Background: This review aims to explore the role of physiotherapy in early and traditional palliative care (PC) for oncology patients, focusing on its impact on six patient-reported outcomes (PROMs), namely fatigue, pain, cachexia, quality of life (QoL), physical functioning (PHF), and psychosocial functioning (PSF). The purpose is to assess the effectiveness of various physiotherapy interventions and identify gaps in the current research to understand their potential benefits in PC better. Methods: A systematic literature search was conducted across PubMed, Embase, and Web of Science, concluding on 21 December 2023. Two independent reviewers screened the articles for inclusion. The Cochrane Risk of Bias Tool 2 was employed to assess the risk of bias, while the GRADE approach was used to evaluate the certainty of the evidence. Results: Nine randomized controlled trials (RCTs) were included, with most showing a high risk of bias, particularly in outcome measurement and missing data. Cognitive behavioral therapy (CBT) was the only intervention that significantly reduced fatigue, enhanced PHF, and improved QoL and emotional functioning. Graded exercise therapy (GET) did not yield significant results. Combined interventions, such as education with problem-solving or nutritional counseling with physical activity, showed no significant effects. Massage significantly improved QoL and reduced pain, while physical application therapies were effective in pain reduction. Mindful breathing exercises (MBE) improved QoL but had a non-significant impact on appetite. The overall certainty of the evidence was low. Conclusions: Physiotherapy can positively influence PROMs in oncology PC; however, the low quality and high risk of bias in existing studies highlight the need for more rigorous research to confirm these findings and guide clinical practice.
背景：本综述旨在探讨物理治疗在肿瘤患者早期及传统姑息治疗中的作用，重点关注其对六项患者报告结局指标的影响，包括疲劳、疼痛、恶病质、生活质量、躯体功能及心理社会功能。研究目的在于评估不同物理治疗干预措施的有效性，识别当前研究中的空白，以更深入理解其在姑息治疗中的潜在价值。 方法：系统检索PubMed、Embase和Web of Science数据库，检索截止日期为2023年12月21日。由两名独立评审员进行文献筛选。采用Cochrane偏倚风险评估工具2.0评估偏倚风险，使用GRADE方法评价证据质量。 结果：共纳入9项随机对照试验，多数研究存在较高偏倚风险，尤其在结局测量和数据缺失方面。认知行为疗法是唯一能显著减轻疲劳、增强躯体功能、改善生活质量及情绪功能的干预措施。分级运动疗法未显示显著效果。联合干预措施（如教育结合问题解决训练，或营养咨询结合体力活动）未见显著疗效。按摩治疗显著改善生活质量并减轻疼痛，物理应用疗法在缓解疼痛方面效果显著。正念呼吸练习虽能提升生活质量，但对食欲改善作用不显著。整体证据质量较低。 结论：物理治疗可对肿瘤姑息治疗中的患者报告结局产生积极影响，但现有研究质量偏低且偏倚风险较高，亟需开展更严谨的研究以验证这些发现并指导临床实践。
肿瘤(癌症)患者之家