ICF框架下运动疗法对慢性非特异性颈痛效果的Meta分析

doi:10.3969/j.issn.1006-9771.2024.07.005

Abstract

Abstract:

Objective To systematically evaluate the effect of exercise therapy on body structure, function, and activity and participation in patients with chronic nonspecific neck pain (CNSNP) based on the International Classification of Functioning, Disability and Health (ICF) framework.
Methods A PICO framework was constructed, and randomized controlled trials (RCTs) on the intervention of different types of exercise therapy for patients with CNSNP were retrieved from databases of CBM, Wanfang data, VIP, CNKI, Cochrane Library, Embase, PubMed and Web of Science, from the establishment to March, 2024. The quality of the literature was evaluated with Cochrane Risk of Bias Tool and Physiotherapy Evidence Database (PEDro) scale, and the evidence quality of the outcome indicators was evaluated using GRADE. Data were synthesized and analyzed using RevMan 5.3, and the risk of bias was evaluated using Stata 18.0.
Results A total of eleven RCTs involving 668 subjects were included. The scores of PEDro scale were five to eight. The types of interventions included muscle strength training, stability training, proprioception training, Yoga and Pilates. The control groups received placebo, physical factor therapy and health education. Exercise therapy could increase the craniovertebral angle (SMD = 0.84, 95%CI 0.42 to 1.26, P < 0.001), reduce the Visual Analogue Scale score (SMD = -2.05, 95%CI -2.58 to -1.52, P < 0.001), increase the pressure pain threshold (MD = 112.27, 95%CI 75.03 to 149.50, P < 0.001), increase the range of motion of cervical forward (SMD = 1.24, 95%CI 0.34 to 2.15, P = 0.007) and lateral (SMD = 1.52, 95%CI 0.40 to 2.65, P = 0.008) flexion, and improve the endurance of the deep cervical flexors (SMD = 1.02, 95%CI 0.10 to 1.94, P = 0.03) and position sense of the cervical spine (SMD = -1.00, 95%CI -1.47 to -0.53, P < 0.001); however, it was not significant in improving the range of motion of backward flexion (SMD = 0.85, 95%CI -1.04 to 2.75, P = 0.38) and rotation (SMD = 1.65, 95%CI -0.35 to 3.65, P = 0.11). Exercise therapy could also reduce the Neck Disability Index score (MD = -11.88, 95%CI -16.09 to -7.68, P < 0.001), and it was no significant in the Short-Form-36 score (MD = 19.04, 95%CI -3.00 to 41.08, P = 0.09).
Conclusion Exercise therapy can improve head posture, pain, motion of forward flexion and lateral flexion, endurance of the cervical flexors and joint position sense, and the overall function in patients with CNSNP. However, further researches are needed to verify the effects on cervical backward flexion and rotation, and quality of life.

Key words: chronic nonspecific neck pain, exercise, International Classification of Functioning, Disability and Health, meta-analysis

CLC Number:

R681.55

WEN Yanfei, YANG Lu, BAN Yue, Ykabaru Daniela BERBESI NORIEGA, ZHANG Haoqi, WANG Li, LIU Hua. Effect of exercise therapy on chronic nonspecific neck pain: a meta-analysis based on ICF[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(7): 778-788.

Figures/Tables 9

Table 1

Figure 1

Figure 2

Figure 3

Table 2

Table 3

Basic characteristics of included literatures"

纳入文献	国家	n		年龄/岁		干预人员	干预场所	干预措施		干预周期	结局
纳入文献	国家	T	C	T	C	干预人员	干预场所	T	C	干预周期	结局
Alshehre等^[16] (2023)	沙特阿拉伯	30	30	42.1±4.5	44.2±4.8	物理治疗师	医院和工作场所	综合运动训练(肌力、牵伸、耐力)+人体工程学+健康教育	人体工程学+健康教育	每周2次，共8周	身体结构：未提及身体功能：数字分级量表评分降低活动和参与：NDI评分降低，生活质量改善
Andersen等^[17] (2014)	丹麦	24	23	44±13	45±11	物理治疗师	工作场所	稳定性训练	空白对照	每周3次，共10周	身体结构：未提及身体功能：PPTs提高活动和参与：未提及
Hernandez-Lucas等^[18] (2023)	西班牙	18	17	51.9±7.8	51.4±11.3	物理治疗师	医院	肌力训练+本体感觉训练	空白对照	每周2次，共8周	身体结构：未提及身体功能：VAS评分降低，颈部肌肉耐力增强活动和参与：未提及
Khosrokiani等^[19] (2018)	伊朗	15	15	36.07±5.59	37.60±5.58	物理治疗师	医院	方向-运动控制训练	健康教育	每周3次，共6个月	身体结构：未提及身体功能：VAS评分降低，颈部肌肉耐力增强，关节位置觉改善，关节活动度增加活动和参与：NDI评分降低
Kim^[20] (2018)	韩国	18	20	20.8±1.2	21.1±1.2	大学研究人员	学校	瑜伽	空白对照	每周2次，共8周	身体结构：未提及身体功能：VAS评分降低活动和参与：未提及
Letafatkar等^[21] (2020)	伊朗	24	24	34.27±2.72	34.60±3.30	物理治疗师	医院	综合运动训练(本体感觉、肌力和稳定性训练)+健康教育	健康教育	每周3~5次，共8周	身体结构：CVA增加身体功能：VAS评分降低活动和参与：NDI评分降低
Li等^[22] (2017)	中国	组1：36 组2：32	34	组1：35.6±7.9 组2：33.7±9.0	34.1±8.2	物理治疗师	医院	组1：渐进抗阻训练组2：固定抗阻训练	健康教育	每周4次，共6周	身体结构：未提及身体功能：VAS评分降低，PPTs提高，颈部肌力增加活动和参与：NDI评分降低
Ma等^[23] (2011)	中国	15	15	34.2±10.3	30.0±10.3	社区卫生人员	工作场所和家庭社区	肌力训练+牵伸训练+健康教育	健康教育	每次20 min，共6周	身体结构：未提及身体功能：VAS评分降低活动和参与：NDI评分降低
Picak等^[24] (2023)	土耳其	24	25	31.54±5.23	29.40±5.24	物理治疗师	医院	普拉提	健康教育	每周3次，共6周	身体结构：CVA增加身体功能：VAS评分降低，颈部肌肉耐力增加，关节活动度增加，关节位置觉改善活动和参与：NDI评分降低
Tunwattanapong等^[25] (2016)	泰国	48	48	34.2±9.0	36.5±8.7	物理治疗师	医院	牵伸训练+健康教育	健康教育	每周5次，共4周	身体结构：未提及身体功能：VAS评分降低活动和参与：功能障碍程度改善；生活质量提高
胡鸢等^[26](2011)	中国	65	68	40.63±10.20	41.81±9.27	物理治疗师	医院	稳定性训练	物理因子治疗	每周3次，共6周	身体结构：未提及身体功能：VAS评分降低活动和参与：NDI评分降低

Table 3

Table 4

Figure 4

Table 5

References 47

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纳入文献	资格标准	随机分配	分配隐藏	基线相似	评估者施盲	被试流失率≤15%	意向性分析	组间统计比较	变异性测量	总分
Alshehre等^[16] (2023)	√	√	√	√	√	√	√	√	√	8
Andersen等^[17] (2014)	√	√	√	√	√		√	√	√	7
Hernandez-Lucas等^[18] (2023)	√	√	√	√	√		√	√	√	7
Khosrokiani等^[19] (2018)	√	√		√		√		√	√	5
Kim^[20] (2018)	√	√		√		√		√	√	5
Letafatkar等^[21] (2020)	√	√	√	√	√	√	√	√	√	8
Li等^[22] (2017)	√	√	√	√	√	√	√	√	√	8
Ma等^[23] (2011)	√	√		√		√		√	√	5
Picak等^[24] (2023)	√	√		√		√		√	√	5
Tunwattanapong等^[25] (2016)	√	√	√	√	√	√	√	√	√	8
胡鸢等^[26] (2011)	√	√		√		√	√	√	√	6

结局指标	纳入研究数/n	异质性检验		效应模型	Meta分析结果
结局指标	纳入研究数/n	I²值/%	P值	效应模型	MD (95%CI)	SMD (95%CI)	P值
CVA^[21,24]	2	8	0.300	固定效应模型		0.84 (0.42, 1.26)	< 0.001
VAS^{[18⇓⇓⇓⇓⇓⇓⇓-26]}	9	85	< 0.001	随机效应模型		-2.05 (-2.58, -1.52)	< 0.001
PPTs^[17,22]	2	58	0.090	随机效应模型	112.27 (75.03, 149.50)		< 0.001
关节活动度(前屈)^[19,24]	2	67	0.080	随机效应模型		1.24 (0.34, 2.15)	0.007
关节活动度(后屈)^[19,24]	2	92	< 0.001	随机效应模型		0.85 (-1.04, 2.75)	0.380
关节活动度(侧屈)^[19,24]	2	76	0.040	随机效应模型		1.52 (0.40, 2.65)	0.008
关节活动度(旋转)^[19,24]	2	91	< 0.001	随机效应模型		1.65 (-0.35, 3.65)	0.110
颈深屈肌耐力^[18-19,24]	3	77	0.010	随机效应模型		1.02 (0.10, 1.94)	0.030
关节位置觉^[19,24]	2	12	0.290	固定效应模型		-1.00 (-1.47, -0.53)	< 0.001
NDI^{[16,19,21⇓⇓-24,26]}	7	95	< 0.001	随机效应模型	-11.88 (-16.09, -7.68)		< 0.001
生活质量^[16,25]	2	95	< 0.001	随机效应模型	19.04 (-3.00, 41.08)		0.090

结局指标	纳入研究数/n	研究的局限性	不一致性	间接性	不精确性	发表偏倚	证据质量
VAS^{[18⇓⇓⇓⇓⇓⇓⇓-26]}	9	不严重	严重	不严重	不严重	不严重	中级
NDI^{[16,19,21⇓⇓-24,26]}	7	不严重	严重	不严重	不严重	不严重	中级
颈深屈肌耐力^[18-19,24]	3	严重	严重	严重	严重	不严重	极低级

Effect of exercise therapy on chronic nonspecific neck pain: a meta-analysis based on ICF

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