腰背痛运动疗法中情境效应的影响：系统回顾与荟萃分析。

IF 7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

BMC Medicine Pub Date : 2024-10-23 DOI:10.1186/s12916-024-03679-3

Aaltje de Roode, Martijn W Heymans, Wim van Lankveld, J Bart Staal

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引用次数: 0

摘要

背景：腰背痛是导致全球残疾的主要原因，而运动疗法是被广泛推荐的治疗方法。研究表明，环境因素也可能影响腰背痛的治疗效果。例如，患者与治疗师之间的关系以及影响患者期望的其他治疗相关情况。临床试验只关注具体的治疗效果，往往会忽视环境因素的影响，从而导致所谓的疗效悖论。这意味着临床实践中观察到的治疗效果往往大于临床试验报告的效果。本系统综述旨在研究在腰背痛患者的运动疗法结果中，可归因于情境效应的疼痛和残疾改善所占的比例：方法：进行荟萃分析。方法：进行了一项荟萃分析。在 PubMed、Embase 和 Cochrane 数据库中检索了符合条件的文章，这些文章报告了将运动疗法与安慰剂干预进行比较的随机对照试验。采用修订版 Cochrane 偏倚风险工具评估偏倚风险。研究结果为疼痛和残疾。对疼痛和残疾进行了元分析，以计算可归因于环境效应的比例。采用 GRADE 方法对证据进行了评估：八项研究符合纳入标准并被纳入荟萃分析。五项研究被评为存在中度偏倚风险，两项研究存在低度偏倚风险。在疼痛方面，可归因于环境效应的比例为 0.60（95% CI 0.40-0.89），在残疾方面，可归因于环境效应的比例为 0.69（95% CI 0.48-1.00）。根据 GRADE 方法评估的证据确定性较低：结论：腰背痛患者在接受运动疗法后，疼痛和残疾的改善在很大程度上可归因于环境效应，尽管这一结论是基于确定性较低的证据得出的。

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The impact of contextual effects in exercise therapy for low back pain: a systematic review and meta-analysis.

Background: Low back pain is the leading cause of global disability for which exercise therapy is a widely recommended treatment. Research indicates that contextual factors may also influence treatment outcomes in low back pain. Examples include the patient-therapist relationship and other treatment-related circumstances that affect patient expectations. By focusing on the specific treatment effect, clinical trials often ignore the effect of contextual factors, thereby contributing to the so-called efficacy paradox. This means that treatment effects observed in clinical practice are often greater than those reported in clinical trials. This systematic review aims to investigate the proportion of improvement in pain and disability that can be attributed to contextual effects in the outcome of exercise therapy for patients with low back pain.

Methods: A meta-analysis was conducted. PubMed, Embase, and the Cochrane database were searched for eligible articles reporting randomized controlled trials that compared exercise therapy to placebo interventions. Risk of bias was assessed with the Revised Cochrane Risk of Bias Tool. Outcomes of interest were pain and disability. Meta-analysis was carried out to calculate the proportion attributable to contextual effects for both pain and disability. The body of evidence was assessed using the GRADE methodology.

Results: Eight studies met the inclusion criteria and were included in the meta-analysis. Five studies were rated as having a moderate risk of bias and two studies had a low risk of bias. Proportion attributable to contextual effects was 0.60 (95% CI 0.40-0.89) for pain and 0.69 (95% CI 0.48-1.00) for disability. Certainty of the evidence as assessed with the GRADE methodology was low.

Conclusions: A large extent of pain and disability improvement after exercise therapy in low back pain is attributable to contextual effects although this conclusion is based on low certainty evidence.

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来源期刊

BMC Medicine 医学-医学：内科

CiteScore

13.10

自引率

1.10%

发文量

435

审稿时长

4-8 weeks

期刊介绍： BMC Medicine is an open access, transparent peer-reviewed general medical journal. It is the flagship journal of the BMC series and publishes outstanding and influential research in various areas including clinical practice, translational medicine, medical and health advances, public health, global health, policy, and general topics of interest to the biomedical and sociomedical professional communities. In addition to research articles, the journal also publishes stimulating debates, reviews, unique forum articles, and concise tutorials. All articles published in BMC Medicine are included in various databases such as Biological Abstracts, BIOSIS, CAS, Citebase, Current contents, DOAJ, Embase, MEDLINE, PubMed, Science Citation Index Expanded, OAIster, SCImago, Scopus, SOCOLAR, and Zetoc.