徒手治療對足底疼痛患者之療效：統合分析與系統性回顧

背景與目的：足底疼痛（plantar heel pain）是種常見的足部問題。發表於2018年前的系統性回顧皆顯示徒手治療可減輕疼痛和恢復足部功能，但2018年後有數篇徒手治療相關文獻發表，因此需要重新檢視文獻證據；另外過去研究使用不同徒手治療手法及研究方法探討徒手治療與一般物理治療（例如：物理因子治療、伸展運動或／和肌力訓練）相較的療效或是額外給予徒手治療的療效。因此，本研究將以系統性回顧與統合分析，探討相較於一般物理治療，徒手治療和其中特定徒手治療手法的效益，以及一般物理治療額外加上徒手治療，對於足部疼痛及功能之療效。方法：於9個資料庫（PubMed、Physiotherapy Evidence Database、Cochrane Library、Embase、Medline、Web of Science、Google Scholar、中國學術文獻網絡出版總庫和華藝線上圖書館）搜尋2021年5月31日前所發表的隨機對照試驗。結果：本研究納入11篇文獻，統合分析結果顯示總括來說在改善疼痛上徒手治療可能並未優於一般物理治療，但肌筋膜放鬆技術相較於一般物理治療可能可以顯著減輕疼痛且改善足部功能，但可能需為短期多次治療且施作部位包含足底筋膜；另外，一般物理治療合併額外徒手治療也可能增進足部功能。其中質性分析顯示一般物理治療額外搭配肌筋膜放鬆術或軟組織鬆動合併關節鬆動術可能更有治療效果。結論：肌筋膜放鬆技術可減輕足底疼痛患者的疼痛以及改善足部功能，而一般物理治療結合徒手治療可能可以提升治療的療效。

關鍵字

足底疼痛；肌筋膜放鬆術；徒手治療；關節鬆動術；軟組織鬆動術

並列摘要

Background and Purpose: Plantar heel pain is one of the most common foot orthopedic complaints. Previous systemic reviews published before 2018 have shown that generally manual therapy could decrease pain and improve function. However, some articles related to effects of manual therapy on plantar heel pain have been published after 2018. There is a need to review the effects of manual therapy on plantar heel pain again. In addition, previous studies applied various types of manual therapy with different study designs to compare manual therapy with conventional physical therapy (e.g., therapeutic modalities, stretching exercise, and/or strengthening training) and investigate the additional effects of manual therapy. Therefore, we conducted this systematic review and meta-analysis to compare the effects of overall manual therapy and a specific manual therapy technique to conventional physical therapy. We also aimed to determine the additional effects of manual therapy in combination with the conventional physical therapy on pain and function. Methods: A systematic search for randomized controlled trials published before May 31, 2021 in nine online major databases (PubMed, Physiotherapy Evidence Database, Cochrane Library, Embase, Medline, Web of Science, Google Scholar, China Academic Journal Network Publishing Database, and Airiti Library) was conducted. Results: After screening, 11 studies were included. The results of meta-analysis showed that compared to the conventional physical therapy, there may be no significant effects of manual therapy on pain. But myofascial release may result in better improvement in pain and foot function than the conventional physical therapy. It was suggested that manual therapy should apply to the regions including plantar fascia with a short-term protocol. Also, adding manual therapy in treatment protocols could lead to additional improvement in foot function. The results of the systematic review showed that myofascial release or soft tissue mobilization plus joint mobilization would be a better choice to further decrease pain and improve foot function in combination with conventional physical therapy. Conclusions: Myofascial release could help decrease pain intensity and improve functional performance in people with plantar heel pain. Treatment programs including manual therapy (myofascial release or soft tissue mobilization combined with joint mobilization) could also provide better effects than those without manual therapy.

並列關鍵字

Plantar heel pain ； Myofascial release ； Manual therapy ； Joint mobilization ； Soft tissue mobilization

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