| Epidemiological investigations have shown that the incidence of osteoarthritis is gradually increasing with age,and one of the most common large joints affected by Asians is the knee joint,ie knee osteoarthritis.With the aging of social populations increasing,knee osteoarthritis has received widespread attention in the medical field because of its high morbidity and economic burden and its severe impact on quality of life.In particular,how to improve the quality of life of patients with knee osteoarthritis has been Has become one of the important topics in the current medical community.At present,the treatment status of knee osteoarthritis is not ideal,and Chinese medicine massage therapy has been playing an important role in clinical treatment of tendon injury and pain.Therefore,this study tried to analyze the clinical treatment of knee osteoarthritis.The current situation of medical research and the study of the therapeutic effects of massage on knee osteoarthritis provide new ideas and new methods for the treatment of knee osteoarthritis.PurposeThe epidemiological study of knee osteoarthritis and the current status of related therapies are reviewed and reviewed.Evidence-based medical research methods are also used to evaluate the effectiveness and safety of massage in the treatment of knee osteoarthritis.At the same time,massage and other treatment of knee joints are also discussed.The pros and cons of the commonly used treatments.MethodLiterature review:Traditional Chinese medicine theory is used as a starting point in the form of review in the traditional methods to organize and summarize the name of traditional Chinese medicine for osteoarthritis of the knee,understanding of the cause and pathogenesis of traditional Chinese medicine theory,and treatment and treatment of osteoarthritis of traditional Chinese medicine.Systematic review:computer search Cochrane Library,PubMed,Web of Science,CNKI,Wanfang and other databases,find a randomized controlled trial of massage treatment of knee osteoarthritis,retrieval time from the library to the library in March 2018.Independently selected by two investigators,the literature was selected according to the inclusion exclusion criteria,and data was extracted from the eligible literature.Two investigators used the Cochrane Reviewer Handbook 5.1.0 risk assessment tool to assess risk of bias.Qualitative analysis and quantitative analysis were performed on the extracted data.Quantitative analysis was performed using Meta analysis and RevMan 5.3 software.Use GRAEDpro GDT to rank the quality of evidence.ResultLiterature review:Through the review method,we know that the incidence of knee osteoarthritis,the economic burden and social burden caused by it are becoming increasingly severe,and seriously affect human life.However,the current status of its treatment is not ideal.Western medicine for the treatment of knee osteoarthritis The main point is to improve the symptoms,that is,symptomatic treatment of pain,swelling,stiffness of the joints,and limitation of function in patients with knee osteoarthritis.At present,clinical recommendations for the treatment of knee osteoarthritis are mainly divided into four aspects,routine treatment recommendations,non-drug treatment recommendations,drug treatment recommendations and surgical treatment recommendations.Routine treatment suggests non-pharmacological treatment combined with drug therapy;non-pharmaceutical treatment is widely accepted,less individual application,and long-term adherence;drug therapy has limitations,more or less questioned by safety or efficacy;surgical treatment Strict surgical indications and contraindications,there is a surgical risk;Chinese medicine treatment KOA shows a unique advantage;massage safe,simple and effective to improve the symptoms of knee osteoarthritis,but the evidence is weak.Systematic review:A total of 26 randomized controlled trials were included in this review,involving a total of 2,920 subjects.The main results are as follows:1 The total effective rate of the massage group was 13%higher than that of the western medicine group(RR 1.13,95%CI 1.06 to 1.20,P<0.0001;moderate quality).Compared with western medicine group,there was not enough evidence in the massage group to prove that there was a difference in VAS score(MD-0.38,95%CI-1.52 to 0.75,P = 0.51;very low quality).Compared with western medicine group,there was not enough evidence in the massage group to prove that the WOMAC scores of the two groups were different(MD-2.50,95%CI-15.50 to 10.50,P = 0.71;very low quality).Compared with western medicine group,there is not enough evidence in the massage group to prove that the HSS scores of the two groups are different(MD 6.41,95%CI-5.92 to 18.74,P = 0.31;very low quality).Compared with western medicine group,there was not enough evidence in the massage group to prove that there were differences in adverse reactions(RD-0.02,95%CI-0.07 to 0.03,P = 0.36;low quality).2 The evidence in the massage group compared with the Chinese medicine oral group is not sufficient to prove that there is a difference between the two(RR 1.10,95%CI 0.90 to 1.35,P=0.34;low quality).Compared with the traditional Chinese medicine oral group,there was not enough evidence in the Tuina group to prove that the WOMAC scores were different(MD 5.56,95%CI-9.45 to 20.77,P = 0.46).3 Compared with the TCM external application group,there is not enough evidence to prove the difference in efficiency between the massage group and the external use group(RR 1.05,95%CI 0.92 to 1.20,P=0.44;low quality).In the massage group,the VAS score was 0.83(MD 0.83,95%CI 0.11 to 1.56,P=0.02)on average compared with the TCM topical group.Compared with the TCM topical group,there was not enough evidence in the Tuina group to show the difference in adverse reactions(RD 0.00,95%CI-0.01 to 0.01,P=1.00;moderate quality).4 The evidence in the massage group compared with the Chinese herb fumigation group is not sufficient to prove that there is a difference between the two(RR 1.07,95%CI 0.95 to 1.21,P=0.27;low quality).Compared with traditional Chinese medicine fumigation group,there was not enough evidence in the massage group that the WOMAC score was different(MD 0.30,95%CI-3.18 to 3.78,P = 0.87),5 The evidence in the massage group compared with the acupuncture group is not sufficient to prove that there is a difference between the two(RR 0.87,95%CI 0.70 to 1.07,P=0.18;very low quality).The evidence is not sufficient to prove that there is a difference between the two WOMAC scores(MD 2.29,95%CI-7.73 to 12.31,P = 0.65;low quality).The evidence is not sufficient to prove that there are differences in adverse reactions(RD 0.00,95%CI-0.04 to 0.04,P = 1.00).6 The evidence from the massage group and the joint cavity injection group is not sufficient to prove that there is a difference between the two(RR 1.03,95%CI 0.96 to 1.11,P=0.41;low quality).The VAS score in the massage group was 0,55 higher than that in the joint cavity group(MD 0.55,95%CI 0.51 to 0.58,P<0.00001).The evidence is not sufficient to prove that there are differences in adverse reactions between the two groups(RD 0.02,95%CI-0.04 to 0.08,P = 0.46).7 In the massage group,compared with the functional exercise group,the massage group had an effective rate of 34%(RR 1.34,95%CI 1.13 to 1.59,P=0.0009;low quality).Compared with the functional exercise group in the massage group,the evidence is not enough to prove that the two groups have different WOMAC scores(MD-8.13,95%CI-26.43 to 10.17,P = 0.38).Conclusion1 At present,knee osteoarthritis is still difficult to cure and can only be treated symptomatically to improve the quality of life of patients.With the development of science and technology,many new interventions have emerged in the treatment of knee osteoarthritis.2 The effect of massage on knee osteoarthritis was better,and the improvement of VAS score,WOMAC score,HSS score,etc.was not weaker than that of western medicine,traditional Chinese medicine,acupuncture or joint cavity injection.3 Although massage has advantages in the treatment of knee osteoarthritis,most of the evidence is of poor quality.The main reasons are the small sample size,the small number of relevant tests,the unreasonable and unreliable design of the test plan,and the non-standard test reports.4 The innovation of this research is that this study is the first systematic review of traditional Chinese medicine for knee osteoarthritis in the treatment of knee osteoarthritis.The results are more representative,and it also discusses massage and other common knee osteoarthritis therapies.The advantages and disadvantages of the comparison are of great significance for the patients with knee osteoarthritis in our country,the doctors to select suitable therapies,and the guidelines for the development of knee osteoarthritis.5 Suggest that more massaging should be performed in the future for a large-scale,multicenter,randomized controlled trial of knee osteoarthritis in order to obtain a higher level of evidence and confirm the efficacy and safety of tuina therapy for knee osteoarthritis.It is recommended that future investigators register clinical trials,publish trial protocols,and publish test results in accordance with international standards before conducting clinical trials,so that clinical research can be uniformly standardized and managed.Unnecessary waste of resources can also help researchers to standardize trial designs and avoid unnecessary risks in the testing process. |
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