How strong is the evidence that conservative treatment reduces pain and improves function in individuals with patellar tendinopathy? A systematic review of randomised controlled trials including GRADE recommendations
How strong is the evidence that conservative treatment reduces pain and improves function in individuals with patellar tendinopathy? A systematic review of randomised controlled trials including GRADE recommendations
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保守治疗可减轻髌腱病患者的疼痛并改善其功能的证据有多充分？
DOI：
10.1136/bjsports-2018-099747
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发表时间：
2019
影响因子：
18.4
通讯作者：
V. C. Oliveira
中科院分区：
文献类型：
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作者：
L. Mendonça;H. Leite;J. Zwerver;N. Henschke;Guilherme R. Branco;V. C. Oliveira
目的比较保守治疗(CT)与微创干预(MI)或其他侵入性干预治疗(MI)或合并下沉偏心蹲治疗(CT)对髌腱病(PT)患者疼痛和功能的影响。方法检索MEDLINE、Embase、Cochrane、Pedro、SPORTDiscus、CINAHL和Amed数据库。所有评估CT的随机试验(不涉及侵入性程序或药物的任何干预)都包括在PT患者中。两位评价者筛选研究，提取数据，评估所有纳入研究的偏倚风险。在适当的情况下，进行荟萃分析；我们使用等级方法评估证据的确定性。结果与MI组比较，CT组在短期(3个月)内对疼痛(加权平均差−2.6，95%CI−6.5~1.2)和功能(WMD 1.8，95%CI−2.4~6.1)无明显改善。与有创干预相比，短期内CT对疼痛(WMD0.7，95%CI−0.1~1.4)和功能(WMD−6.6，95%CI−13.3~0.2)均无改善作用。短期随访时，联合CT对疼痛(WMD−0.5，95%CI−1.4~0.4)或功能(WMD−2.3，95%~9.1~4.6)均无总体影响。单一研究显示，短期随访时离子导入(d=2.42)或中长期随访时干针(d=1.17)对疼痛有影响，中长期随访(超过3个月)时运动干预对疼痛有影响(d=0.83)。总结/结论我们对治疗效果的估计只有很低到很低的确定性证据来支持它们。这一运动医学/运动理疗领域迫切需要更大规模的高质量研究，将疼痛和功能列为潜在的主要结果。
Objective To determine the effectiveness of conservative treatment (CT) on pain and function in patients with patellar tendinopathy (PT) compared with minimal intervention (MI) or other invasive intervention, or in addition to decline eccentric squat. Methods Searches were performed in MEDLINE, Embase, Cochrane, PEDro, SPORTDiscus, CINAHL and AMED databases. All randomised trials that evaluated CT (any intervention not involving invasive procedures or medication) in individuals with PT were included. Two reviewers screened studies, extracted data and assessed risk of bias of all included studies. Where suitable, meta-analyses were conducted; we assessed certainty of the evidence using GRADE methodology. Results When compared with MI, CT did not improve pain (weighted mean difference (WMD) −2.6, 95% CI −6.5 to 1.2) or function (WMD 1.8, 95% CI −2.4 to 6.1) in the short-term (up to 3 months) follow-up. When compared with invasive intervention, CT did not improve pain (WMD 0.7, 95% CI −0.1 to 1.4) or function (WMD −6.6, 95% CI −13.3 to 0.2) in the short-term follow-up. No overall effects were found for combined CT (when a conservative intervention was added to decline eccentric squat) on pain (WMD −0.5, 95% CI −1.4 to 0.4) or function (WMD −2.3, 95 % –9.1 to 4.6) at short-term follow-up. Single studies showed an effect on pain with iontophoresis at short-term follow-up (d = 2.42) or dry needling at medium/long-term follow-up (d = 1.17) and function with exercise intervention at medium/long-term follow-up (over 3 months) (d = 0.83). Summary/Conclusion Our estimates of treatment effect have only low to very low certainty evidence to support them. This field of sports medicine/sports physiotherapy urgently needs larger, high-quality studies with pain and function among the potential primary outcomes.
DOI：
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发表时间：
2011
期刊：
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影响因子：
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作者：
J. Higgins
通讯作者：
J. Higgins