中国全科医学 ›› 2022, Vol. 25 ›› Issue (20): 2534-2540.DOI: 10.12114/j.issn.1007-9572.2022.0062

• 方法学研究·中医药专题 • 上一篇    下一篇

中西医治疗慢性腰痛临床研究的有效率定义及其判定标准存在差异:一项概况性评价

黎霞1, 李多多1, 程潞瑶1, 万颖2, 于长禾1,*()   

  1. 1100700 北京市,北京中医药大学东直门医院推拿疼痛科
    2100009 北京市鼓楼中医医院
  • 收稿日期:2022-01-15 修回日期:2022-02-28 出版日期:2022-07-15 发布日期:2022-02-14
  • 通讯作者: 于长禾
  • 黎霞,李多多,程潞瑶,等.中西医治疗慢性腰痛临床研究的有效率定义及其判定标准存在差异:一项概况性评价[J].中国全科医学,2022,25(20):2534-2540. [www.chinagp.net]
    作者贡献:黎霞进行原稿写作、研究方法的设计、数据管理、绘制表格;李多多进行研究方法的设计,审查与编辑写作;程潞瑶、万颖进行数据提取与管理;于长禾提出主要研究目标、为研究课题提供资金支持;所有作者确认了论文的最终稿。
  • 基金资助:
    国家自然科学基金青年科学基金项目--慢性腰背痛中医临床研究核心结局指标集的构建与优化(81803956); 北京市首发青年优才项目--退行性腰椎管狭窄症中医综合诊疗方案的规范化研究(2020-4-4195); 首都临床特色应用研究--"以筋带骨"理论下中医推拿综合方案防治膝骨关节炎的临床研究(Z181100001718165)

Definition and Differences of Determination Criteria of the Rate of Chronic Low Back Pain Response to Integrated Traditional Chinese and Western Medicine Treatment in Clinical Studies: a Scoping Review

Xia LI1, Duoduo LI1, Luyao CHENG1, Ying WAN2, Changhe YU1,*()   

  1. 1Department of Tuina and Pain Management, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
    2Beijing Gulou Hospital of Chinese Medicine, Beijing 100009, China
  • Received:2022-01-15 Revised:2022-02-28 Published:2022-07-15 Online:2022-02-14
  • Contact: Changhe YU
  • About author:
    LI X, LI D D, CHENG L Y, et al. Definition and differences of determination criteria of the rate of chronic low back pain response to integrated traditional Chinese and Western medicine treatment in clinical studies: a scoping review[J]. Chinese General Practice, 2022, 25 (20) : 2534-2540.

摘要: 背景 中西医结合治疗腰痛的疗效显著,复合结局指标——有效率作为重要的疗效观察指标,在临床研究中尚未得到统一规范。 目的 系统回顾以有效率为复合结局指标的中西医治疗慢性腰痛的临床研究,分析其中有效率的定义和具体内容,为后期研究合理地选择慢性腰痛的复合结局指标提供参考。 方法 计算机检索Web of Science、PubMed、EMBase、Cochrane Library、中国期刊全文数据库、维普网、万方数据知识服务平台和中国生物医学文献服务系统关于中西医治疗慢性腰痛的临床研究,检索时限为2015—2019年。由2名研究者根据纳入、排除标准独立排除不符合纳入标准的文献,根据BPICOS原则提取文献中的内容,并对复合结局指标(有效率)的判定标准进行回顾与总结。 结果 共纳入研究830篇,以腰肌劳损患者作为研究对象的最多,共178篇(21.4%),其他研究对象包括第三腰椎横突综合征患者103篇(12.4%)、腰椎间盘突出患者91篇(11.0%)、腰背痛患者89篇(10.7%)、腰背肌筋膜炎患者72篇(8.7%)、腰椎管狭窄患者69篇(8.3%)、腰椎滑脱患者61篇(7.3%)。830篇研究中808篇(97.3%)具体表述了有效率的参照标准或自定义评判标准,其中参考最多的是不同版本的《中医病证诊断疗效标准》,共271篇(32.7%)。在复合结局指标中使用最多的是临床症状、活动功能、疼痛、体征、工作生活能力这5项评判指标,常见以2~5项指标随意结合成三级或四级疗效评判标准,此外,常见的腰痛测量工具也被应用其中。 结论 由于缺乏统一的规范化标准,中西医治疗腰痛的临床研究在使用复合结局指标——有效率时存在诸多问题,例如定义、划分标准、评价项目等不统一,笔者认为有效率这一复合结局指标可通过核心结局体系(COMET)进一步规范,并提高其效度形成统一标准以供临床研究使用,以提高中西医临床研究的质量与价值。

关键词: 腰痛, 疼痛, 症状和体征, 中医药疗法, 中西医结合疗法, 治疗结果, 结局指标, 概况性评价

Abstract:

Background

The integrated traditional Chinese and Western medicine has proved to be significantly effective in low back pain. But the response rate, a key composite outcome index for assessing the efficacy, has not been unified and standardized in clinical research.

Objective

To perform a scoping review of the definition and contents of rate of chronic low back pain response to integrated traditional Chinese and Western medicine in clinical studies with response rate as a composite outcome indicator, offering a reference for appropriately selecting composite outcome indicators of this disease.

Methods

Databases including Web of Science, PubMed, EMBase, Cochrane Library, CNKI, CQVIP, Wanfang Data and SinoMed were searched for clinical studies of chronic low back pain treated by integrated traditional Chinese and Western medicine published from January 2015 to December 2019. Two researchers independently enrolled studies according to inclusion and exclusion criteria, extracted data according to the BPICOS principles, and reviewed and summarized the criteria for defining the response rate as a composite outcome indicator.

Results

Among 830 included studies, lumbar muscle degeneration had been studied the most 〔178 (21.4%) 〕, followed by the third lumbar transverse process syndrome〔103 (12.4%) 〕, lumbar disc herniation〔91 (11 .0%) 〕, low back pain〔89 (10.7%) 〕, lumbodorsal myofasciitis〔72 (8.7%) 〕, lumbar spinal stenosis〔69 (8.3%) 〕, and lumbar spondylolisthesis〔61 (7.3%) 〕. 808 studies (97.3%) described the reference for the definition of response rate or explained the definition of response rate developed by the author. Specifically, different versions of Criteria for the Diagnosis, Syndrome Differentiation, and Response Assessment of Diseases by Chinese Medicine was referred the most〔271 (32.7%) 〕. Clinical symptoms, level of daily life activities, pain, signs and work & living ability, these five indictors were used most frequently as composite outcome indicators, and 2-5 of them were often randomly used in combination as the third or fourth level of response criteria. In addition, common low back pain measurement tools were also used.

Conclusion

Due to the lack of unified standard, composite outcome indicators used for response assessment in clinical studies about chronic low back pain treated by traditional Chinese and Western medicine might have many problems, such as various definitions, division criteria, and assessment items. In view of this, it is suggested to standardize the composite outcome indicators for response assessment in accordance with the CORE Outcome Measurement and Evaluation Tool, and to improve their validity to be used in clinical studies regarding integrated traditional Chinese and Western medicine as unified indicators, thereby improving the quality and value of such studies.

Key words: Low back pain, Pain, Signs and symptoms, Traditional Chinese medicine therapy, Integrated Chinese traditional and Western medicine therapy, Treatment outcome, Outcome index, Scoping review