Reneker Jennifer C, Clay Moughiman M, Cook Chad E
Division of Physical Therapy, Walsh University, North Canton, OH, USA; Community Based Outpatient Therapy, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Akron, OH, USA.
Community Based Outpatient Therapy, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Akron, OH, USA.
J Sci Med Sport. 2015 Jul;18(4):366-72. doi: 10.1016/j.jsams.2014.05.002. Epub 2014 May 17.
Dizziness after a sports-related concussion is very common and is associated with prolonged recovery. The events in sports that cause concussion include strong mechanical forces exerted to the head and neck, potentially injuring the cervical region, the peripheral vestibular and central nervous system, all of which can contribute to a sensation of dizziness. The purpose of this study was to identify proper clinically administered tests and measures that are useful in differentiating between cervicogenic and other causes of dizziness after a sports-related concussion.
The Delphi method.
The workgroup identified the initial list of suggested clinical tests and the initial list of content experts on dizziness and/or concussion through a search of peer-reviewed and grey literature. The respondent group included all invited experts who opted to participate. A sequential three-round process was used for elicitation of consensus opinions from the targeted content experts.
The respondent group included 25 members from several medical disciplines who were experts in concussion and dizziness. At the conclusion of the study, ten clinical tests achieved the designation of strong clinical utility, six were determined to have weak clinical utility and seven achieved no consensus among the experts.
The majority of clinical tests identified as having strong clinical utility are tests used to identify dizziness originating from the vestibular or central nervous system. No clinical tests specific for the cervical region achieved consensus. Expert opinion from different medical professions and even within professions was widely divergent regarding the utility of clinical tests to assess cervical dysfunction.
与运动相关的脑震荡后头晕非常常见，且与恢复时间延长有关。导致脑震荡的运动事件包括作用于头部和颈部的强大机械力，这可能会损伤颈椎区域、外周前庭和中枢神经系统，所有这些都可能导致头晕感。本研究的目的是确定适当的临床应用测试和措施，以有助于区分与运动相关的脑震荡后颈源性头晕和其他头晕原因。
德尔菲法。
工作组通过检索同行评审文献和灰色文献，确定了建议的临床测试初始清单以及头晕和/或脑震荡方面的内容专家初始清单。应答组包括所有选择参与的受邀专家。采用连续三轮的过程从目标内容专家中获取共识意见。
应答组包括来自多个医学学科的25名成员，他们是脑震荡和头晕方面的专家。在研究结束时，十项临床测试被指定为具有很强的临床实用性，六项被确定临床实用性较弱，七项在专家中未达成共识。
大多数被确定具有很强临床实用性的临床测试是用于识别源自前庭或中枢神经系统的头晕的测试。没有针对颈椎区域的临床测试达成共识。不同医学专业甚至同一专业内的专家意见在评估颈椎功能障碍的临床测试实用性方面存在很大差异。
