基于扰动的平衡训练能否预防跌倒？初步随机对照试验的系统评价和荟萃分析。
Does perturbation-based balance training prevent falls? Systematic review and meta-analysis of preliminary randomized controlled trials.
作者信息
Mansfield Avril, Wong Jennifer S, Bryce Jessica, Knorr Svetlana, Patterson Kara K
机构信息
A. Mansfield, PhD, Toronto Rehabilitation Institute, University Health Network, 550 University Ave, Room 11-117, Toronto, Ontario, Canada M5G 2A2; Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; and Department of Physical Therapy and Graduate Department of Rehabilitation Sciences, University of Toronto, Toronto, Ontario, Canada.
J.S. Wong, BSc, Toronto Rehabilitation Institute, University Health Network, and Graduate Department of Rehabilitation Sciences, University of Toronto.
出版信息
Phys Ther. 2015 May;95(5):700-9. doi: 10.2522/ptj.20140090. Epub 2014 Dec 18.
BACKGROUND
Older adults and individuals with neurological conditions are at an increased risk for falls. Although physical exercise can prevent falls, certain types of exercise may be more effective. Perturbation-based balance training is a novel intervention involving repeated postural perturbations aiming to improve control of rapid balance reactions.
PURPOSE
The purpose of this study was to estimate the effect of perturbation-based balance training on falls in daily life.
DATA SOURCES
MEDLINE (1946-July 2014), EMBASE (1974-July 2014), PEDro (all dates), CENTRAL (1991-July 2014), and Google Scholar (all dates) were the data sources used in this study.
STUDY SELECTION
Randomized controlled trials written in English were included if they focused on perturbation-based balance training among older adults or individuals with neurological conditions and collected falls data posttraining.
DATA EXTRACTION
Two investigators extracted data independently. Study authors were contacted to obtain missing information. A PEDro score was obtained for each study. Primary outcomes were proportion of participants who reported one or more falls (ie, number of "fallers") and the total number of falls. The risk ratio (proportion of fallers) and rate ratio (number of falls) were entered into the analysis.
DATA SYNTHESIS
Eight studies involving 404 participants were included. Participants who completed perturbation-based balance training were less likely to report a fall (overall risk ratio=0.71; 95% confidence interval=0.52, 0.96; P=.02) and reported fewer falls than those in the control groups (overall rate ratio=0.54; 95% confidence interval=0.34, 0.85; P=.007).
LIMITATIONS
Study authors do not always identify that they have included perturbation training in their intervention; therefore, it is possible that some appropriate studies were not included. Study designs were heterogeneous, preventing subanalyses.
CONCLUSIONS
Perturbation-based balance training appears to reduce fall risk among older adults and individuals with Parkinson disease.
背景
老年人及患有神经系统疾病的个体跌倒风险增加。尽管体育锻炼可以预防跌倒，但某些类型的锻炼可能更有效。基于扰动的平衡训练是一种新型干预措施，涉及反复的姿势扰动，旨在改善对快速平衡反应的控制。
目的
本研究的目的是评估基于扰动的平衡训练对日常生活中跌倒的影响。
数据来源
本研究使用的数据源包括MEDLINE（1946年至2014年7月）、EMBASE（1974年至2014年7月）、PEDro（所有日期）、CENTRAL（1991年至2014年7月）和谷歌学术（所有日期）。
研究选择
纳入以英文撰写的随机对照试验，这些试验聚焦于老年人或患有神经系统疾病的个体的基于扰动的平衡训练，并在训练后收集跌倒数据。
数据提取
两名研究人员独立提取数据。联系研究作者以获取缺失信息。为每项研究获得PEDro评分。主要结局是报告一次或多次跌倒的参与者比例（即“跌倒者”数量）和跌倒总数。将风险比（跌倒者比例）和率比（跌倒次数）纳入分析。
数据综合
纳入八项研究，共404名参与者。完成基于扰动的平衡训练的参与者报告跌倒的可能性较小（总体风险比=0.71；95%置信区间=0.52，0.96；P=.02），且报告的跌倒次数少于对照组（总体率比=0.54；95%置信区间=0.34，0.85；P=.007）。
局限性
研究作者并不总是明确表示他们在干预中纳入了扰动训练；因此，可能未纳入一些合适的研究。研究设计具有异质性，无法进行亚组分析。
结论
基于扰动的平衡训练似乎可降低老年人及帕金森病患者的跌倒风险。
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