Does the efficacy of neurodynamic treatments depend on the presence and type of criteria used to define neural mechanosensitivity in spinally-referred leg pain? A systematic review and meta-analysis.

IF 1 Q4 REHABILITATION
South African Journal of Physiotherapy Pub Date : 2022-07-22 eCollection Date: 2022-01-01 DOI:10.4102/sajp.v78i1.1627
Tawanda Murape, Timothy R Ainslie, Cato A Basson, Annina B Schmid
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引用次数: 0

Abstract

Background: It remains unclear whether definite neural mechanosensitivity (NM) is required for neural mobilisations to be beneficial in people with spinally referred leg pain.

Objective: To determine whether the efficacy of neural mobilisations in patients with spinally referred leg pain depends on the presence and type of criteria used to define NM.

Method: PubMed, CINAHL, Cochrane Central Register of Controlled Trials, PEDro and Science Direct were searched from 1980 to March 2020. Randomised controlled trials evaluating the efficacy of neural mobilisations on pain and disability in spinally referred leg pain were included. Studies were grouped according to the certainty of NM into NMdefinite, NMunclear, NMuntested and NMabsent. Effects on pain and disability and subgroup differences were examined.

Results: We identified 21 studies in 914 patients (3 NMdefinite, 16 NMunclear, 2 NMuntested, 0 NMabsent). Meta-analysis revealed medium to large effect sizes on pain for neurodynamic compared to control interventions in NMdefinite and NMunclear groups. For disability, neurodynamic interventions had medium to large effects in NMunclear but not NMdefinite groups. NMuntested studies could not be pooled.

Conclusion: The nonexistence of studies in patients with negative neurodynamic tests prevents inferences whether neural mobilisations are effective in the absence of NM. The criteria used to define NM may not impact substantially on the efficacy of neural mobilisations. The mostly high risk of bias and heterogeneity prevents firm conclusions.

Clinical implications: Neural mobilisations seem beneficial to reduce pain and disability in spinally referred leg pain independent of the criteria used to interpret neurodynamic tests.

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神经动力学治疗的疗效是否取决于用于定义脊柱性腿痛的神经机械敏感性标准的存在和类型?系统回顾和荟萃分析。
背景:目前尚不清楚是否需要明确的神经机械敏感性(NM)才能对脊柱性腿痛患者的神经活动有益。目的:确定神经活动治疗脊柱牵涉性腿痛患者的疗效是否取决于NM的存在和定义标准的类型。方法:检索1980年至2020年3月PubMed、CINAHL、Cochrane Central Register of Controlled Trials、PEDro和Science Direct。纳入了评估神经活动对脊柱相关腿部疼痛和残疾的疗效的随机对照试验。根据NM的确定度将研究分为NMdefinite、NMunclear、NMuntested和NMabsent。观察对疼痛和残疾的影响及亚组差异。结果:我们在914例患者中确定了21项研究(3例NMdefinite, 16例NMunclear, 2例NMuntested, 0例NMabsent)。荟萃分析显示,与对照干预相比,NMdefinite组和NMunclear组对神经动力学疼痛的影响中等到较大。对于残疾,神经动力学干预在NMunclear组中有中等到较大的效果,但在NMdefinite组中没有。未测试的研究无法汇总。结论:缺乏对神经动力学试验阴性患者的研究,无法推断神经活动在没有神经动力学试验的情况下是否有效。用于定义NM的标准可能不会对神经活动的疗效产生实质性影响。大部分高偏倚和异质性的风险阻碍了确定的结论。临床意义:与解释神经动力学测试的标准无关,神经活动似乎有利于减轻脊柱性腿痛的疼痛和残疾。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
1.70
自引率
9.10%
发文量
35
审稿时长
30 weeks
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