呼吸運動於慢性非特異性下背痛之疼痛與失能改善成效：系統性文獻回顧暨統合分析

Effectiveness of Breathing Exercises in Managing Pain and Disability in Chronic Nonspecific Low Back Pain: A Systematic Review and Meta- Analysis

慢性非特異性下背痛為常見肌肉骨骼疾病，將導致疼痛與活動功能障礙。研究指出呼吸運動可強化橫膈膜與核心肌群，改善疼痛與減緩失能。本文旨在綜整不同呼吸運動之疼痛與失能改善成效。依循Joanna Briggs Institute系統性文獻回顧指引，搜尋台灣期刊論文索引、華藝線上圖書館、CINAHL、Cochrane Library、Embase、PubMed、ProQuest資料庫2025年4月以前文獻，鍵入下背痛、呼吸運動之MeSH Term與同義詞，採布林邏輯、限制隨機控制試驗等進階檢索技巧，篩選納入14篇隨機控制試驗文獻，以JBI 2023年隨機控制試驗查核表評讀文獻品質，以Review Manager 5.4版軟體進行統合分析。呼吸運動比常規照護顯著降低疼痛程度（SMD=-1.07，p=0.001）、改善失能程度（SMD=-0.63，p=0.0005）；次族群分析顯示呼吸阻力器訓練可顯著改善疼痛，核心穩定呼吸肌訓練可顯著改善疼痛與失能。現有證據皆為小樣本研究，整體為偏高的選擇性、執行性、檢測性與損耗性偏差風險，證據力顯薄弱，然呼吸運動非侵入性、無顯著副作用，建議臨床可考慮知識轉譯，並追蹤個案反應決策長期適用性。

Chronic nonspecific low back pain (CNLBP) is a common musculoskeletal disorder that leads to pain and disability. Breathing exercises can strengthen the diaphragm and core muscles, alleviating pain and reducing disability. The aim in this study was to investigate the effects of various breathing exercises on the level of pain and disability in patients with CNLBP. Following the Joanna Briggs Institute (JBI) manual for evidence synthesis, databases including the Taiwan Periodical Literature System, Airiti Library, CINAHL, Cochrane Library, Embase, PubMed, and ProQuest were searched for studies published before April 2025. The Medical Subject Headings (MeSH) and synonyms related to“low back pain”and“breathing exercises”were used, applying Boolean logic and advanced search strategies such as filters for randomized controlled trials (RCTs). A total of 14 RCTs were included in this study. The methodological quality of these studies was evaluated using the JBI 2023 checklist for RCTs. A meta-analysis was performed using Review Manager version 5.4. Breathing exercises significantly reduced pain (SMD=- 1.07, p=0.001) and disability (SMD=-0.63, p=0.0005) compared with those experienced by patients treated with usual care. Subgroup analyses revealed that inspiratory muscle training notably reduced pain, whereas core-stabilizing respiratory muscle training substantially reduced pain and disability. The current evidence of the effects of breathing exercises on reducing pain and disability in those with CNLBP is based on small-sample studies, most of which exhibit high risk of selection, performance, detection, and attrition biases, resulting in weak evidence. However, breathing exercises are noninvasive and have no serious adverse effects. Therefore, breathing exercises should be clinically implemented through knowledge translation with ongoing monitoring of individual responses to assess the long-term applicability of this intervention.