature screening, data extraction and quality evaluation, and used STATA 15.0 software for meta-analyses.
Results Forty studies involving 2 976 participants were included. The total PCE of pain was 0.61 (95% CI 0.54 to 0.69). PCE of treatments from the largest to the smallest were corticosteroid injection, extracorporeal shockwave therapy, oral non-steroidal anti-inflammatory drugs (NSAIDs), manual therapy, hyaluronic acid injection therapy, platelet-rich plasma injection therapy, laser therapy, NSAIDs injection therapy, and acupuncture therapy. Total PCE for function and range of motion was 0.69 (95% CI 0.61 to 0.77) and 0.62 (95% CI 0.48 to 0.81), respectively. Blinding, studies in developed countries, and longer courses of treatment increased the PCE of pain.
Conclusion Up to 61% of PCE for the non-surgical treatments for rotator cuff injuries means instable research. A higher proportion of PCE may be the cause of inconsistencies between clinical practice and clinical research conclusions.

Key words: rotator cuff injuries, non-surgical treatments, contextual effect, meta-analysis

CLC Number:

R686

REN Kaixin,LI Lingcong,WANG Xiujing,MA Liying,WANG Zhenyu. Proportion of contextual effect of non-surgical treatments for rotator cuff injuries: a meta-analysis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(9): 1039-1048.

Figures/Tables 7

纳入研究	国家	n	年龄/岁	干预措施		治疗次数	疗程	基础治疗	止痛药物	结局指标	随访时间	Jadad 评分
纳入研究	国家	n	年龄/岁	试验组	对照组	治疗次数	疗程	基础治疗	止痛药物	结局指标	随访时间	Jadad 评分
Alvarez-Nemegyei等^[19](2008)	墨西哥	56	52.5±8.9	CS+利多卡因	利多卡因	1	< 1周	理疗	NSAIDs	VAS/SDQ/ ROM	6个月	6
Alvarez等^[20](2005)	加拿大	58	48.1±13.1	CS+利多卡因	利多卡因	1	< 1周	未提及	未提及	VAS/DASH	3个月	7
Penning等^[21](2012)	荷兰	149	53.0±10.1	HA+利多卡因;CS+利多卡因	NS+利多卡因	3	6周	无	扑热息痛	VAS/SDQ	3~4.5个月	7
Akgün等^[22](2004)	土耳其	32	48.5±8.5	CS+利多卡因	利多卡因	2	20 d	运动	萘普生	VAS/CMS	3个月	3
Petri等^[23](1987)	美国	75	无数据	CS+利多卡因+NSAIDs;利多卡因+NSAIDs	利多卡+CS+安慰剂;利多卡因+安慰剂	1	30 d	运动	扑热息痛	VAS/临床指数/ROM	1个月	6
Hong等^[24](2011)	韩国	54	50.8±9.9	CS+利多卡因	利多卡因	1	< 1周	运动	禁止使用	VAS/SDQ/ ROM	8周	7
Kesikburun等^[25](2013)	土耳其	40	48.5±11.4	PRP+利多卡因	NS+利多卡因	1	< 1周	运动	扑热息痛	VAS/SPADI	12个月	7
Schwitzguebel 等^[26](2019)	瑞士	80	47.9±13.9	PRP	NS	2	8周	无	扑热息痛	VAS/CMS	12个月	6
Cai等^[27](2019)	中国	136	40.2±8.2	PRP+利多卡因;HA+利多卡因	NS+利多卡因	4	4周	未提及	未提及	VAS/CMS	6个月	5
Rha等^[28](2013)	韩国	30	53.0±10.5	PRP+利多卡因	干针刺+利多卡因	2	4周	运动	扑热息痛	VAS/SPADI	6个月	5
Chou等^[29](2010)	中国	51	51.8±8.4	HA	NS	5	5周	无	未提及	VAS/CMS	1周	6
Moghtaderi等^[30](2013)	伊朗	40	无数据	HA	NS	3	3周	未提及	未提及	VAS/CMS	3周	4
Itzkowitch等^[31](1996)	英格兰	77	58.0±12.0	NSAIDs注射	安慰剂注射	4	4周	未提及	扑热息痛	VAS/临床指数/ROM	4周	5
Devereaux等^[32](2016)	加拿大	67	47.4±12.4	NSAIDs+运动	运动	4	2周	运动	未提及	VAS/CMS/ ROM	2周	4
Petri等^[33](2004)	美国	306	49.1±12.3	口服NSAIDs	安慰剂	28	2周	未提及	未提及	VAS/患者满意度/ROM	2周	4
Abrisham等^[34](2011)	伊朗	80	51.7±6.2	激光	假激光	10	2周	运动	无	VAS/ROM	2 周	4
Yeldan等^[35](2009)	土耳其	60	55.2±8.7	激光	假激光	15	3周	运动	未提及	VAS/SDQ/ ROM	3 周	5
Elsodany等^[36](2018)	埃及	60	50.2±3.7	激光	假激光	12	4周	运动	未提及	VAS/SPADI/ROM	0周	5
Dogan等^[37](2010)	土耳其	52	53.6±11.3	激光	假激光	14	3周	运动	未提及	VAS/SPADI/ROM	0周	7
Kibar等^[38](2017)	土耳其	62	60.0±10.0	激光	假激光	15	3周	运动	扑热息痛	VAS/SPADI/ROM	1 个月	5
Vecchio等^[39](1993)	英格兰	35	52.0±16.3	激光	假激光	16	8周	运动	扑热息痛	VAS/VAS/功能	2个月	4
Kelle等^[40](2014)	土耳其	90	50.7±10.2	激光	假激光	9	3周	运动	扑热息痛	VAS/UCLA肩关节评分	6个月	1
Eslamian等^[41](2012)	伊朗	50	50.2±12.1	激光	无	10	3周	运动	NSAIDs	VAS/SDQ/ROM	3周	5
Vas等^[42](2008)	西班牙	322	55.7±11.3	针刺	经皮神经电刺激	3	3周	运动	NSAIDs/止痛药	VAS/CMS	12个月	7
Lathia等^[43](2009)	美国	20	61.9±4.6	针刺	假针刺	12	6周	运动	未提及	VAS/SPADI	1.5个月	5
Rueda等^[44](2016)	西班牙	68	33.4±12.5	针刺	假针刺	4	4周	未提及	未提及	VAS/UCLA肩关节评分	0周	4
Kvalvaag等^[45](2018)	挪威	130	46.8±10.2	ESWT	假ESWT	4	4周	运动	未提及	VAS/SPADI	12个月	6
Li等^[46](2017)	中国	84	47.7±9.9	ESWT	假ESWT	5	15天	未提及	未提及	VAS/CMS	2个月	7
Ko等^[47](2020)	中国	31	53.1±2.7	ESWT	假ESWT	1	< 1周	运动	扑热息痛	VAS/CMS/ ROM	12个月	6
Kolk等^[48](2013)	荷兰	69	46.9±9.1	ESWT	假ESWT	3	6周	无	止痛药	VAS/CMS	6个月	7
Speed等^[49](2002)	英国	74	52.0±11.4	ESWT	假ESWT	3	12周	无	无	VAS/SPADI	6个月	4
Galasso等^[50](2012)	意大利	20	50.9±10.6	ESWT	假ESWT	2	2周	未提及	扑热息痛	VAS/CMS	3个月	3
Bennell等^[51](2010)	澳大利亚	120	59.3±10.1	手法治疗	假治疗	10	10周	无	止痛药	VAS/SPADI	22周	7
Delgado-Gil等^[52](2015)	西班牙	42	55.0±9.0	手法治疗	假治疗	4	2周	无	禁止使用	VAS/ROM	1 d	5
Haik等^[53](2017)	西班牙	55	32.5±12.0	手法治疗	假治疗	2	< 1周	未提及	未提及	VAS/DASH	2 d	4
Bertrand等^[54](2016)	加拿大	53	53.8±13.5	葡萄糖+利多卡因	利多卡因	3	3月	运动	对乙酰氨基酚	VAS	3个月	6
Lin等^[55](2019)	中国	31	46.3±5.7	葡萄糖+利多卡因	利多卡因	1	< 1周	未提及	未提及	VAS/SPADI/ROM	2周	6
Yilmaz等^[56](2018)	土耳其	28	51.6±9.7	SWD	假SWD	10	2周	运动冷敷	美洛昔康	VAS/SDQ/ ROM	2个月	7
Galace de Freitas等^[57](2014)	巴西	46	50.5±8.9	PEMF	假PEMF	9	3周	运动	未提及	VAS/CMS	1 d	6
Aceituno-Gómez等^[58](2019)	西班牙	43	59.1±9.1	激光	假激光	15	3周	运动	止痛药	VAS/SPADI/ROM	3个月	2

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结局指标	治疗措施	研究数量	样本量	治疗效应 (95% CI)	I²/%	PCE (95% CI)	I²/%
疼痛	皮质类固醇注射	6	314	1.12 (0.77~1.62)	58.4	0.79 (0.56~1.10)	46.1
	富血小板血浆注射	4	219	2.05 (1.31~3.21)	42.9	0.60 (0.39~0.91)	78.6
	透明质酸注射	4	231	1.47 (0.70~3.11)	85.0	0.62 (0.37~1.03)	75.0
	增生疗法	2	84	2.53 (0.56~11.5)	76.3	0.62 (0.41~0.95)	3.5
	NSAIDs 注射	1	77	2.18 (1.23~3.85)	-	0.36 (0.23~0.55)	-
	NSAIDs口服	3	410	1.10 (0.91~1.33)	0	0.76 (0.60~0.95)	0
	激光治疗	9	532	1.93 (1.40~2.66)	49.3	0.54 (0.42~0.69)	82.3
	针刺治疗	3	410	1.66 (1.32~2.09)	0	0.36 (0.28~0.46)	0
	体外冲击波治疗	6	408	1.24 (0.83~1.87)	67.1	0.76 (0.51~1.13)	78.0
	手法	3	217	0.59 (0.34~1.02)	72.1	0.72 (0.47~1.12)	0
	其他	2	74	1.71 (0.74~3.97)	46.2	0.41 (0.10~1.73)	85.6
	合计	43	2976	1.41 (1.20~1.65)	69.9	0.61 (0.54~0.69)	78.1
功能	皮质类固醇注射	6	314	1.13 (0.81~1.56)	49.1	0.83 (0.60~1.14)	37.0
	富血小板血浆注射	4	219	2.14 (0.75~6.16)	86.2	0.54 (0.29~1.00)	75.0
	透明质酸注射	4	231	1.29 (0.47~3.54)	90.8	0.47 (0.17~1.30)	82.0
	增生疗法	1	31	0.85 (0.41~1.76)	-	0.33 (0.05~2.20)	-
	NSAIDs 注射	1	77	1.67 (0.99~2.81)	-	0.46 (0.30~0.73)	-
	NSAIDs口服	3	410	1.75 (0.92~3.32)	73.5	0.71 (0.60~0.84)	41.1
	激光治疗	8	452	1.39 (1.06~1.83)	31.0	0.73 (0.53~0.99)	77.6
	针刺治疗	3	472	1.83 (1.47~2.27)	0	0.53 (0.46~0.62)	0
	体外冲击波治疗	6	408	1.18 (0.90~1.55)	28.9	0.79 (0.65~0.97)	35.4
	手法	2	175	1.75 (0.54~5.66)	84.6	0.27 (0.02~3.48)	87.7
	其他	2	75	1.10 (0.67~1.81)	0	0.63 (0.26~1.51)	41.6
	合计	40	2864	1.37 (1.17~1.62)	69.7	0.69 (0.61~0.77)	71.9
ROM	合计	16	1034	1.02 (0.72~1.43)	81.6	0.62 (0.48~0.81)	84.0

亚组		研究数量	n	治疗效应 (95% CI)	I²/%	PCE (95% CI)	I²/%
疗程	≤ 4周	30	2196	1.53 (1.25~1.88)	73.9	0.57 (0.48~0.67)	82.5
	> 4周	13	780	1.16 (0.94~1.44)	47.6	0.73 (0.61~0.86)	32.9
参与者年龄	< 40岁	3	190	1.38 (0.59~3.22)	85.7	0.40 (0.26~0.63)	25.4
	40~50岁	11	966	1.20 (0.91~1.58)	69.9	0.75 (0.59~0.97)	71.9
	50~60岁	27	1738	1.47 (1.20~1.82)	68.6	0.61 (0.53~0.70)	74.6
	≥ 60岁	2	82	2.71 (1.44~5.10)	0	0.15 (0.07~0.33)	0
损伤类型	肩袖肌腱炎	18	1585	1.38 (1.10~1.74)	70.0	0.57 (0.48~0.67)	76.9
	肩峰撞击综合征	16	940	1.21 (0.91~1.60)	73.5	0.71 (0.55~0.91)	75.4
	肩袖肌腱撕裂	7	377	1.98 (1.50~2.63)	22.6	0.57 (0.42~0.77)	75.1
给药途径	注射治疗	17	925	1.54 (1.16~2.05)	71.6	0.64 (0.53~0.77)	67.5
	口服药物	3	410	1.10 (0.91~1.33)	0	0.76 (0.60~0.95)	0
	物理治疗	23	1641	1.42 (1.13~1.80)	72.4	0.56 (0.46~0.69)	82.9
是否充分隐藏	是	24	1665	1.36 (1.07~1.73)	75.8	0.64 (0.52~0.78)	84.7
	否	19	1311	1.49 (1.22~1.82)	56.9	0.58 (0.50~0.67)	56.1
患者是否盲法	是	32	2117	1.34 (1.10~1.62)	73.1	0.65 (0.57~0.75)	71.5
	否	11	859	1.68 (1.26~2.22)	55.6	0.52 (0.41~0.67)	77.2
国家经济水平	发展中国家	19	1029	1.89 (1.44~2.47)	65.1	0.55 (0.46~0.67)	80.4
	发达国家	24	1947	1.16 (0.96~1.39)	67.6	0.66 (0.55~0.79)	73.1
资金来源	公共	16	1142	1.49 (1.16~1.90)	64.8	0.54 (0.44~0.67)	70.6
	企业	4	523	1.13 (0.95~1.34)	0	0.86 (0.53~1.39)	82.0
是否联合治疗	是	31	2031	1.53 (1.29~1.82)	59.5	0.63 (0.54~0.73)	81.9
	否	12	945	1.13 (0.81~1.59)	81.3	0.55 (0.42~0.72)	56.7
随访时间	治疗后即刻	3	180	2.37 (1.40~4.00)	27.5	0.51 (0.39~0.68)	68.7
	≤ 3个月	26	1545	1.32 (1.06~1.65)	71.1	0.61 (0.53~0.70)	50.1
	3~6个月	8	575	1.54 (1.14~2.09)	60.4	0.62 (0.45~0.87)	78.6
	> 6个月	6	676	1.32 (0.90~1.94)	75.8	0.72 (0.44~1.17)	91.1

亚组		研究数量	n	治疗效应(95% CI)	I²/%	PCE(95% CI)	I²/%
疗程	≤ 4周	11	673	1.55(1.30~1.84)	58.9	0.66(0.58~0.76)	77.8
	> 4周	29	2191	0.99(0.74~1.31)	65.8	0.69(0.61~0.79)	0
参与者年龄	< 40岁	3	190	2.97(1.79~4.93)	30.7	0.13(0.03~0.63)	79.5
	40~50岁	11	966	1.16(0.85~1.58)	76.1	0.80(0.64~1.00)	52.3
	50~60岁	24	1626	1.33(1.08~1.63)	64.9	0.71(0.62~0.80)	70.3
	≥ 60岁	2	82	2.13(1.21~3.76)	0	0.24(0.08~0.78)	59.6
损伤类型	肩袖肌腱炎	16	1514	1.35(1.09~1.69)	63.5	0.68(0.60~0.78)	72.4
	肩峰撞击综合征	15	899	1.25(0.96~1.61)	67.3	0.76(0.59~0.98)	69.1
	肩袖肌腱撕裂	7	377	2.00(1.01~3.98)	83.8	0.45(0.27~0.77)	77.7
治疗途径	注射治疗	16	872	1.33(0.95~1.85)	79.0	0.61(0.46~0.82)	68.1
	口服药物	3	410	1.75(0.92~3.32)	73.5	0.71(0.60~0.84)	41.1
	物理治疗	21	1582	1.38(1.17~1.63)	42.4	0.70(0.60~0.82)	75.5
是否充分隐藏	是	22	1606	1.17(0.94~1.46)	69.6	0.77(0.68~0.89)	66.2
	否	18	1258	1.66(1.31~2.09)	62.7	0.56(0.45~0.70)	71.1
是否盲法	是	29	2005	1.31(1.07~1.61)	73.9	0.72(0.62~0.84)	66.0
	否	11	859	1.65(1.41~1.93)	0	0.60(0.48~0.74)	76.4
国家经济水平	发展中国家	18	950	1.59(1.22~2.07)	60.9	0.65(0.53~0.79)	75.8
	发达国家	22	1914	1.25(1.01~1.55)	74.8	0.70(0.60~0.81)	59.8
基金来源	公共	15	1151	1.64(1.23~2.20)	69.5	0.66(0.54~0.81)	72.0
	企业	4	523	1.33(0.91~1.93)	64.3	0.83(0.65~1.07)	40.1
是否联合治疗	是	29	1961	1.30(1.09~1.56)	62.9	0.72(0.64~0.81)	68.8
	否	11	903	1.57(1.07~2.30)	80.0	0.51(0.34~0.75)	77.6
随访时间	治疗后即刻	3	180	1.52(0.64~3.61)	67.5	0.80(0.47~1.36)	87.2
	≤ 3个月	23	1371	1.29(1.07~1.56)	53.7	0.66(0.56~0.79)	53.6
	3~6个月	8	575	1.88(1.28~2.77)	68.3	0.58(0.4~0.85)	79.4
	> 6个月	6	738	1.17(0.67~2.07)	89.5	0.71(0.55~0.93)	72.1

Proportion of contextual effect of non-surgical treatments for rotator cuff injuries: a meta-analysis

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