Osteoarthritis year 2010 in review: non-pharmacologic therapy
Osteoarthritis year 2010 in review: non-pharmacologic therapy
复制标题
DOI：
10.1016/j.joca.2011.01.021
复制
发表时间：
2011-04-01
影响因子：
7
通讯作者：
Stanaitis, I.
中科院分区：
文献类型：
--
作者：
Hawker, G. A.;Mian, S.;Stanaitis, I.
目的：为了突出在过去一年中关于骨关节炎（OA）的非药物治疗主题的开创性出版物，设计：从2009年9月至2010年9月对PUBMED和科克伦数据库进行了系统检索，以识别报告研究非药物治疗在OA治疗中的安全性或有效性的文章。非药物治疗是2008年OARSI OA指南中考虑的治疗。确定的文章进行了审查的质量;那些最高质量的，被认为有最大的潜在影响OA的管理进行了summarized.Results：检索确定了117个独特的文章。其中，有四项研究被选中。一项嵌套的两阶段试验发现，中国传统针灸（TCA）并不上级假针灸，但提供者的风格影响了疼痛减轻和对治疗的满意度，这表明针灸的镇痛效果可能部分由针灸师的行为介导。一项系统性综述发现，几乎没有证据表明电刺激与假手术或无干预相比对膝关节OA疼痛有显著影响。一项关于太极拳与注意力控制的单盲试验发现，12周的太极拳与膝关节OA患者的症状和残疾改善相关。一项在急性前交叉韧带撕裂受试者中进行的早期ACL重建手术和康复与单纯结构化康复的随机试验发现，在随机分组后24个月，所有研究参与者都有所改善，这表明急性ACL损伤后的结构化康复策略可能会排除手术重建的需要。由于难以充分设盲和适当选择注意力控制，非药物治疗OA的安全性和有效性的高质量研究仍然具有挑战性。高质量的研究表明，许多非药物治疗相对于注意力控制或安慰剂的益处是适度的，但两者的影响都比完全没有干预要大。(C)2011年国际骨关节炎研究学会。由爱思唯尔有限公司出版。保留所有权利。
Objective: To highlight seminal publications in the past year on the topic of non-pharmacologic management of osteoarthritis (OA).Design: A systematic search of the PUBMED and Cochrane databases from September 2009 to September 2010 was conducted to identify articles reporting on studies examining the safety or efficacy of non-pharmacologic therapies in the management of OA. Non-pharmacologic therapies were those considered in the 2008 OARSI OA guidelines. Identified articles were reviewed for quality; those of highest quality and deemed to have greatest potential impact on the management of OA were summarized.Results: The search identified 117 unique articles. Of these, four studies were chosen to highlight. A nested two-stage trial found that traditional Chinese acupuncture (TCA) was not superior to sham acupuncture, but that the providers' style affected both pain reduction and satisfaction with treatment, suggesting that the analgesic benefits of acupuncture may be partially mediated by the acupuncturists' behavior. A systematic review found little evidence of a significant effect for electrostimulation vs sham or no intervention on pain in knee OA. A single-blinded trial of Tai Chi vs attention controls found that 12 weeks of Tai Chi was associated with improvements in symptoms and disability in patients with knee OA. A randomized trial of early ACL reconstructive surgery and rehabilitation vs structured rehabilitation alone in subjects with acute anterior cruciate ligament tears found that, at 24 months following randomization, all study participants had improved, suggesting that a strategy of structured rehabilitation followed acute ACL injury may preclude the need for surgical reconstruction.Conclusions: High quality studies of the safety and efficacy of non-pharmacologic agents in the management of OA remain challenging due to difficulties with adequate blinding and appropriate selection of attention controls. High quality studies suggest modest, if any, benefit of many non-pharmacologic therapies over attention control or placebo, but a significant impact of both over no intervention at all. (C) 2011 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.