The effectiveness of interventions aimed at increasing physical activity in adults with persistent musculoskeletal pain: a systematic review and meta-analysis.
The effectiveness of interventions aimed at increasing physical activity in adults with persistent musculoskeletal pain: a systematic review and meta-analysis.
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DOI：
10.1186/s12891-017-1836-2
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发表时间：
2017-11-22
影响因子：
2.3
通讯作者：
McDonough SM
中科院分区：
文献类型：
--
作者：
Marley J;Tully MA;Porter-Armstrong A;Bunting B;O'Hanlon J;Atkins L;Howes S;McDonough SM
与没有疼痛的人相比，患有持续性肌肉骨骼疼痛（PMP）的人患共病健康状况和早期死亡的风险增加。尽管有无可辩驳的证据支持体力活动在降低这些风险方面的作用，但证据的综合性有限，可能会影响这些形式的干预措施的优化。本文综述了改善体力活动水平的干预措施的有效性以及这些干预措施的组成部分。随机和半随机对照试验纳入本综述。从开始到2016年3月检索了以下数据库：科克伦图书馆的CENTRAL、科克伦系统评价数据库（CDSR）、MEDLINE、Embase、CINAHL、PsycINFO和AMED。两名评审员独立筛选引文，评估合格性，提取数据，评估偏倚风险，并使用93种分层聚类技术的行为变化分类法（BCTTv 1）编码干预内容。GRADE用于评价证据的质量。对276篇文章的全文进行了合格性评估，20项涉及3441名参与者的研究被纳入综述。在所有研究中，BCT编码的平均数量为8个（范围0-16）;最常编码的是“目标设定”和"如何执行行为的指导“。对于主观体力活动的测量：基于极低质量的证据，干预措施在短期内无效;基于低质量的证据（SMD 0.25，95% CI 0.01至0.48），干预措施在中期内的影响较小;基于中等质量的证据，干预措施在长期内的影响较小（SMD 0.21，95% CI 0.08至0.33）。对于客观身体活动的措施：干预措施是无效的-基于非常低到低质量的证据。有一些证据支持干预措施在改善主观测量的身体活动方面的有效性，然而，这些证据大多基于低质量的研究，效果很小。考虑到证据的质量，进一步的研究可能/很可能对我们对效果估计的信心产生重要影响，并可能改变估计。未来的研究应提供干预成分的详细信息，并纳入身体活动的客观措施。本文的在线版本（10.1186/s12891-017-1836-2）包含补充材料，可供授权用户使用。
Individuals with persistent musculoskeletal pain (PMP) have an increased risk of developing co-morbid health conditions and for early-mortality compared to those without pain. Despite irrefutable evidence supporting the role of physical activity in reducing these risks; there has been limited synthesis of the evidence, potentially impacting the optimisation of these forms of interventions. This review examines the effectiveness of interventions in improving levels of physical activity and the components of these interventions. Randomised and quasi-randomised controlled trials were included in this review. The following databases were searched from inception to March 2016: CENTRAL in the Cochrane Library, Cochrane Database of Systematic Reviews (CDSR), MEDLINE, Embase, CINAHL, PsycINFO and AMED. Two reviewers independently screened citations, assessed eligibility, extracted data, assessed risk of bias and coded intervention content using the behaviour change taxonomy (BCTTv1) of 93 hierarchically clustered techniques. GRADE was used to rate the quality of the evidence. The full text of 276 articles were assessed for eligibility, twenty studies involving 3441 participants were included in the review. Across the studies the mean number of BCTs coded was eight (range 0–16); with ‘goal setting’ and ‘instruction on how to perform the behaviour’ most frequently coded. For measures of subjective physical activity: interventions were ineffective in the short term, based on very low quality evidence; had a small effect in the medium term based on low quality evidence (SMD 0.25, 95% CI 0.01 to 0.48) and had a small effect in the longer term (SMD 0.21 95% CI 0.08 to 0.33) based on moderate quality evidence. For measures of objective physical activity: interventions were ineffective - based on very low to low quality evidence. There is some evidence supporting the effectiveness of interventions in improving subjectively measured physical activity however, the evidence is mostly based on low quality studies and the effects are small. Given the quality of the evidence, further research is likely/very likely to have an important impact on our confidence in effect estimates and is likely to change the estimates. Future studies should provide details on intervention components and incorporate objective measures of physical activity. The online version of this article (10.1186/s12891-017-1836-2) contains supplementary material, which is available to authorized users.
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