肌腱病的运动疗法:探索可行性、可接受性和有效性的混合方法证据综合。

IF 3.5 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Kay Cooper, Lyndsay Alexander, David Brandie, Victoria Tzortziou Brown, Leon Greig, Isabelle Harrison, Colin MacLean, Laura Mitchell, Dylan Morrissey, Rachel Ann Moss, Eva Parkinson, Anastasia Vladimirovna Pavlova, Joanna Shim, Paul Alan Swinton
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引用次数: 0

摘要

背景:肌腱病是一种常见的、疼痛的、功能受限的疾病,主要通过运动疗法进行保守治疗。回顾问题:(i)文献中报道了哪些运动干预措施可治疗哪些腱病?(ii)研究肌腱病运动干预措施的研究报告了哪些结果?(iii)哪种运动干预措施对所有肌腱疾病最有效?(iv)腱病的类型/位置或其他特定协变量是否影响哪些是最有效的运动疗法?(v) 肌腱病的运动干预措施的可行性和可接受性如何?方法:一项范围界定综述绘制了迄今为止报告的腱病和结果的运动干预措施图(问题i和ii)。此后,开展了两个特遣队系统审查工作流程。第一项研究调查了大量研究,分为三项疗效评估,对不同干预措施的疗效进行量化和比较(问题iii),并调查了一系列潜在调节因素的影响(问题iv)。第二个是收敛分离混合方法审查(问题五)。检索1998年发表的研究在图书馆数据库(n=9)、试验登记处(n=6)、灰色文献数据库(n=5)和谷歌学者中进行。范围界定综述搜索于2020年4月28日完成,疗效和混合方法搜索更新于2021年1月19日和2021年3月29日进行。结果:范围界定综述555项研究确定了一系列肌腱疾病的运动干预措施和结果,最常见的是阿喀琉斯、髌骨、肘外侧和肩袖相关肩痛。强化运动是最常见的,柔韧性运动主要用于上肢。残疾是阿喀琉斯、髌骨和肩袖相关肩部疼痛中最常见的结果;肘外侧腱病变以身体机能能力最为常见。疗效评价-204项研究提供了证据,证明运动疗法是安全有益的,患者普遍对治疗结果感到满意,并认为治疗效果有显著改善。在证据质量普遍较低和非常低的情况下,结果表明:(1)肩部可能更多地受益于柔韧性(效果大小阻力:柔韧性=0.18[95%CrI0.07-0.29])和本体感觉(效果大小:本体感觉=0.16[95%CrI-1.8-0.32]);(2) 当进行强化运动时,将同心和偏心模式相结合可能是最有益的(效果大小仅偏心:同心+偏心=0.48[95%CrI-0.13至1.1];和(3)当与另一种保守模式相结合时(例如注射或电针将效果大小增加≈0.1至0.3),运动可能是最有利的。混合方法综述-94项研究(11定性)提供了证据,证明对腱病的运动干预在很大程度上是可行和可接受的,并且在为腱病开运动处方时应考虑几个重要因素,包括对参与运动的潜在障碍和促进因素的认识、患者和提供者的先前经验和信念,以及患者教育、自我管理和患者与医疗保健专业关系的重要性。局限性:尽管有大量关于肌腱病运动的文献,但仍有方法和报告方面的局限性影响了可能提出的建议。结论:研究结果为运动结合另一种保守方式的使用提供了一些支持;肩部的灵活性和本体感觉锻炼;以及针对肌腱疾病的偏心和同心强化运动相结合。然而,必须根据现有证据的质量来解释调查结果。未来的工作:迫切需要高质量的疗效、有效性、成本效益和定性研究,并使用共同的术语、定义和结果进行充分报告。研究注册:该项目注册为DOI:10.11124/JBIES-20-0175(范围审查);PROSPERO CRD 42020168187(疗效评价);https://osf.io/preprints/sportrxiv/y7sk6/(疗效评价1);https://osf.io/preprints/sportrxiv/eyxgk/(疗效评价2);https://osf.io/preprints/sportrxiv/mx5pv/(疗效评价3);PROSPERO CRD42020164641(混合方法综述)。资助:该项目由美国国立卫生与保健研究所(NIHR)HTA项目资助,并将在《HTA期刊》上全文发表;第27卷第24期。有关更多项目信息,请访问NIHR期刊图书馆网站。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Exercise therapy for tendinopathy: a mixed-methods evidence synthesis exploring feasibility, acceptability and effectiveness.

Background: Tendinopathy is a common, painful and functionally limiting condition, primarily managed conservatively using exercise therapy.

Review questions: (i) What exercise interventions have been reported in the literature for which tendinopathies? (ii) What outcomes have been reported in studies investigating exercise interventions for tendinopathy? (iii) Which exercise interventions are most effective across all tendinopathies? (iv) Does type/location of tendinopathy or other specific covariates affect which are the most effective exercise therapies? (v) How feasible and acceptable are exercise interventions for tendinopathies?

Methods: A scoping review mapped exercise interventions for tendinopathies and outcomes reported to date (questions i and ii). Thereafter, two contingent systematic review workstreams were conducted. The first investigated a large number of studies and was split into three efficacy reviews that quantified and compared efficacy across different interventions (question iii), and investigated the influence of a range of potential moderators (question iv). The second was a convergent segregated mixed-method review (question v). Searches for studies published from 1998 were conducted in library databases (n = 9), trial registries (n = 6), grey literature databases (n = 5) and Google Scholar. Scoping review searches were completed on 28 April 2020 with efficacy and mixed-method search updates conducted on 19 January 2021 and 29 March 2021.

Results: Scoping review - 555 included studies identified a range of exercise interventions and outcomes across a range of tendinopathies, most commonly Achilles, patellar, lateral elbow and rotator cuff-related shoulder pain. Strengthening exercise was most common, with flexibility exercise used primarily in the upper limb. Disability was the most common outcome measured in Achilles, patellar and rotator cuff-related shoulder pain; physical function capacity was most common in lateral elbow tendinopathy. Efficacy reviews - 204 studies provided evidence that exercise therapy is safe and beneficial, and that patients are generally satisfied with treatment outcome and perceive the improvement to be substantial. In the context of generally low and very low-quality evidence, results identified that: (1) the shoulder may benefit more from flexibility (effect sizeResistance:Flexibility = 0.18 [95% CrI 0.07 to 0.29]) and proprioception (effect sizeResistance:Proprioception = 0.16 [95% CrI -1.8 to 0.32]); (2) when performing strengthening exercise it may be most beneficial to combine concentric and eccentric modes (effect sizeEccentricOnly:Concentric+Eccentric = 0.48 [95% CrI -0.13 to 1.1]; and (3) exercise may be most beneficial when combined with another conservative modality (e.g. injection or electro-therapy increasing effect size by ≈0.1 to 0.3). Mixed-method review - 94 studies (11 qualitative) provided evidence that exercise interventions for tendinopathy can largely be considered feasible and acceptable, and that several important factors should be considered when prescribing exercise for tendinopathy, including an awareness of potential barriers to and facilitators of engaging with exercise, patients' and providers' prior experience and beliefs, and the importance of patient education, self-management and the patient-healthcare professional relationship.

Limitations: Despite a large body of literature on exercise for tendinopathy, there are methodological and reporting limitations that influenced the recommendations that could be made.

Conclusion: The findings provide some support for the use of exercise combined with another conservative modality; flexibility and proprioception exercise for the shoulder; and a combination of eccentric and concentric strengthening exercise across tendinopathies. However, the findings must be interpreted within the context of the quality of the available evidence.

Future work: There is an urgent need for high-quality efficacy, effectiveness, cost-effectiveness and qualitative research that is adequately reported, using common terminology, definitions and outcomes.

Study registration: This project is registered as DOI: 10.11124/JBIES-20-00175 (scoping review); PROSPERO CRD 42020168187 (efficacy reviews); https://osf.io/preprints/sportrxiv/y7sk6/ (efficacy review 1); https://osf.io/preprints/sportrxiv/eyxgk/ (efficacy review 2); https://osf.io/preprints/sportrxiv/mx5pv/ (efficacy review 3); PROSPERO CRD42020164641 (mixed-method review).

Funding: This project was funded by the National Institute for Health and Care Research (NIHR) HTA programme and will be published in full in HTA Journal; Vol. 27, No. 24. See the NIHR Journals Library website for further project information.

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来源期刊
Health technology assessment
Health technology assessment 医学-卫生保健
CiteScore
6.90
自引率
0.00%
发文量
94
审稿时长
>12 weeks
期刊介绍: Health Technology Assessment (HTA) publishes research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS.
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