文章摘要
凌梦钰,杨一卓,叶超群.运动疗法治疗类风湿性关节炎的Meta分析[J].中国康复,2021,36(5):298-304
运动疗法治疗类风湿性关节炎的Meta分析
Efficacy of exercises in rheumatoid arthritis: A meta-analysis
  
DOI:
中文关键词: 类风湿性关节炎  运动疗法  康复  Meta分析
英文关键词: Rheumatoid arthritis  Exercises  Rehabilitation  Meta-analysis
基金项目:中央军委后勤科研重点项目资助(BKJ17J006)
作者单位
凌梦钰 1.安徽医科大学空军临床学院北京1001422.空军特色医学中心康复医学科北京100412 
杨一卓 空军特色医学中心康复医学科北京100412 
叶超群 空军特色医学中心康复医学科北京100412 
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中文摘要:
      目的:采用Meta分析法评价运动疗法治疗类风湿性关节炎(RA)的疗效。方法:使用知网(CNKI)、万方、维普、中国生物医学文献数据库(CBM)以及PubMed、Cochrane、Embase数据库,检索国内外有关运动疗法治疗RA的随机对照试验(RCT)。检索时间从2010年1月~2020年2月,按照纳入与排除标准对文献进行筛选、信息提取,用Cochrane风险偏倚评估表进行质量评价,并使用Review Manager 5.2软件进行Meta分析。研究结果包括关节压痛计数、关节肿胀计数、晨僵时间、血沉、28个关节疾病活动度评分、双手平均握力、健康评估问卷和患者总体评估。用标准化均数差(SWD)、加权均数差(WMD)评定疗效,并对异质性进行检验。结果:共纳入9项RCT研究,合计患者547例,其中运动组(干预组)262例,非运动组(对照组)285例。Meta分析结果显示:干预组与对照组治疗RA的疗效相比,在患者的关节肿胀计数[WMD=-0.74,P<0.00001]、晨僵时间[SMD=-0.54,P<0.0001]、血沉[SMD=-0.26,P=0.04]、28个关节疾病活动度评分[WMD=-0.45,P=0.02]、双手平均握力[SMD=0.38,P=0.001]、健康评估问卷[SMD=-0.51,P<0.0001]和患者总体评估[SMD=-2.43,P=0.0006]上的结果均有统计学差异,运动组较非运动组在治疗RA的效果上有明显优势。结论:采用运动疗法治疗RA是安全有效的,较非运动疗法能进一步改善患者功能障碍,减轻关节疼痛和肿胀,并提高其生活质量。
英文摘要:
      Objective: To evaluate the effectiveness of exercises on rheumatoid arthritis (RA) by meta-analysis. Methods: A systematic literature search was done using CNKI, Wanfang, Vip, CBM, as well as PubMed, Embase and Cochrane databases from January 2010 to February 2020 at home and abroad. The RCTs comparing exercise-based therapy with non-exercise-based therapy on RA were included. Literature was screened and information extracted according to inclusion and exclusion criteria, and quality evaluation was performed by Cochrane risk bias assessment form. Meta analysis was performed by Review Manager 5.2 software. Outcomes studied included post-intervention joint count, morning stiffness time, ESR, DAS28, average grip strength of both hands, disability on the HAQ and PGA. Efficacy was assessed by Standard mean difference/Weighted mean differences and the heterogeneity was tested. Results: A total of 9 RCTs, with a total of 547 patients, including 262 in the exercises & drug group and 285 in the drug group, were analyzed. There was significant difference between two groups in SJC [WMD=-0.74, P<0.00001], morning stiffness time [SMD=-0.54, P<0.0001], ESR [SMD=-0.26, P=0.04], DAS28 [WMD=-0.45, P=0.02], mean grip strength of both hands [SMD=0.38, P=0.001], HAQ [SMD=-0.51, P<0.0001] and PGA [SMD=-2.43, P=0.0006]. The results suggested that the exercises combined with conventional drug group had a significant advantage in the treatment of RA in comparison to the traditional drug treatment group. Conclusion: The combination of exercises and drug therapy in RA is safe, and the improvement in most outcomes was statistically significant, which can improve patients’ dysfunction, reduce joint pain and swelling, and improve the quality of life.
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