以系統性文獻回顧與整合分析探討瑜珈對更年期相關症狀之成效

Effectiveness of yoga for improving menopause-related symptoms: a systematic review and meta-analysis

目標：更年期相關症狀對於婦女的生活常造成相當程度困擾，瑜珈是常被用於處理更年期相關症狀之輔助方式之一，但其成效未獲確定。方法：此系統性文獻回顧與整合分析探討瑜珈對於改善更年期相關症狀之成效，於PubMed、MEDLINE、CINAHL、Cochrane Library及華藝線上圖書館等電子資料庫設定關鍵字搜尋2018年2月以前出版之中、英文文獻，依據納入及排除條件，排除不符合此研究主題之文獻後共納入11篇文獻，依考科藍隨機對照試驗誤差風險評估（The Cochrane risk of bias tool for randomized clinical trials）之評析標準進行文獻研究品質評價，並使用牛津大學之實證醫學證據等級表（Oxford centre for Evidence-based Medicine）評定證據等級。整合分析（Meta-Analysis）部分乃使用Review Manager軟體（RevMan）5.3版本。結果：整合分析結果顯示：瑜珈改善整體更年期症狀之效果量SMD為-0.96（95％ CI：-1.60, -0.32, p＝0.003；異質性I^2＝86％），改善憂鬱之效果量SMD為-0.23（95％ CI：-0.42, -0.03, p＝0.02；異質性I^2＝0％），改善睡眠障礙之效果量SMD為-0.21（95％ CI：-0.41, -0.02, p＝0.03；異質性I^2＝0％），改善血管舒縮症狀之效果量SMD為-0.23（95％ CI：-0.41, -0.05, p＝0.01；異質性I^2＝0％）；但瑜珈對於改善壓力感受未呈現顯著成效。結論：此系統性文獻回顧與整合分析支持瑜珈可改善整體更年期相關症狀、憂鬱、睡眠障礙與血管舒縮症狀，針對此特殊族群提出練習瑜珈之相關建議將受限於納入研究之內外在信度的影響，仍需執行更多嚴謹研究以豐富現存文獻。 Objectives: Menopause-related symptoms often cause considerable distress to women. Yoga is widely employed as a complementary method for managing menopause-related symptoms, but its effectiveness must still be determined. Methods: This systematic review and meta-analysis examined the effectiveness of yoga for improving menopause-related symptoms. Using identified keywords, a systematic literature search for relevant English and Chinese language studies published before February 2018 was conducted in the following electronic databases: PubMed, MEDLINE, CINAHL, the Cochrane Library, and the Airiti Library. Results of the literature search were screened using proposed inclusion and exclusion criteria. Eleven articles were included for systematic review after removing some articles on irrelevant topics. Study quality was assessed based on the Cochrane Risk of Bias Tool for Randomized Controlled Trials, and ranking of evidence was based on the Oxford 2011 Levels of Evidence. Meta-analysis was conducted using Review Manager version 5.3. Results: Meta-analysis results indicated that practicing yoga resulted in an improvement in overall menopause-related symptoms [standardized mean difference (SMD): -0.96, 95% confidence interval (95% CI): -1.60, -0.32, p = 0.003; heterogeneity I^2 = 86%], depression (SMD: -0.23, 95% CI: -0.42, -0.03, p = 0.02; I^2 = 0%), sleep disorders (SMD: -0.21, 95% CI: -0.41, -0.02, p = 0.03; I^2 = 0%), and vasomotor symptoms (SMD: -0.23, 95% CI: -0.41, -0.05, p = 0.01; I^2 = 0%). However, practicing yoga did not result in a significant reduction in the perception of stress. Conclusions: The results of this systematic review and meta-analysis support that yoga may improve overall menopause-related symptoms, depression, sleep disorders, and vasomotor symptoms. Recommendations related to practicing yoga for this specific population may be attenuated by influences associated with the internal and external validities of the included studies. Conducting additional rigorous studies is necessary to enrich the currently available information.