Exercise-based management versus surgery for multidirectional instability of the glenohumeral joint: a systematic review
Exercise-based management versus surgery for multidirectional instability of the glenohumeral joint: a systematic review
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基于运动的管理与手术治疗盂肱关节多向不稳定性：系统评价
DOI：
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发表时间：
2015
影响因子：
18.4
通讯作者：
L. Watson
中科院分区：
文献类型：
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作者：
S. Warby;T. Pizzari;Jon J. Ford;A. Hahne;L. Watson
多向不稳定（MDI）最常推荐的治疗方法是运动治疗，如果运动治疗失败，则手术治疗。我们的目的是评估MDI患者运动管理与手术相比的有效性。次要目的是确定有效的协议和任何与运动或手术相关的不良反应。方法检索科克伦系统评价数据库、MEDLINE、EMBASE、CINAHL、PEDro、Current Contents、AMED、AMI、Ausport和Clinical Trials Registers，检索从开始日期到2014年8月的已发表和未发表的研究，检索词为多向不稳定、盂肱关节、运动和手术。选择标准包括所有研究设计（病例报告和病例系列除外）和MDI参与者，其中在同一研究中比较了基于运动的管理和手术。入选标准不受结局的限制。使用科克伦标准评估偏倚风险。GRADE方法用于综合证据。结果4个非随机对照研究符合纳入标准。所有4项研究的偏倚风险均较高。GRADE评估显示，在损伤结局指标方面，手术上级运动疗法的证据质量非常低，在患者报告的结局指标方面，运动优于手术。总结：由于受试者的异质性和纳入研究的高偏倚水平，难以确定基于运动的管理与手术治疗MDI的效果。
Background The most commonly recommended treatment for multidirectional instability (MDI) is exercise-based management, followed by surgery if exercise management fails. We aimed to evaluate the effectiveness of exercise-based management compared with surgery in patients with MDI. Secondary aims were to identify effective protocols and any adverse effects associated with exercise or surgery. Method The Cochrane database of systematic reviews, MEDLINE, EMBASE, CINAHL, PEDro, Current Contents, AMED, AMI, Ausport and Clinical Trials Registers were searched for published and unpublished studies from inception date to August 2014, using the key words multidirectional instability, and glenohumeral and exercise and surgery. Selection criteria included all study designs (except case reports and case series) and participants with MDI where both exercise-based management and surgery were compared in the same study. Inclusion criteria were not limited by outcomes. Risk of bias was assessed using Cochrane criteria. The GRADE approach was used to synthesise the evidence. Results 4 non-randomised studies met the inclusion criteria. Risk of bias was high in all 4 studies. GRADE assessment revealed very low-quality evidence that surgery was superior to exercise therapy for impairment outcome measures, and exercise was favoured over surgery for patient-reported outcome measures. Summary The effect of exercise-based management compared with surgery for MDI is difficult to determine due to participant heterogeneity and a high level of bias across included studies.