Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis.
Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis.
复制标题
慢性非特异性下腰痛的心理干预：系统性回顾和网络荟萃分析
DOI：
10.1136/bmj-2021-067718
复制
发表时间：
2022-03-30
期刊：
影响因子：
--
通讯作者：
Ferreira PH
中科院分区：
文献类型：
--
作者：
Ho EK;Chen L;Simic M;Ashton-James CE;Comachio J;Wang DXM;Hayden JA;Ferreira ML;Ferreira PH
确定心理干预对慢性腰痛的有效性和安全性。采用网络荟萃分析的系统性综述。Medline、Embase、PsycINFO、科克伦对照试验中心注册中心、Web of Science、SCOPUS和CINAHL，数据库创建至2021年1月31日。随机对照试验，比较心理干预与任何对照干预对慢性非特异性腰痛成人的影响。两名评审员独立筛选研究，提取数据，并评估偏倚风险和证据的置信度。主要结局为身体功能和疼痛强度。在干预后（从治疗结束至干预后<2个月）、短期（干预后≥2至<6个月）、中期（干预后≥6至<12个月）和长期随访（干预后≥12个月）时，使用频率主义方法进行随机效应网络荟萃分析。物理治疗护理是参考比较干预。使用设计-治疗相互作用模型评估整体不一致性，使用布赫方法评估局部不一致性。纳入了97项随机对照试验，涉及13136名受试者和17个治疗节点。在短期和中期随访时检测到身体功能的不一致性，以及在短期随访时检测到疼痛强度的不一致性，并通过敏感性分析解决。对于身体功能，认知行为治疗（标准化平均差异1.01，95%置信区间0.58至1.44）和疼痛教育（0.62，0.08至1.17），与物理治疗护理一起提供，导致干预后临床重要的改善（中等质量证据）。至少在中期随访之前，报告了疼痛教育和物理治疗护理对改善身体功能的最可持续治疗效果（0.63，0.25 - 1.00;低质量证据）。没有研究调查疼痛教育与物理治疗护理的长期有效性。对于疼痛强度，行为治疗（1.08，0.22至1.94），认知行为治疗（0.92，0.43至1.42）和疼痛教育（0.91，0.37至1.45），与物理治疗护理一起提供，在干预后产生临床重要影响（低至中等质量证据）。只有行为治疗与物理治疗护理一起提供，在中期随访前保持了临床上重要的减轻疼痛强度的效果（1.01，0.41至1.60;高质量证据）。对于患有慢性、非特异性腰痛的人，心理干预与物理治疗护理（主要是结构性运动）结合使用时最有效。疼痛教育计划（低至中等质量的证据）和行为疗法（低至高质量的证据）产生了最可持续的治疗效果;然而，其长期有效性仍存在不确定性。虽然发现了不一致之处，但查明并解决了潜在的来源。PROSPERO CRD 42019138074。
To determine the comparative effectiveness and safety of psychological interventions for chronic low back pain. Systematic review with network meta-analysis. Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS, and CINAHL from database inception to 31 January 2021. Randomised controlled trials comparing psychological interventions with any comparison intervention in adults with chronic, non-specific low back pain. Two reviewers independently screened studies, extracted data, and assessed risk of bias and confidence in the evidence. Primary outcomes were physical function and pain intensity. A random effects network meta-analysis using a frequentist approach was performed at post-intervention (from the end of treatment to <2 months post-intervention); and at short term (≥2 to <6 months post-intervention), mid-term (≥6 to <12 months post-intervention), and long term follow-up (≥12 months post-intervention). Physiotherapy care was the reference comparison intervention. The design-by-treatment interaction model was used to assess global inconsistency and the Bucher method was used to assess local inconsistency. 97 randomised controlled trials involving 13 136 participants and 17 treatment nodes were included. Inconsistency was detected at short term and mid-term follow-up for physical function, and short term follow-up for pain intensity, and were resolved through sensitivity analyses. For physical function, cognitive behavioural therapy (standardised mean difference 1.01, 95% confidence interval 0.58 to 1.44), and pain education (0.62, 0.08 to 1.17), delivered with physiotherapy care, resulted in clinically important improvements at post-intervention (moderate quality evidence). The most sustainable effects of treatment for improving physical function were reported with pain education delivered with physiotherapy care, at least until mid-term follow-up (0.63, 0.25 to 1.00; low quality evidence). No studies investigated the long term effectiveness of pain education delivered with physiotherapy care. For pain intensity, behavioural therapy (1.08, 0.22 to 1.94), cognitive behavioural therapy (0.92, 0.43 to 1.42), and pain education (0.91, 0.37 to 1.45), delivered with physiotherapy care, resulted in clinically important effects at post-intervention (low to moderate quality evidence). Only behavioural therapy delivered with physiotherapy care maintained clinically important effects on reducing pain intensity until mid-term follow-up (1.01, 0.41 to 1.60; high quality evidence). For people with chronic, non-specific low back pain, psychological interventions are most effective when delivered in conjunction with physiotherapy care (mainly structured exercise). Pain education programmes (low to moderate quality evidence) and behavioural therapy (low to high quality evidence) result in the most sustainable effects of treatment; however, uncertainty remains as to their long term effectiveness. Although inconsistency was detected, potential sources were identified and resolved. PROSPERO CRD42019138074.
登录
查看更多内容
影响因子：
4.8
作者：
Ahern, Malene;Dean, Catherine Mary;Hush, Julia Margaret
通讯作者：
Hush, Julia Margaret
影响因子：
3.3
作者：
Bury, T. J.;Stokes, E. K.
通讯作者：
Stokes, E. K.
影响因子：
3.7
作者：
Clement RC;Welander A;Stowell C;Cha TD;Chen JL;Davies M;Fairbank JC;Foley KT;Gehrchen M;Hagg O;Jacobs WC;Kahler R;Khan SN;Lieberman IH;Morisson B;Ohnmeiss DD;Peul WC;Shonnard NH;Smuck MW;Solberg TK;Stromqvist BH;Hooff ML;Wasan AD;Willems PC;Yeo W;Fritzell P
通讯作者：
Fritzell P
影响因子：
2.9
作者：
Gannon, Jamie;Atkinson, Joseph H.;Rutledge, Thomas
通讯作者：
Rutledge, Thomas
影响因子：
5.2
作者：
Caldwell, Deborah M.;Welton, Nicky J.
通讯作者：
Welton, Nicky J.