Zhou Y, Lu J, Liu L, et al. Is Exercise Rehabilitation an Effective Adjuvant to Clinical Treatment for Myofascial Trigger Points? A Systematic Review and Meta-Analysis. J Pain Res. 2023 Jan 28;16:245-256. doi: 10.2147/JPR.S390386. eCollection 2023. (Systematic review)

PURPOSE: To systematically evaluate the effect of exercise rehabilitation as an adjuvant to clinical treatment for myofascial trigger points (MTrPs).

PATIENTS AND METHODS: ESBCO, PubMed, Science Direct, Web of Science, China Knowledge Network (CNKI), and Wanfang databases were comprehensively searched from database inception date through July 2022. Randomized controlled trials comparing MTrPs treatments that included exercise rehabilitation with a single clinical treatment. Two researchers independently screened articles using inclusion/exclusion criteria, scored methodologic quality, and extracted data including patient demographics, interventions, and outcomes.

RESULTS: We included 14 RCTs (N = 734). Results showed short-term (mean difference [MD], -2.25; 95% confidence interval [CI], -4.08 to -0.41; Z = 2.40; P = 0.02) and long-term (MD = -0.47; 95% CI: -0.80 to -0.17; Z = 3.05; P = 0.02) adjuvant exercise rehabilitation treatments were superior in reducing musculoskeletal pain intensity to single clinical treatment in controls, but long-term versus short-term effectiveness was not significantly different. The exercise rehabilitation group more effectively increased the range of motion (ROM) (standardized mean difference [SMD], 1.04; 95% CI: 0.32 to 1.77; Z = 2.84; P = 0.005) and decreased dysfunction (SMD = -0.93; 95% CI: -1.82 to -0.05; Z = 2.06; P = 0.04) than controls; no significant difference was observed in the pressure pain threshold (PPT) between two groups.

CONCLUSION: Exercise rehabilitation as an adjuvant to clinical treatment for MTrPs was moderately effective in relieving pain intensity, increasing ROM, and improving dysfunction versus single clinical intervention. These findings must be validated by larger, higher-quality studies.

Discipline Area Score
Physician 5 / 7
Rehab Clinician (OT/PT) 5 / 7
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Comments from MORE raters

Physician rater

Lack of "mock" treatment comparison groups precludes evaluation of the placebo effect of additional "hands on" patient experiences. While I believe PT to be important, the studies cited are not sufficient and probably not comparable.

Physician rater

This article has interesting discussion points, but l think little scientific back up. I would have liked to have more clarity on the demographics and characteristics of the study populations. There was no meaningful discussion of retention rates and no mention of adverse events. The last two references refer to points in the discussion that would seem to be backed up by measuring physiological phenomena, but the references seem to be review articles that are unlikely to contain the data behind the statements. I couldn't apply the information contained herein in practice.

Physician rater

This paper is helpful in providing patients with information about which parameters would improve when recommending exercise. Provided support to combine treatment modalities.

Physician rater

This systematic review suggests that exercise rehabilitation (e.g., aerobics, stretching, strength training, or a combination) can complement individual clinical interventions (e.g., dry acupuncture, ultrasound, extracorporeal shock wave therapy, and ischaemic compression) in patients with myofascial trigger points to help reduce pain, improve dysfunction, and increase range of motions. However, the overall quality of evidence for the effectiveness of exercise rehabilitation is moderate/low because the diagnostic criteria for myofascial trigger points are not consistent, and there are only a small number of eligible studies with adequate sample sizes. Moreover, the search strategy of this review did not include grey literature sources. Therefore, more higher-quality and larger RCTs are needed to validate the findings of this review.
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