目的:系统评价三种运动疗法对乳腺癌术后患肢淋巴水肿患者上肢功能的康复效果.方法:计算机检索CNKI、万方、维普、Web of Science、PubMed、The Cochran library、Medline、Embase 等数据库,搜集 2005 年1月-2024年5月有关三种运动疗法干预乳腺癌术后患肢淋巴水肿患者上肢功能的随机对照试验(RCT).由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用R软件与Addis软件进行网状Meta分析.结果:共纳入20项RCT,包括1736例乳腺癌术后患肢淋巴水肿患者.网状Meta分析结果显示,在乳腺癌术后患肢淋巴水肿患者手臂周径差康复方面,三种运动疗法均优于对照组(P＞0.05);在乳腺癌术后患肢淋巴水肿患者上肢前屈康复方面,有氧训练干预治疗[MD=20.05(11.17,28.69),P＜0.05]、抗阻训练干预治疗[MD=11.51(1.04,22.11),P＜0.05]显著优于对照组的无干预治疗;在乳腺癌术后患肢淋巴水肿患者上肢后伸康复方面,有氧训练干预治疗[MD=7.72(3.67,11.54),P＜0.05]、等速肌力训练干预治疗[MD=10.79(1.65,19.64),P＜0.05]显著优于对照组的无干预治疗;在改善乳腺癌术后患肢淋巴水肿患者DASH评分方面,有氧训练干预治疗[MD=22.14(6.80,35.95),P＜0.05]、等速肌力训练干预治疗[MD=11.48(1.16,22.34),P＜0.05]显著优于对照组的无干预治疗.结论:根据定量合并证据显示,三种运动疗法均可有效改善乳腺癌术后患肢淋巴水肿患者上肢功能.等速肌力训练在干预乳腺癌术后患肢淋巴水肿患者手臂周径差,上肢前屈,上肢后伸,有氧训练在降低DASH方面更具优势.
A reticulated Meta-analysis of the Effect of Three Exercise Therapies on Functional Rehabilitation of the Upper Extremity in Patients with Postoperative Lymphedema of the Affected Extremity after Breast Cancer
Objective:To systematically evaluate the rehabilitation effect of three exercise therapies on upper limb function in patients with lymphoedema of the affected limb after breast cancer surgery.METHODS:Computer searches of CNKI,Wanfang,Wipu,Web of Science,PubMed,The Cochran library,Medline,Embase and other databases were conducted to collect randomized controlled trials(RCTs)from January 2005 to May 2024 on the intervention of three exercise therapies on the function of the upper limbs of patients with postoperative lymphedema of the affected limbs after breast cancer surgery(RCT).After 2 investigators independently screened the literature,extracted the information and evaluated the risk of bias of the included studies,a net Meta-analysis was performed using R software with Addis software.RESULTS:A total of 20 RCTs were included,including 1736 patients with lymphoedema in the affected limb after breast cancer surgery.The results of reticulated Meta-analysis showed that all three exercise therapies were superior to the control group in the rehabilitation of arm circumference difference in patients with postoperative lymphoedema of the affected limb after breast cancer(P＞0.05);in the rehabilitation of upper limb forward flexion in patients with postoperative lymphoedema of the affected limb after breast cancer,aerobic training intervention therapy[MD=20.05(11.17,28.69),P＜0.05],resistance training intervention therapy[MD=11.51(1.04,22.11),P＜0.05]were significantly better than no intervention treatment in the control group;in terms of upper limb posterior extension rehabilitation in patients with postoperative breast cancer lymphoedema of the affected limb,aerobic training intervention treatment[MD=7.72(3.67,11.54),P＜0.05],isokinetic muscle strength training intervention treatment[MD=10.79(1.65.19.64),P＜0.05]were significantly better than the no-intervention treatment in the control group;in terms of improving the DASH scores of the patients with postoperative lymphoedema of the affected limbs after breast cancer surgery,the aerobic training intervention treatment[MD=22.14(6.80,35.95),P＜0.05],isokinetic plyometrics training intervention treatment[MD=11.48(1.16,22.34),P＜0.05]was significantly better than no intervention treatment in the control group.CONCLUSION:All three exercise therapies are effective in improving upper extremity function in patients with postoperative breast cancer lymphoedema of the affected extremity,according to quantitative combined evidence.Isometric plyometric training was more advantageous in intervening with poor arm circumference,forward flexion of the upper extremity,and backward extension of the upper extremity,and aerobic training was more advantageous in reducing DASH in patients with postoperative breast cancer lymphoedema of the affected extremity.
Exercise therapyPatients with lymphedema of the affected limb after breast cancer surgeryUpper limb functionReticulated meta-analysis
万方数据
维普
