Powden Cameron J, Hoch Johanna M, Hoch Matthew C
Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute.
Division of Athletic Training, University of Kentucky, Lexington.
J Athl Train. 2017 Aug;52(8):753-765. doi: 10.4085/1062-6050-52.5.01. Epub 2017 Jul 13.
To conduct a systematic review with meta-analysis assessing the effectiveness of conservative rehabilitation programs for improving health-related quality of life (HRQL) in individuals with chronic ankle instability (CAI).
PubMed, MEDLINE, CINAHL, and SPORTDiscus were searched from inception to January 2016.
Studies were included if the researchers examined the effects of a conservative rehabilitation protocol in individuals with CAI, used validated patient-reported outcomes (PROs) to quantify participant-perceived HRQL, and provided adequate data to calculate the effect sizes (ESs) and 95% confidence intervals (CIs). Studies were excluded if the authors evaluated surgical interventions, prophylactic taping, or bracing applications or examined only the immediate effects of 1 treatment session.
Two investigators independently assessed methodologic quality using the Physiotherapy Evidence Database (PEDro) Scale. Studies were considered low quality if fewer than 60% of the criteria were met. Level of evidence was assessed using the Strength of Recommendation Taxonomy. Preintervention and postintervention sample sizes, means, and standard deviations of PROs were extracted.
A total of 15 studies provided 24 participant groups that were included in the analysis. Seven high-quality studies with a median PEDro score of 50% (range = 10%-80%) and a median level of evidence of 2 (range = 1-2) were identified. The magnitudes of preintervention to postintervention PRO differences were examined using bias-corrected Hedges g ESs. Random-effects meta-analysis was performed to synthesize PRO changes across all participant groups. Positive ES values indicated better PRO scores at postintervention than at preintervention. The α level was set at .05. Meta-analysis revealed a strong ES with a nonoverlapping 95% CI (ES = 1.20, CI = 0.80, 1.60; P < .001), indicating HRQL improved after conservative rehabilitation.
Based on the quality of the evidence and the results of the meta-analysis, grade A evidence showed that conservative rehabilitation produces large improvements in HRQL for people with CAI.
进行一项系统评价并荟萃分析，评估保守康复计划对改善慢性踝关节不稳（CAI）患者健康相关生活质量（HRQL）的有效性。
检索了自数据库建立至2016年1月的PubMed、MEDLINE、CINAHL和SPORTDiscus数据库。
如果研究人员考察了保守康复方案对CAI患者的影响，使用经过验证的患者报告结局（PROs）来量化参与者感知的HRQL，并提供足够的数据以计算效应量（ESs）和95%置信区间（CIs），则纳入该研究。如果作者评估了手术干预、预防性贴扎或支具应用，或仅考察了1次治疗 session的即时效应，则排除该研究。
两名研究人员使用物理治疗证据数据库（PEDro）量表独立评估方法学质量。如果满足的标准少于60%，则认为研究质量较低。使用推荐分级系统评估证据水平。提取PROs的干预前和干预后样本量、均值和标准差。
共有15项研究提供了24个参与者组纳入分析。确定了7项高质量研究，PEDro评分中位数为50%（范围 = 10% - 80%），证据水平中位数为2（范围 = 1 - 2）。使用偏差校正的Hedges g效应量考察干预前至干预后PRO差异的大小。进行随机效应荟萃分析以综合所有参与者组的PRO变化。正的效应量值表明干预后PRO评分优于干预前。α水平设定为0.05。荟萃分析显示效应量较强，95%置信区间不重叠（效应量 = 1.20，置信区间 = 0.80，1.60；P < 0.001），表明保守康复后HRQL得到改善。
基于证据质量和荟萃分析结果，A级证据表明保守康复可使CAI患者的HRQL有大幅改善。
