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北京大学学报（医学版） ›› 2018, Vol. 50 ›› Issue (6): 991-997. doi: 10.19723/j.issn.1671-167X.2018.06.009

• 论著 • 上一篇    下一篇

功能锻炼对类风湿关节炎患者效果评价的meta分析

王莉,高超,朱笛,陈立红()   

  1. 北京大学人民医院风湿免疫科, 北京 100044
  • 收稿日期:2018-07-03 出版日期:2018-12-18 发布日期:2018-12-18
  • 通讯作者: 陈立红 E-mail:13901007280@163.com
  • 基金资助:
    北京市科技计划项目(Z171100000417007)

Effect of functional exercises on patients with rheumatoid arthritis: a meta-analysis

Li WANG,Chao GAO,Di ZHU,Li-hong CHEN()   

  1. Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing 100044, China
  • Received:2018-07-03 Online:2018-12-18 Published:2018-12-18
  • Contact: Li-hong CHEN E-mail:13901007280@163.com
  • Supported by:
    Supported by the Beijing Municipal Science and Technology Project(Z171100000417007)

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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、PubMed、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EndNote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。

关键词: 功能锻炼, 类风湿关节炎, 关节功能, 生活质量

Abstract:

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.

Key words: Functional exercise, Rheumatoid arthritis, Joint function, Quality of life

中图分类号: 

  • R593.22

图1

文献检索流程"

表1

纳入文献的基本情况"

Research Year Country Count of samples Intervention period Quality level of the paper
Test group Control group
Baillet,et al[10] 2009 France 25 23 12 months A
da Silva, et al[11] 2013 Brazil 51 51 16 weeks A
Siqueira, et al[12] 2017 Brazil 33/33 34 16 weeks A
Chen, et al[13] 2002 China 28 28 3 weeks B
Liu, et al[14] 2004 China 20 20 14 days B
Cima, et al[15] 2013 Brazil 13 7 2 months B
Zhang, et al[16] 2008 China 25 25 24 weeks B
Du[17] 2017 China 64 64 6 months B
Wu, et al[18] 2017 China 19 20 6 weeks B
Durcan, et al[19] 2014 Ireland 42 38 12 weeks B
Stavropoulos-Kalinoglou, et al[20] 2013 UK 18 18 6 months B
H?kkinen, et al[21] 2003 Finland 35 35 24 months B
Bilberg, et al[22] 2005 Sweden 20 23 12 weeks B

表2

纳入文献中的干预措施和结局指标"

Research Intervention Outcome
index
Experimental group Control group
Baillet,et al[10] Exercises for the upper and lower limbs five times a week in a gymnasium (cycling, running or resisting pulley cord, 45 min/d) and in a hydrotherapy pool (60 min/d), 12 months Usual care ①②
da Silva, et al[11] Sensorimotor exercises progressed from stable surfaces to unstable surfaces, training gait in a line followed by gait including change in directions, gait without obstacles to gait with obstacles, change in the support base (feet apart and then together), physical exercises with eyes opened and closed (twice a week, 30-50 min sessions each, 16 weeks) Usual care ②③
Siqueira, et al[12] Land-based and water-based aerobic exercises for the lower limbs (32℃±1℃, 3 times per week, 16 weeks) Usual care ①③
Chen, et al[13] Gymnastics for hand functions (20-30 min each time, twice a day, 3 weeks) Usual treatment ④
Liu, et al[14] Gymnastics for wrist joint functions (25-30 min each time, twice a day, 14 days) Usual treatment ③④
Cima, et al[15] Exercises to strengthen the intrinsic muscles of the hands (3 sustained contractions each time, once a day for two days per week, then 3 sessions each time, once a day, for 3 days a week. Both intensity and load of the strengthening exercise were increased every 3 weeks, last 2 months) Usual care ③
Zhang, et al[16] Joint functional Class 1 (gymnastics for joints + swimming, cycling, 24 weeks)
Joint functional Class 2 and 3 (gymnastics for all joints, 2-3 times each day for 24 weeks)
Joint functional Class 4 (muscle exercises and slight contraction and extension for 24 weeks)		 Usual care ②
Du[17] Exercises (constraction and release for upper and lower limbs, 20 sessions each time, twice a day for 6 months)
Functional exercises for hands, wrists, shoulder, elbow and knee joints (3-5 min each time, twice a day for 6 months)		 Usual care ①③
Wu, et al[18] Functional exercises for fingers, wrists and knee joints(15-35 min each time) Usual care ①②③④
Durcan, et al[19] Cardiovascular exercises (walking/swimming, 30-60 min each day, 150 min per week, 2 days a week for 12 weeks)
Resisting pulley cord (functional exercises for main muscle groups and hands, twice each day,
2-3 days a week for 12 weeks)
Flexibility and neutral modulation (ROM exercise, 2-3 min each day, 2-3 days a week for 12 weeks)		 Usual care ②③
Stavropoulos-
Kalinoglou, et al[20]		 Aerobic exercises and resistance exercise (walk on treadmill, cycle, exercises for muscle groups, etc. 50-60 min each time, 3 sessions a week for 6 months) Usual care ①②
H?kkinen, et al[21] Dynamic training (exercises for all main muscle groups, using elastic bands and dumbbells as resistance, twice a week, 2 sets per exercise for 12 months) Usual care ③
Bilberg, et al[22] Exercises in a temperate pool (exercises for aerobic capacity, dynamic and static muscle strength, and muscle endurance in the upper and lower extremities, flexibility, coordination and relaxation, 45 min each time, twice a week for 12 weeks) Usual care ②

图 2

功能锻炼对RA患者疾病活动度的影响"

图3

功能锻炼对RA患者关节功能的影响"

图4

功能锻炼对RA患者疼痛情况的影响"

图5

功能锻炼对RA患者晨僵时间的影响"

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