Data Sheet 2_Effectiveness of physical therapies for patients with knee osteoarthritis: a systematic review and network meta-analysis of randomized controlled trials.doc

BackgroundPhysical therapy offers a useful option for management of knee osteoarthritis (KOA) and this study aims to summarize the latest evidence on the effectiveness of variable physical therapies.
MethodsWe considered randomized trials of patients with KOA that compared any of the following interventions for treatment of osteoarthritis pain: physical therapies, general nursing, placebo. We performed frequentist random-effect network meta-analyses to summarize the evidence and applied the Confidence in Network Meta-Analysis frameworks to rate the certainty of evidence, calculate the treatment effects, categorize interventions, and present the findings.
ResultsThe search identified 74 eligible RCTs, enrolling 3,707 participants. TENS demonstrated the largest reduction of NRS (MD, −2.73; 95% CI, −5.20 to −0.26) and VAS pain at rest (MD, −2.87; 95% CI, −4.87 to −0.87). Moderate to low-level evidence established laser as most effective for improving VAS for pain during walking at <1 month (MD, −2.50; 95% CI, −3.88 to −1.11) and 1–3 months (MD, −2.49; 95% CI, −4.51 to −0.48), and neuromuscular exercise (MD, −1.77; 95% CI, −3.14 to −0.39) at 3 months. For WOMAC total scores at <1 month, 1–3 months, and >3 months, shockwave (MD, −9.56; 95% CI, −16.71 to −2.41; low-level confidence), aquatic sports (MD, −16.53; 95% CI, −30.74 to −2.31; low-level confidence), and shockwave (MD, −30.02; 95% CI, −40.39 to −19.65, moderate-level confidence) respectively, demonstrated the greatest improvements.
ConclusionPhysical therapies exhibited varying efficacy profiles in management of KOA with most being supported by moderate-to-low levels evidence, warranting further studies to better establish their effectiveness.
Systematic review registrationIdentifier PROSPERO CRD42023458296.

背景 物理治疗是膝关节骨性关节炎（knee osteoarthritis, KOA）管理的有效手段之一，本研究旨在汇总各类物理疗法有效性的最新研究证据。
方法 本研究纳入针对膝关节骨性关节炎患者的随机对照试验（randomized controlled trial, RCT），比较以下各类干预措施用于骨性关节炎疼痛治疗的效果：物理治疗、常规护理与安慰剂。本研究采用频率学派随机效应网络meta分析（frequentist random-effect network meta-analysis）对现有证据进行汇总，并应用《网络meta分析置信度评价框架》（Confidence in Network Meta-Analysis）对证据确定性进行评级、计算治疗效应、对干预措施进行分类并呈现研究结果。
结果 本次检索共纳入74项符合标准的随机对照试验，共计纳入3707名受试者。经皮神经电刺激（Transcutaneous Electrical Nerve Stimulation, TENS）在降低数字疼痛评分量表（Numerical Rating Scale, NRS）得分（均数差：-2.73；95%置信区间：-5.20至-0.26）以及静息状态下视觉模拟评分法（Visual Analogue Scale, VAS）疼痛得分（均数差：-2.87；95%置信区间：-4.87至-0.87）方面效果最为显著。中等到低等级证据显示，激光治疗在改善步行时疼痛的VAS得分方面效果最优：在干预后<1个月（均数差：-2.50；95%置信区间：-3.88至-1.11）、1~3个月（均数差：-2.49；95%置信区间：-4.51至-0.48）时段均表现突出，而神经肌肉训练（均数差：-1.77；95%置信区间：-3.14至-0.39）在干预后3个月时效果最佳。针对不同随访时段的WOMAC骨关节炎指数（Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC）总分：<1个月时，冲击波治疗（均数差：-9.56；95%置信区间：-16.71至-2.41；低等级证据可信度）改善效果最优；1~3个月时，水中运动（均数差：-16.53；95%置信区间：-30.74至-2.31；低等级证据可信度）效果最佳；>3个月时，冲击波治疗（均数差：-30.02；95%置信区间：-40.39至-19.65；中等级证据可信度）改善最为显著。
结论 各类物理疗法在膝关节骨性关节炎管理中展现出各异的疗效特征，多数疗法的有效性仅获得中低等级证据支持，因此仍需开展进一步研究以明确其临床应用价值。
系统评价注册 注册标识符：PROSPERO CRD42023458296。