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太极拳改善平衡和减少跌倒:14 项系统评价综述。

Tai Chi for improving balance and reducing falls: An overview of 14 systematic reviews.

机构信息

Chengdu University of Traditional Chinese Medicine, Chengdu, PR China.

Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, PR China.

出版信息

Ann Phys Rehabil Med. 2020 Nov;63(6):505-517. doi: 10.1016/j.rehab.2019.12.008. Epub 2020 Jan 22.


DOI:10.1016/j.rehab.2019.12.008
PMID:31981834
Abstract

BACKGROUND: Falls play a pivotal role in the cause of injury or death and have become a public health problem, especially for older people. Tai Chi may be an effective approach to improving balance and reducing falls. However, the conclusions of systematic reviews (SRs) have been inconsistent and the quality needs to be appraised critically. OBJECTIVE: To provide an overview of the methodological quality, risk of bias and reporting quality as well as quality of evidence of SRs of Tai Chi for improving balance and reducing falls. METHODS: We conducted a systematic search of English- and Chinese-language SRs in 8 electronic databases, from inception to October 2019. The methodological quality, risk of bias, reporting quality and the quality of evidence were independently assessed by 2 reviewers who used the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), Risk of Bias in Systematic reviews (ROBIS), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Grades of Recommendations, Assessment, Development and Evaluation (GRADE). Primary outcomes were fall rate and the Berg Balance Scale score in older people and people with Parkinson disease. Secondary outcomes included these outcomes in stroke, osteoarthritis and heart failure. RESULTS: A total of 14 relevant SRs were included: 13 were rated critically low quality and 1 was rated low quality by AMSTAR 2. By the ROBIS, all SRs were rated low risk in Phase 1 (assessing relevance) and Domain 1 of Phase 2 (study eligibility criteria). With regard to Domain 2, assessing the identification and selection of studies, 3 (21.4%) SRs were rated low risk. Eleven (71.4%) were rated low risk in Domain 3 (data collection and study appraisal), 11 (71.4%) were rated low risk in Domain 4 (synthesis and findings), and 9 (64.3%) were rated low risk in Phase 3 (risk of bias in the review). According to PRISMA, the reporting was relatively complete, but there were still some reporting flaws in the topic of protocol and registration (2/14, 14.3%), search strategy (5/14, 35.7%), risk of bias (6/14, 42.9%), additional analyses (6/14, 42.9%) and funding (4/14, 28.6%). Among the 14 SRs, Tai Chi had benefits for improving balance and reducing falls in older people and people with Parkinson disease; however, no definitive conclusions could be drawn for its effectiveness in stroke, osteoarthritis and heart failure. The level of evidence for fall rate was "moderate" to "high" for older people and "low" for those with Parkinson disease. The level of evidence of the Berg Balance Scale was "low" to "moderate" for older people and "low" for those with Parkinson disease. Among the downgraded factors, imprecision was the most common, followed by inconsistency and publication bias. CONCLUSIONS: Tai Chi may be beneficial for improving balance and reducing falls in older people and those with Parkinson disease. Because of limitations and inconsistent conclusions, further rigorous, normative and comprehensive SRs are needed to provide robust evidence for definitive conclusions.

摘要

背景:跌倒在伤害或死亡的原因中起着关键作用,已成为一个公共卫生问题,尤其是老年人。太极拳可能是改善平衡和减少跌倒的有效方法。然而,系统评价(SRs)的结论一直不一致,需要批判性地评估其质量。

目的:提供关于太极拳改善平衡和减少跌倒的 SRs 的方法学质量、偏倚风险和报告质量以及证据质量的概述。

方法:我们在 8 个电子数据库中进行了英语和中文 SRs 的系统检索,检索时间从建库开始到 2019 年 10 月。两名评审员独立评估方法学质量、偏倚风险、报告质量和证据质量,使用评估系统评价的测量工具 2(AMSTAR 2)、系统评价偏倚风险(ROBIS)、系统评价和荟萃分析的首选报告项目(PRISMA)和推荐分级、评估、发展和评估(GRADE)。主要结局是老年人和帕金森病患者的跌倒率和伯格平衡量表评分。次要结局包括中风、骨关节炎和心力衰竭患者的这些结局。

结果:共纳入 14 项相关的 SRs:13 项被 AMSTAR 2 评为严重低质量,1 项被评为低质量。根据 ROBIS,所有 SRs 在第 1 阶段(评估相关性)和第 2 阶段的第 1 域(研究纳入标准)均被评为低风险。关于第 2 域,评估研究的识别和选择,有 3 项(21.4%)SRs 被评为低风险。有 11 项(71.4%)在第 3 域(数据收集和研究评估)中被评为低风险,11 项(71.4%)在第 4 域(综合和发现)中被评为低风险,9 项(64.3%)在第 3 阶段(综述中的偏倚风险)中被评为低风险。根据 PRISMA,报告相对完整,但在方案和注册(2/14,14.3%)、搜索策略(5/14,35.7%)、偏倚风险(6/14,42.9%)、额外分析(6/14,42.9%)和资金(4/14,28.6%)方面仍存在一些报告缺陷。在这 14 项 SRs 中,太极拳对改善老年人和帕金森病患者的平衡和减少跌倒都有好处;然而,对于中风、骨关节炎和心力衰竭患者,其疗效尚无明确结论。跌倒率的证据水平为“中等到高”,对老年人而言为“低”,对帕金森病患者而言为“低”。伯格平衡量表的证据水平为“低到中”,对老年人而言为“低”,对帕金森病患者而言为“低”。在降级因素中,最常见的是不精确,其次是不一致和发表偏倚。

结论:太极拳可能有益于改善老年人和帕金森病患者的平衡和减少跌倒。由于存在局限性和不一致的结论,需要进一步进行严格、规范和全面的 SRs,以提供确凿的证据来得出明确的结论。

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