张亮勇,刘学怡,麦燕紫,杨 暘,张海涛

目的系统评价与Meta分析认知功能疗法（Cognitive Functional Therapy，CFT）对成人慢性腰痛患者功能障碍与疼痛强度的疗效。方法检索PubMed、Embase、Cochrane Library、Web of Science（建库至2025年8月），纳入CFT与常规护理、常规物理治疗、核心锻炼和手法治疗等对照干预的随机对照试验（Randomized Controlled Trial，RCT）。主要结局为功能障碍与疼痛强度。采用RevMan5.0进行合并分析，以标准化均数差（SMD）及95%置信区间（CI）表示效应量；异质性以I²评估，并进行干预周期（≤8周vs＞8周）亚组分析、留一法敏感性分析及漏斗图发表偏倚评估。结果共纳入12项英文RCT（2013–2025年，5个国家）。在功能障碍方面，11项RCT（CFT组650例，对照组639例）显示CFT较对照干预可显著降低功能障碍[SMD=−0.97，95%CI（−1.30～−0.65），P＜0.001]，但异质性较高（I²=86%）。在疼痛强度方面，11项RCT（CFT组648例，对照组640例）显示CFT较对照干预可显著降低疼痛强度[SMD=−0.89，95%CI（−1.25～−0.54），P＜0.001]，异质性较高（I²=88%）。亚组分析显示≤8周与＞8周均有获益，且＞8周异质性明显降低（功能障碍I²=0%，疼痛强度I²=20%），提示干预周期可能为异质性来源之一。结论现有证据表明CFT可改善成人慢性腰痛的功能与疼痛，但可能存在发表偏倚；其长期疗效、最佳干预周期及适用人群仍需进一步研究。

认知功能疗法；慢性腰痛；功能障碍；疼痛强度；系统评价；Meta分析；随机对照试验

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