功能锻炼对类风湿关节炎患者效果评价的meta分析
|
摘要
目的:评价功能锻炼对改善类风湿关节炎(rheumatoid arthritis,RA)患者的疾病活动度、关节功能、生活质量等方面的效果。方法:计算机检索Cochrane Library、Pub Med、中国知网(China National Knowledge Infrastructure,CNKI)、维普、万方数据库中符合标准的随机对照试验(randomized controlled trials,RCTs),根据纳入与排除标准,由两人对上述数据库分别进行文献筛选、提取及文献质量评价后,采用Review Manager 5. 3软件对结局指标进行meta分析。结果:初步检索获得文献2 173篇(英文1 522篇,中文651篇),经过End Note软件去除重复文献913篇,通过阅读文题和摘要排除不符合纳入标准的文献1 194篇,经过阅读全文、剔除数据不全等最终纳入13篇文献(英文8篇,中文5篇),纳入的总样本数812例,其中实验组426例,常规组386例。13篇文献中5篇文献采用疾病活动评分(disease activity score 28,DAS28)作为其中的结局指标,8篇文献采用健康评定调查表(health assessment questionnaire,HAQ)作为其中的结局指标,6篇文献采用视觉模拟疼痛评分(visual analogue score,VAS)作为其中的结局指标,3篇文献采用晨僵时间作为其中的结局指标。meta分析结果显示,功能锻炼在一定程度上能够缓解RA患者的疾病活动度(mean difference=-0. 76; 95%CI:-1. 13,-0. 38; P <0. 001),改善患者关节功能(mean difference=-0. 36; 95%CI:-0. 47,-0. 24; P <0. 001),降低关节疼痛感(mean difference=-1. 75; 95%CI:-1. 98,-1. 53;P <0. 001)以及减少关节晨僵时间(mean difference=-17. 65; 95%CI:-22. 09,-13. 21; P <0. 001)。结论:功能锻炼可以降低RA患者的关节疼痛感,减少晨僵时间,缓解患者病情,对改善关节功能、提高患者生存质量有积极作用。
Objective: To evaluate the effect of functional exercises on disease activity,joint function and quality of life of patients with rheumatoid arthritis( RA). Methods: Randomized controlled trials were searched in Cochrane Library,PubMed,China National Knowledge Infrastructure( CNKI),VIP database and Wanfang database with keywords being "rheumatoid arthritis/RA","function exercise( training)/joint exercise( training)/physical exercise( training)/resistance movement( exercise)/isotonic and isometric/stretching exercise/muscle exercise",and "trials/clinical trials". Then literature selection,extraction and literature quality evaluation were carried out by two of the authors independently following the including and excluding standards. Then the outcome indicators were analyzed with Review Manager 5. 3 software. Results: In the study,2 173 articles were achieved by searching in databases,including 1 522 English papers and 651 Chinese papers. Then 913 duplicated papers were identified and removed using EndNote software. After reading the titles and abstracts,1 194 papers were excluded that did not satisfy the including standards. Finally,the full texts of these papers were read and papers with insufficient data were excluded,resulting in 13 included papers for systematic review,including 8 English and 5 Chinese papers. A total of 812 cases were studied in these papers,including 426 in the experimental groups and 386 in the conventional groups. For the outcome index in these articles,disease activity score 28( DAS28) was used in 5 of them,health assessment questionnaire( HAQ) was used in 8 articles,visual analogue scale( VAS) for pain was used in 6 articles,and morning stiffness duration was used in 3 articles. The meta-analysis showed that functional exercises could delay the development of the disease activity of RA patients( mean difference =-0. 76; 95% CI:-1. 13,-0. 38; P < 0. 001),improve the joint function( mean difference =-0. 36; 95% CI:-0. 47,-0. 24; P < 0. 001),alleviate the pain of joints( mean difference =-1. 75; 95% CI:-1. 98,-1. 53; P < 0. 001),and reduce the duration of morning stiffness( mean difference =-17. 65; 95% CI:-22. 09,-13. 21; P < 0. 001).Conclusion: This study showed the positive effects of functional exercises on alleviating the pain of joints,reducing the morning stiffness duration,and delaying the disease exacerbation of RA patients. It has a positive effect on improving the joint function and improving the quality of life in patients with RA.
Objective: To evaluate the effect of functional exercises on disease activity,joint function and quality of life of patients with rheumatoid arthritis( RA). Methods: Randomized controlled trials were searched in Cochrane Library,PubMed,China National Knowledge Infrastructure( CNKI),VIP database and Wanfang database with keywords being "rheumatoid arthritis/RA","function exercise( training)/joint exercise( training)/physical exercise( training)/resistance movement( exercise)/isotonic and isometric/stretching exercise/muscle exercise",and "trials/clinical trials". Then literature selection,extraction and literature quality evaluation were carried out by two of the authors independently following the including and excluding standards. Then the outcome indicators were analyzed with Review Manager 5. 3 software. Results: In the study,2 173 articles were achieved by searching in databases,including 1 522 English papers and 651 Chinese papers. Then 913 duplicated papers were identified and removed using EndNote software. After reading the titles and abstracts,1 194 papers were excluded that did not satisfy the including standards. Finally,the full texts of these papers were read and papers with insufficient data were excluded,resulting in 13 included papers for systematic review,including 8 English and 5 Chinese papers. A total of 812 cases were studied in these papers,including 426 in the experimental groups and 386 in the conventional groups. For the outcome index in these articles,disease activity score 28( DAS28) was used in 5 of them,health assessment questionnaire( HAQ) was used in 8 articles,visual analogue scale( VAS) for pain was used in 6 articles,and morning stiffness duration was used in 3 articles. The meta-analysis showed that functional exercises could delay the development of the disease activity of RA patients( mean difference =-0. 76; 95% CI:-1. 13,-0. 38; P < 0. 001),improve the joint function( mean difference =-0. 36; 95% CI:-0. 47,-0. 24; P < 0. 001),alleviate the pain of joints( mean difference =-1. 75; 95% CI:-1. 98,-1. 53; P < 0. 001),and reduce the duration of morning stiffness( mean difference =-17. 65; 95% CI:-22. 09,-13. 21; P < 0. 001).Conclusion: This study showed the positive effects of functional exercises on alleviating the pain of joints,reducing the morning stiffness duration,and delaying the disease exacerbation of RA patients. It has a positive effect on improving the joint function and improving the quality of life in patients with RA.
引文
[1] Smolen JS,LandewéR,Breedveld FC,et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs[J]. Ann Rheum Dis,2010,69(6):964-975.
[2] Mc Innes IB,Schett G. Pathogenetic insights from the treatment of rheumatoid arthritis[J]. Lancet,2017,389(10086):2328-2337.
[3]曾小峰,朱松林,谭爱春,等.我国类风湿关节炎疾病负担和生存质量研究的系统评价[J].中国循证医学杂志,2013,13(3):300-307.
[4]周云杉,王秀茹,安媛,等.全国多中心类风湿关节炎患者残疾及功能受限情况的调查[J].中华风湿病学杂志,2013,17(8):526-532.
[5]王秀丽,唐玉萍,孙树萍,等.类风湿关节炎患者功能锻炼现状及影响因素分析[J].护理进修杂志,2016,31(5):442-444.
[6]王庆,徐桂华,周学平,等.功能锻炼在类风湿关节炎患者康复中的作用研究近况[J].风湿病与关节炎,2013,2(5):46-48.
[7]风湿免疫疾病慢病管理全国护理协作组.类风湿关节炎患者的慢病管理专家共识(2014版)[J].中华风湿病学杂志,2016,20(2):127-130.
[8] Arnett FC,Edworthy SM,Bloch DA,et al. The American rheumatism association 1987 revised criteria for the classification of rheumatoid arthritis[J]. Arthritis Rheum,1988,31(3):315-324.
[9] Higgins JPT,Green S. Cochrane handbook for systematic reviews of interventions version 5. 1. 0[EB/OL].(2011-04-10)(2015-07-05). https://training. cochrane. org/handbook.
[10] Baillet A,Payraud E,Niderprim VA,et al. A dynamic exercise programme to improve patients’disability in rheumatoid arthritis:A prospective randomized controlled trial[J]. Rheumatology,2009,48(4):410-415.
[11] da Silva KN,Teixeira LE,Imoto AM,et al. Effectiveness of sensorimotor training in patients with rheumatoid arthritis:a randomized controlled trial[J]. Rheumatol Int,2013,33(9):2269-2275.
[12] Siqueira US,Orsini Valente LG,de Mello MT,et al. Effectiveness of aquatic exercises in women with rheumatoid arthritis:a rando-mized,controlled,16-week intervention-the HydRA trial[J]. Am J Phys Med Rehabil,2017,96(3):167-175.
[13]陈立红,杨玉琴,吴鸥,等.手腕部锻炼对类风湿关节炎手功能恢复的影响[J].中华护理杂志,2002,37(9):668-669.
[14]刘启华,王玉玲,孙美红,等.手腕部关节功能操减轻类风湿关节炎局部症状的观察[J].中华护理杂志,2004,39(7):508-510.
[15] Cima SR,Barone A,Porto JM,et al. Strengthening exercises to improve hand strength and functionality in rheumatoid arthritis with hand deformities:a randomized,controlled trial[J]. Rheumatol Int,2013,33(3):725-732.
[16]张标新,朱庆云.个体化系统锻炼对类风湿关节炎患者活动能力的影响[J].护士进修杂志,2008,23(22):2029-2030.
[17]杜晓云.功能锻炼及个性化运动对类风湿关节炎患者预后及生活质量的影响[J].当代护士,2017(6):31-33.
[18]吴莉萍,张子云,李晓倩,等.活动期类风湿关节炎患者关节功能锻炼的延续护理[J].护理学杂志,2017,32(4):83-85.
[19] Durcan L,Wilson F,Cunnane G. The effect of exercise on sleep and fatigue in rheumatoid arthritis:a randomized controlled study[J]. J Rheumatol,2014,41(10):1966-1973.
[20] Stavropoulos-Kalinoglou A,Metsios GS,Veldhuijzen van Zanten JJ,et al. Individualised aerobic and resistance exercise training improves cardiorespiratory fitness and reduces cardiovascular risk in patients with rheumatoid arthritis[J]. Ann Rheum Dis,2013,72(11):1819-1825.
[21] Hakkinen A,Sokka T,Lietsalmi AM,et al. Effects of dynamic strength training on physical function,Valpar 9 work sample test,and working capacity in patients with recent-onset rheumatoid arthritis[J]. Arthritis Rheum,2003,49(1):71-77.
[22] Bilberg A,Ahlmén M,Mannerkorpi K. Moderately intensive exercise in a temperate pool for patients with rheumatoid arthritis:a randomized controlled study[J]. Rheumatology,2005,44(4):502-508.
[23] Prioreschi A,Makda MA,Tikly M,et al. In patients with established RA,positive effects of a randomised three month WBV therapy intervention on functional ability,bone mineral density and fatigue are sustained for up to six months[J]. PLo S One,2016,11(4):e0153470.
[24] Mc Kenna S,Tierney M,O’Neill A,et al. Sleep and physical activity:a cross-sectional objective profile of people with rheumatoid arthritis[J]. Rheumatol Int,2018,38(5):845-853.
[25] Agca R,Heslinga SC,Rollefstad S,et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders:2015/2016 update[J]. Ann Rheum Dis,2017,76(1):17-28.
[26]中华医学会风湿病学分会. 2018中国类风湿关节炎诊疗指南[J].中华内科杂志,2018,57(4):242-251.
[2] Mc Innes IB,Schett G. Pathogenetic insights from the treatment of rheumatoid arthritis[J]. Lancet,2017,389(10086):2328-2337.
[3]曾小峰,朱松林,谭爱春,等.我国类风湿关节炎疾病负担和生存质量研究的系统评价[J].中国循证医学杂志,2013,13(3):300-307.
[4]周云杉,王秀茹,安媛,等.全国多中心类风湿关节炎患者残疾及功能受限情况的调查[J].中华风湿病学杂志,2013,17(8):526-532.
[5]王秀丽,唐玉萍,孙树萍,等.类风湿关节炎患者功能锻炼现状及影响因素分析[J].护理进修杂志,2016,31(5):442-444.
[6]王庆,徐桂华,周学平,等.功能锻炼在类风湿关节炎患者康复中的作用研究近况[J].风湿病与关节炎,2013,2(5):46-48.
[7]风湿免疫疾病慢病管理全国护理协作组.类风湿关节炎患者的慢病管理专家共识(2014版)[J].中华风湿病学杂志,2016,20(2):127-130.
[8] Arnett FC,Edworthy SM,Bloch DA,et al. The American rheumatism association 1987 revised criteria for the classification of rheumatoid arthritis[J]. Arthritis Rheum,1988,31(3):315-324.
[9] Higgins JPT,Green S. Cochrane handbook for systematic reviews of interventions version 5. 1. 0[EB/OL].(2011-04-10)(2015-07-05). https://training. cochrane. org/handbook.
[10] Baillet A,Payraud E,Niderprim VA,et al. A dynamic exercise programme to improve patients’disability in rheumatoid arthritis:A prospective randomized controlled trial[J]. Rheumatology,2009,48(4):410-415.
[11] da Silva KN,Teixeira LE,Imoto AM,et al. Effectiveness of sensorimotor training in patients with rheumatoid arthritis:a randomized controlled trial[J]. Rheumatol Int,2013,33(9):2269-2275.
[12] Siqueira US,Orsini Valente LG,de Mello MT,et al. Effectiveness of aquatic exercises in women with rheumatoid arthritis:a rando-mized,controlled,16-week intervention-the HydRA trial[J]. Am J Phys Med Rehabil,2017,96(3):167-175.
[13]陈立红,杨玉琴,吴鸥,等.手腕部锻炼对类风湿关节炎手功能恢复的影响[J].中华护理杂志,2002,37(9):668-669.
[14]刘启华,王玉玲,孙美红,等.手腕部关节功能操减轻类风湿关节炎局部症状的观察[J].中华护理杂志,2004,39(7):508-510.
[15] Cima SR,Barone A,Porto JM,et al. Strengthening exercises to improve hand strength and functionality in rheumatoid arthritis with hand deformities:a randomized,controlled trial[J]. Rheumatol Int,2013,33(3):725-732.
[16]张标新,朱庆云.个体化系统锻炼对类风湿关节炎患者活动能力的影响[J].护士进修杂志,2008,23(22):2029-2030.
[17]杜晓云.功能锻炼及个性化运动对类风湿关节炎患者预后及生活质量的影响[J].当代护士,2017(6):31-33.
[18]吴莉萍,张子云,李晓倩,等.活动期类风湿关节炎患者关节功能锻炼的延续护理[J].护理学杂志,2017,32(4):83-85.
[19] Durcan L,Wilson F,Cunnane G. The effect of exercise on sleep and fatigue in rheumatoid arthritis:a randomized controlled study[J]. J Rheumatol,2014,41(10):1966-1973.
[20] Stavropoulos-Kalinoglou A,Metsios GS,Veldhuijzen van Zanten JJ,et al. Individualised aerobic and resistance exercise training improves cardiorespiratory fitness and reduces cardiovascular risk in patients with rheumatoid arthritis[J]. Ann Rheum Dis,2013,72(11):1819-1825.
[21] Hakkinen A,Sokka T,Lietsalmi AM,et al. Effects of dynamic strength training on physical function,Valpar 9 work sample test,and working capacity in patients with recent-onset rheumatoid arthritis[J]. Arthritis Rheum,2003,49(1):71-77.
[22] Bilberg A,Ahlmén M,Mannerkorpi K. Moderately intensive exercise in a temperate pool for patients with rheumatoid arthritis:a randomized controlled study[J]. Rheumatology,2005,44(4):502-508.
[23] Prioreschi A,Makda MA,Tikly M,et al. In patients with established RA,positive effects of a randomised three month WBV therapy intervention on functional ability,bone mineral density and fatigue are sustained for up to six months[J]. PLo S One,2016,11(4):e0153470.
[24] Mc Kenna S,Tierney M,O’Neill A,et al. Sleep and physical activity:a cross-sectional objective profile of people with rheumatoid arthritis[J]. Rheumatol Int,2018,38(5):845-853.
[25] Agca R,Heslinga SC,Rollefstad S,et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders:2015/2016 update[J]. Ann Rheum Dis,2017,76(1):17-28.
[26]中华医学会风湿病学分会. 2018中国类风湿关节炎诊疗指南[J].中华内科杂志,2018,57(4):242-251.