Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis.
Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis.
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冻结肩部治疗的比较：系统评价和荟萃分析。
DOI：
10.1001/jamanetworkopen.2020.29581
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发表时间：
2020-12-01
影响因子：
13.8
通讯作者：
Millar NL
中科院分区：
文献类型：
--
作者：
Challoumas D;Biddle M;McLean M;Millar NL
与其他治疗方法相比，是否有任何治疗方法与肩周炎有更好的疗效？在这项包含4097名参与者的65项研究的荟萃分析中，与其他非手术治疗相比，关节内皮质类固醇与增加的短期益处相关，其优势似乎持续了长达6个月。增加家庭锻炼计划和/或电疗或被动活动可能与额外的好处相关。这项研究的结果表明，首次接触肩关节冻结的患者应给予关节内皮质类固醇治疗。这项系统性综述和荟萃分析评估和比较了可供选择的肩周炎治疗方案的有效性，以指导肌肉骨骼从业者，并为指南提供参考。对于肩部冻结的患者，有无数可供选择的治疗方案，这可能会让治疗卫生保健专业人员不堪重负。评估和比较可供选择的治疗肩周炎的有效性，以指导肌肉骨骼医生，并提供指导方针。Medline、EMBASE、Scope us和CINHAL在2020年2月被搜索。纳入了任何类型的随机设计的研究，这些设计将冻结肩的治疗方式与其他方式、安慰剂或不治疗进行比较。数据由2个人独立提取。这项研究遵循系统回顾和荟萃分析(PRISMA)报告指南的首选报告项目。研究采用随机效应模型。疼痛和功能是主要结果，外旋活动范围(ER-ROM)是次要结果。配对Meta分析的结果是疼痛和ER的平均差异(MDS)和功能的标准化平均差异(SMDS)。随访时间分为短期(≤12周)、中期(>；12周至≤12个月)和长期(>；12个月)。在纳入系统综述的65项符合条件的研究中，34项研究2402名参与者纳入配对荟萃分析，39项研究2736名参与者纳入网络荟萃分析。尽管在配对荟萃分析中有几个具有统计学意义的结果，但只有关节内(IA)皮质类固醇治疗与短期内其他干预措施相比具有统计学和临床优势(与不治疗或安慰剂相比：MD，−1.0VAS分；95%CI，−1.5to−0.5VAS分；P <； .001；vs理疗：MD，−1.1VAS分；95%CI，−1.7%至−0.5VAS分；P <； .001)和功能(与未治疗或安慰剂相比：SMD0.6；95%CI，0.3至0.9；P <； .001；vs物理治疗：SMD0.5；95%CI，0.2至0.7；P <； .001)。亚组分析和网络荟萃分析表明，在IA皮质类固醇的基础上增加一项家庭锻炼计划，包括简单的锻炼、伸展运动和物理治疗(电疗和/或动员)，可能会在中期带来额外的益处(例如，IA皮质类固醇与不接受治疗或安慰剂相比，疼痛：MD，−1.4VAS分；95%CI，−1.8%至−1.1VAS分；P <； .001)。这项研究的结果表明，对于病程少于1年的肩周炎患者，早期使用IA皮质类固醇与较好的预后相关。这种治疗应该伴随着家庭锻炼计划，以最大限度地增加康复的机会。
Are any treatment modalities for frozen shoulder associated with better outcomes than other treatments? In this meta-analysis of 65 studies with 4097 participants, intra-articular corticosteroid was associated with increased short-term benefits compared with other nonsurgical treatments, and its superiority appeared to last for as long as 6 months. The addition of a home exercise program and/or electrotherapy or passive mobilizations may be associated with added benefits. The results of this study suggest that intra-articular corticosteroid should be offered to patients with frozen shoulder at first contact. This systematic review and meta-analysis assesses and compares the effectiveness of available treatment options for frozen shoulder to guide musculoskeletal practitioners and inform guidelines. There are a myriad of available treatment options for patients with frozen shoulder, which can be overwhelming to the treating health care professional. To assess and compare the effectiveness of available treatment options for frozen shoulder to guide musculoskeletal practitioners and inform guidelines. Medline, EMBASE, Scopus, and CINHAL were searched in February 2020. Studies with a randomized design of any type that compared treatment modalities for frozen shoulder with other modalities, placebo, or no treatment were included. Data were independently extracted by 2 individuals. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Random-effects models were used. Pain and function were the primary outcomes, and external rotation range of movement (ER ROM) was the secondary outcome. Results of pairwise meta-analyses were presented as mean differences (MDs) for pain and ER ROM and standardized mean differences (SMDs) for function. Length of follow-up was divided into short-term (≤12 weeks), mid-term (>12 weeks to ≤12 months), and long-term (>12 months) follow-up. From a total of 65 eligible studies with 4097 participants that were included in the systematic review, 34 studies with 2402 participants were included in pairwise meta-analyses and 39 studies with 2736 participants in network meta-analyses. Despite several statistically significant results in pairwise meta-analyses, only the administration of intra-articular (IA) corticosteroid was associated with statistical and clinical superiority compared with other interventions in the short-term for pain (vs no treatment or placebo: MD, −1.0 visual analog scale [VAS] point; 95% CI, −1.5 to −0.5 VAS points; P < .001; vs physiotherapy: MD, −1.1 VAS points; 95% CI, −1.7 to −0.5 VAS points; P < .001) and function (vs no treatment or placebo: SMD, 0.6; 95% CI, 0.3 to 0.9; P < .001; vs physiotherapy: SMD 0.5; 95% CI, 0.2 to 0.7; P < .001). Subgroup analyses and the network meta-analysis demonstrated that the addition of a home exercise program with simple exercises and stretches and physiotherapy (electrotherapy and/or mobilizations) to IA corticosteroid may be associated with added benefits in the mid-term (eg, pain for IA coritocosteriod with home exercise vs no treatment or placebo: MD, −1.4 VAS points; 95% CI, −1.8 to −1.1 VAS points; P < .001). The findings of this study suggest that the early use of IA corticosteroid in patients with frozen shoulder of less than 1-year duration is associated with better outcomes. This treatment should be accompanied by a home exercise program to maximize the chance of recovery.
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DOI：
10.2174/1874325001711010065
发表时间：
2017
期刊：
The open orthopaedics journal
影响因子：
--
作者：
Georgiannos D;Markopoulos G;Devetzi E;Bisbinas I
通讯作者：
Bisbinas I
影响因子：
3
作者：
Bal, Ajda;Eksioglu, Emel;Cakci, Aytul
通讯作者：
Cakci, Aytul
影响因子：
2.7
作者：
De Carli, Angelo;Vadala, Antonio;Ferretti, Andrea
通讯作者：
Ferretti, Andrea
影响因子：
4.2
作者：
Dogru, Hacer;Basaran, Sibel;Sarpel, Tunay
通讯作者：
Sarpel, Tunay
影响因子：
3
作者：
Chen, Chih-Yu;Hu, Chia-Chian;Cheng, Cheng-Kung
通讯作者：
Cheng, Cheng-Kung