治疗创伤后肘关节僵硬的保守疗法的有效性：系统性综述。

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice Pub Date : 2024-09-26 DOI:10.1016/j.msksp.2024.103194

Alberto Piacenza , Andrea Zerilli , Ilenia Viccari , Greta Castelli

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引用次数: 0

摘要

背景：创伤后肘关节僵硬是创伤或手术后常见的后果，会导致严重的肢体残疾，对日常生活造成负面影响。虽然保守治疗是一线治疗方法，但目前尚不清楚哪种方法最合适、最有效：调查保守疗法对创伤后肘关节僵硬患者的有效性：方法：在 PROSPERO（CRD42024517823）上发布了本系统综述的方案。研究遵循 PRISMA 标准。在六个数据库（PubMed、CINHAL、Cochrane Library、Web of Science、Scopus 和 PEDro）和 CENTRAL 试验登记册中进行了广泛的系统检索。两名审稿人独立评估、选择结果、收集数据，使用 Cochrane 偏倚风险工具对纳入研究的偏倚风险（RoB）进行评级，综合现有证据，并使用 GRADE 方法进行评级：共有五项研究被纳入综述，但由于干预措施和比较对象存在很大差异，因此无法对结果进行荟萃分析。当固定后立即开始保守治疗时，观察到较大的效应大小，可改善肘关节功能（SMD 3.07；95%CI 1.91 至 4.23）和疼痛（SMD 1.83；95%CI 0.91 至 2.76）。结果表明，在恢复肘关节功能和减轻疼痛方面，感觉神经肌肉刺激疗法（SMD = -1.22; 95%CI [-1.90, -0.54]）和分级运动想象疗法（SMD = -2.79; 95%CI [-3.59, -2.00]）比比较疗法更有效：结论：虽然建议将保守治疗作为一线治疗方法，但由于结果的可信度较低或非常低，因此无法确定最佳的保守治疗方法。

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Effectiveness of conservative treatment in the management of post-traumatic elbow stiffness: A systematic review

Background

Post-traumatic elbow stiffness is a common consequence following trauma or surgery, resulting in significant limb disability, with a negative impact on daily life. Although conservative treatment is the first-line approach, it is not yet known which is most suitable and effective.

Objective

To investigate the effectiveness of conservative treatments in patients with post-traumatic elbow stiffness.

Method

A protocol for this systematic review was published in PROSPERO (CRD42024517823). PRISMA standards were followed. An extensive systematic search was conducted in six databases (PubMed, CINHAL, Cochrane Library, Web of Science, Scopus, and PEDro), and the CENTRAL trial register. Two reviewers independently assessed, selected results, collected data, rated the risk of bias (RoB) of included studies with the Cochrane risk of bias tool, synthesized the available evidence, and rated it using GRADE methodology.

Results

Five studies were included in the review, although high variability in interventions and comparators precluded the synthesis of results into a meta-analysis. Large effect sizes were observed when conservative treatment was initiated immediately after immobilization, improving elbow functionality (SMD 3.07; 95%CI 1.91 to 4.23), and pain (SMD 1.83; 95%CI 0.91 to 2.76). Results indicate that Proprioceptive Neuromuscular Facilitation (SMD = −1.22; 95%CI [-1.90, −0.54]) and Graded Motor Imagery (SMD = −2.79; 95%CI [-3.59, −2.00]) were more effective than comparisons in recovering elbow functionality and pain reduction.

Conclusion

Although conservative treatment is recommended as a first-line approach, the best conservative treatment cannot be determined with certainty due to the low to very low confidence in the results.

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来源期刊

Musculoskeletal Science and Practice Health Professions-Physical Therapy, Sports Therapy and Rehabilitation

CiteScore

4.10

自引率

8.70%

发文量

152

审稿时长

48 days

期刊介绍： Musculoskeletal Science & Practice, international journal of musculoskeletal physiotherapy, is a peer-reviewed international journal (previously Manual Therapy), publishing high quality original research, review and Masterclass articles that contribute to improving the clinical understanding of appropriate care processes for musculoskeletal disorders. The journal publishes articles that influence or add to the body of evidence on diagnostic and therapeutic processes, patient centered care, guidelines for musculoskeletal therapeutics and theoretical models that support developments in assessment, diagnosis, clinical reasoning and interventions.