手法治疗联合运动对膝骨关节炎患者疼痛和功能的附加效应：系统评价与荟萃分析。
完整摘要 · 中文译文
目的：本系统综述旨在分析在运动（EX）基础上加用手法治疗（MT）与单纯运动相比，对膝骨关节炎（KOA）患者疼痛、功能和压痛阈（PPT）的额外疗效。 方法：检索六个数据库（MEDLINE、PEDro、EMBASE、CENTRAL、CINAHL和Web of Science），时间从建库至2026年5月。由两名独立评价者筛选随机临床试验。采用随机效应模型进行荟萃分析，计算标准化均数差（SMD）和95%置信区间（CI）。本综述已在PROSPERO注册（CRD42024525169），并采用GRADE对证据体的确定性进行分级。 结果：共纳入29项研究。与单纯运动相比，运动联合手法治疗在即时（均数差[MD] = -0.53；95% CI = -0.97至-0.09，证据确定性极低）、短期（MD = -1.30；95% CI = -1.74至-0.87，证据确定性极低）和中期（MD = -0.98；95% CI = -1.86至-0.10，证据确定性中等）均能减轻疼痛。功能在短期（SMD = -0.89；95% CI = -1.49至-0.29，证据确定性极低）和中期（SMD = -0.62；95% CI = -1.13至-0.10，证据确定性极低）也有所改善。然而，疼痛和功能均未观察到显著的长期疗效。未发现评估压痛阈（PPT）的合格研究。 结论：观察到手法治疗在运动基础上的额外疗效；但证据确定性为极低至低。手法治疗可被视为膝骨关节炎的辅助干预措施，因为其似乎能提供短期疗效。 对疼痛缓解和功能结局均有影响，但似乎不会延续到长期。意义声明：本系统综述指出，手法治疗（MT）可被视为与运动疗法（EX）联合使用的补充干预措施，在膝骨关节炎（KOA）的疼痛缓解和功能结局方面似乎可提供即刻、短期和中期效果。MT与EX联合使用可在康复过程初期为患者提供帮助。然而，其获益似乎不会延续到长期，这提示MT可作为一种支持运动的策略，尤其是在治疗的初始阶段。
完整摘要 · 英文原文
OBJECTIVE: This systematic review aimed to analyse the additional effects of manual therapy (MT) to exercise (EX) compared to EX alone on pain, function, and PPT in individuals with knee osteoarthritis (KOA). METHODS: Six databases (MEDLINE, PEDro, EMBASE, CENTRAL, CINAHL, and Web of Science) were searched from inception up to May 2026. Two independent reviewers selected randomized clinical trials. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated by random-effects for meta-analyses. The review was registered in PROSPERO (CRD42024525169), and the certainty of a body of evidence was classified using GRADE. RESULTS: Twenty-nine studies were included. MT combined with EX, compared to EX alone, reduced pain in the immediate (mean difference [MD] = -0.53; 95% CI = -0.97 to -0.09 very low certainty of evidence), short-term (MD = -1.30; 95% CI = -1.74 to -0.87 very low certainty of evidence), and medium-term (MD = -0.98; 95% CI = -1.86 to -0.10 moderate certainty of evidence). Function also improved in the short-term (SMD = -0.89; 95% CI = -1.49 to -0.29 very low certainty of evidence) and medium-term (SMD = -0.62; 95% CI = -1.13 to -0.10 very low certainty of evidence). However, no significant long-term effects were observed for either pain and function. No eligible studies assessing pressure pain threshold (PPT) were identified. CONCLUSIONS: An additional effect of MT to EX was observed; however, the certainty of the evidence was very low to low. MT can be considered an adjunctive intervention in KOA, as it appears to provide short-duration effects on both pain relief and functional outcomes, but does not seem to extend to the long term. SIGNIFICANCE STATEMENT: This systematic review identifies that MT can be considered a complementary intervention when combined with EX, which appears to provide immediate, short- and medium-term effects, both in pain relief and functional outcomes in KOA. The use of MT with EX may assist patients at the beginning of the rehabilitation process. However, its benefits do not appear to extend to the long term, highlighting that MT can serve as a strategy to support exercise, particularly during the initial phase of treatment.