Management of frozen shoulder: a systematic review and cost-effectiveness analysis
Management of frozen shoulder: a systematic review and cost-effectiveness analysis
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DOI：
10.3310/hta16110
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发表时间：
2012-03-01
影响因子：
3.6
通讯作者：
McDaid, C.
中科院分区：
文献类型：
--
作者：
Maund, E.;Craig, D.;McDaid, C.
背景：肩周炎是肩部活动受限的病症。它可以被描述为原发性（特发性），即病因未知；也可以被描述为继发性，即可以归因于其他原因。它通常是一种自限性疾病，持续时间约为 1 至 3 年，但可能会出现不完全缓解的情况。 目标：评估原发性肩周炎治疗的临床效果和成本效益，根据病情阶段确定最合适的干预措施，并强调证据中的任何差距。数据来源：进行了系统评价。截至 2010 年 3 月，检索了 19 个数据库和其他来源，包括护理和联合健康累积索引 (CINAHL)、科学引文索引、BIOSIS 预览和效果评价摘要数据库 (DARE)，以及截至 2011 年 1 月的 EMBASE 和 MEDLINE，没有语言限制。 2010 年 6 月在 MEDLINE、CINAHL 和 PsycINFO 中检索了患者对治疗看法的研究。 审查方法：评估物理疗法、关节扩张、类固醇注射、透明质酸钠注射、麻醉下操作、囊膜释放或观察等待（单独或组合）的随机对照试验 (RCT) 符合纳入条件。原发性肩周炎患者（伴或不伴糖尿病）均纳入其中。在缺乏随机对照试验的情况下纳入了准实验研究，并且仅针对麻醉下操作（MUA）和囊膜释放进行了病例系列研究。包括符合临床审查的干预和人群纳入标准的完整经济评估。两名研究人员根据纳入标准独立筛选研究的相关性。一名评审员提取数据并评估研究质量；这是由第二位审稿人检查的。主要关注的结果是疼痛、活动范围、功能和残疾、生活质量和不良事件。该分析包括叙述综合和成对荟萃分析。还进行了混合治疗比较（MTC）。本来打算建立一个经济决策模型，但由于缺乏可用的证据，结果被发现不可信。资源使用情况由临床顾问估算，并与通过绘图获得的质量调整生命年相结合，得出初步的成本效益结果。结果：纳入了 31 项临床有效性研究和一项经济评估。临床效果研究评估了类固醇注射、透明质酸钠、监督忽视、物理治疗（主要是物理治疗）、针灸、MUA、扩张和囊膜松解。许多已确定的研究存在很高的偏倚风险。由于干预措施和比较者的差异，很少有研究可以汇总到荟萃分析中。根据单个随机对照试验，并且仅对于某些结果，短波透热疗法可能比家庭锻炼更有效。在大多数患者已经接受过治疗的人群中，高级别动员可能比低级别动员更有效。两项随机对照试验的数据表明，在家庭锻炼中添加单次关节内类固醇注射可能对患有肩周炎的患者有益。
Background: Frozen shoulder is condition in which movement of the shoulder becomes restricted. It can be described as either primary (idiopathic) whereby the aetiology is unknown, or secondary, when it can be attributed to another cause. It is commonly a self-limiting condition, of approximately 1 to 3 years' duration, though incomplete resolution can occur.Objectives: To evaluate the clinical effectiveness and cost-effectiveness of treatments for primary frozen shoulder, identify the most appropriate intervention by stage of condition and highlight any gaps in the evidence.Data sources: A systematic review was conducted. Nineteen databases and other sources including the Cumulative Index to Nursing and Allied Health (CINAHL), Science Citation Index, BIOSIS Previews and Database of Abstracts of Reviews of Effects (DARE) were searched up to March 2010 and EMBASE and MEDLINE up to January 2011, without language restrictions. MEDLINE, CINAHL and PsycINFO were searched in June 2010 for studies of patients' views about treatment.Review methods: Randomised controlled trials (RCTs) evaluating physical therapies, arthrographic distension, steroid injection, sodium hyaluronate injection, manipulation under anaesthesia, capsular release or watchful waiting, alone or in combination were eligible for inclusion. Patients with primary frozen shoulder (with or without diabetes) were included. Quasi-experimental studies were included in the absence of RCTs and case series for manipulation under anaesthesia (MUA) and capsular release only. Full economic evaluations meeting the intervention and population inclusion criteria of the clinical review were included. Two researchers independently screened studies for relevance based on the inclusion criteria. One reviewer extracted data and assessed study quality; this was checked by a second reviewer. The main outcomes of interest were pain, range of movement, function and disability, quality of life and adverse events. The analysis comprised a narrative synthesis and pair-wise meta-analysis. A mixed-treatment comparison (MTC) was also undertaken. An economic decision model was intended, but was found to be implausible because of a lack of available evidence. Resource use was estimated from clinical advisors and combined with quality-adjusted life-years obtained through mapping to present tentative cost-effectiveness results.Results: Thirty-one clinical effectiveness studies and one economic evaluation were included. The clinical effectiveness studies evaluated steroid injection, sodium hyaluronate, supervised neglect, physical therapy (mainly physiotherapy), acupuncture, MUA, distension and capsular release. Many of the studies identified were at high risk of bias. Because of variation in the interventions and comparators few studies could be pooled in a meta-analysis. Based on single RCTs, and for some outcomes only, short-wave diathermy may be more effective than home exercise. High-grade mobilisation may be more effective than low-grade mobilisation in a population in which most patients have already had treatment. Data from two RCTs showed that there may be benefit from adding a single intra-articular steroid injection to home exercise in patients with frozen shoulder of