School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
School of Physiotherapy, Royal College of Surgeons Ireland, Dublin, Ireland.
Br J Sports Med. 2017 Mar;51(5):442-451. doi: 10.1136/bjsports-2016-096081. Epub 2016 Sep 21.
Concussion symptoms normally resolve within 7-10 days but vertigo, dizziness and balance dysfunction persist in 10-30% of cases causing significant morbidity. This study systematically evaluated the evidence supporting the efficacy, prescription and progression patterns of vestibular rehabilitation therapy (VRT) in patients with concussion.
Systematic Review, guided by PRISMA guidelines and presenting a best evidence synthesis.
Electronic databases PubMed (1949 to May 2015), CINAHL (1982 to May 2015), EMBASE (1947 to May 2015), SPORTDiscus (1985 to May 2015), Web of Science (1945 to May 2015) and PEDRO (1999 to May 2015), supplemented by manual searches and grey literature.
Article or abstract of original research, population of patients with concussion/mild traumatic brain injury (mTBI) with vestibular symptoms, interventions detailing VRT, measurement of outcomes pre-VRT/post-VRT. Study type was not specified.
Following a double review of abstract and full-text articles, 10 studies met the inclusion criteria: randomised controlled trial (n=2), uncontrolled studies (n=3) and case studies (n=5). 4 studies evaluated VRT as a single intervention. 6 studies incorporated VRT in multimodal interventions (including manual therapy, strength training, occupational tasks, counselling or medication). 9 studies reported improvement in outcomes but level I evidence from only 1 study was found that demonstrated increased rates (OR 3.91; 95% CI 1.34 to 11.34; p=0.002) of medical clearance for return to sport within 8 weeks, when VRT (combined with cervical therapy) was compared with usual care. Heterogeneity in study type and outcomes precluded meta-analysis. Habituation and adaptation exercises were employed in 8 studies and balance exercises in 9 studies. Prescription and progression patterns lacked standardisation.
Current evidence for optimal prescription and efficacy of VRT in patients with mTBI/concussion is limited. Available evidence, although weak, shows promise in this population. Further high-level studies evaluating the effects of VRT in patients with mTBI/concussion with vestibular and/or balance dysfunction are required.
脑震荡症状通常在 7-10 天内消退，但眩晕、头晕和平衡功能障碍仍在 10-30%的病例中持续存在，导致发病率显著升高。本研究系统评估了支持前庭康复治疗（VRT）在脑震荡患者中的疗效、处方和进展模式的证据。
根据 PRISMA 指南进行的系统评价，提出最佳证据综合。
电子数据库 PubMed（1949 年至 2015 年 5 月）、CINAHL（1982 年至 2015 年 5 月）、EMBASE（1947 年至 2015 年 5 月）、SPORTDiscus（1985 年至 2015 年 5 月）、Web of Science（1945 年至 2015 年 5 月）和 PEDRO（1999 年至 2015 年 5 月），并辅以手工检索和灰色文献。
原始研究的文章或摘要，伴有前庭症状的脑震荡/轻度创伤性脑损伤（mTBI）患者人群，详细描述 VRT 的干预措施，VRT 前后的结局测量。未指定研究类型。
经过对摘要和全文文章的双重审查，有 10 项研究符合纳入标准：随机对照试验（n=2）、非对照研究（n=3）和病例研究（n=5）。4 项研究评估了 VRT 作为单一干预措施的效果。6 项研究将 VRT 纳入多模式干预措施（包括手动治疗、力量训练、职业任务、咨询或药物治疗）。9 项研究报告了结局的改善，但只有 1 项研究提供了 I 级证据，表明当 VRT（联合颈椎治疗）与常规护理相比时，8 周内运动重返的医疗清除率（OR 3.91；95%CI 1.34-11.34；p=0.002）增加。研究类型和结局的异质性排除了荟萃分析。8 项研究采用习惯化和适应训练，9 项研究采用平衡训练。处方和进展模式缺乏标准化。
目前关于 mTBI/脑震荡患者 VRT 的最佳处方和疗效的证据有限。虽然证据较弱，但显示出在这一人群中的应用前景。需要进一步开展高水平研究，评估 VRT 在伴有前庭和/或平衡功能障碍的 mTBI/脑震荡患者中的效果。
