Efetividade da associação da acupuntura com exercício na dor, incapacidade e qualidade de vida de indivíduos com condições crônicas musculoesqueléticas: revisão sistemática com metanálise

Abstract

Introduction: Chronic musculoskeletal conditions have an increasing prevalence worldwide. Acupuncture and exercise are recommended as treatments for this type of condition. There is no meta-analysis in the literature estimating the effect of the association of these treatments compared to placebo/sham acupuncture associated with exercise for the management of chronic pain. Aim: To analyze the effectiveness of the association of acupuncture and exercise on pain intensity, level of physical disability and perception of quality of life in chronic musculoskeletal conditions in the lumbar, shoulder and knee. Methods: Systematic review with meta-analysis of randomized controlled clinical trials. The search was performed in November 2020 and updated in January 2022 in the PUBMED, EMBASE, Cochrane Library, CENTRAL and PEDro databases, without time or language restrictions. Studies with any acupuncture modality associated with exercise were included. Feasibility studies, protocols or that the comparison group was not using sham/placebo acupuncture associated with exercise were excluded. The analyzes and data extraction were performed by two independent evaluators. The risk of bias was analyzed using the PEDro scale. Data were grouped according to population, intervention, comparison, outcomes, intervention time, and outcomes. For the meta-analysis, the Review Manager software was used. Results: 5,438 articles were identified. 11 with 1,323 participants (3 lumbar, 3 shoulder and 5 knee) were included for the synthesis and extraction of data. More than half of the studies were developed in Europe and only two articles were at high risk of bias (PEDro < 6). For pain intensity, the intervention was effective and had a small effect at post- treatment (MD -6.00, 95% CI -11.05 to -0.94; Moderate certainty) and at the last follow-up (MD -7.04, 95% CI - 13.95 to -0.13; Moderate certainty). Sensitivity analysis removing studies at high risk of bias showed a clinically relevant effect for the intervention at last follow-up (MD -19.78, 95% CI -25.91 to -13.66). No statistical difference was found in the comparisons for disability (Moderate certainty) and quality of life (Low certainty) outcomes. Conclusion: Associating acupuncture with exercise seems to be effective in improving the intensity of chronic musculoskeletal pain in the low back, with a greater effect for the follow-up.