Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany.
Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Marchioninistraße 17, 81377, Munich, Germany.
BMC Geriatr. 2020 Nov 23;20(1):494. doi: 10.1186/s12877-020-01899-9.
Vertigo, dizziness and balance disorders (VDB) are among the most relevant contributors to the burden of disability among older adults living in the community and associated with immobility, limitations of activities of daily living and decreased participation. The aim of this study was to identify the quality of evidence of physical therapy interventions that address mobility and participation in older patients with VDB and to characterize the used primary and secondary outcomes.
A systematic search via MEDLINE (PubMed), Cochrane Library, CINAHL, PEDro, forward citation tracing and hand search was conducted initially in 11/2017 and updated in 7/2019. We included individual and cluster-randomized controlled trials and trials with quasi-experimental design, published between 2007 and 2017/2019 and including individuals ≥65 years with VDB. Physical therapy and related interventions were reviewed with no restrictions to outcome measurement. Screening of titles, abstracts and full texts, data extraction and critical appraisal was conducted by two independent researchers. The included studies were heterogeneous in terms of interventions and outcome measures. Therefore, a narrative synthesis was conducted.
A total of 20 randomized and 2 non-randomized controlled trials with 1876 patients met the inclusion criteria. The included studies were heterogeneous in terms of complexity of interventions, outcome measures and methodological quality. Vestibular rehabilitation (VR) was examined in twelve studies, computer-assisted VR (CAVR) in five, Tai Chi as VR (TCVR) in three, canal repositioning manoeuvres (CRM) in one and manual therapy (MT) in one study. Mixed effects were found regarding body structure/function and activities/participation. Quality of life and/or falls were assessed, with no differences between groups. VR is with moderate quality of evidence superior to usual care to improve balance, mobility and symptoms.
To treat older individuals with VDB, VR in any variation and in addition to CRMs seems to be effective. High-quality randomized trials need to be conducted to inform clinical decision making.
PROSPERO 2017 CRD42017080291 .
眩晕、头晕和平衡障碍（VDB）是导致社区居住的老年人残疾负担的最重要因素之一，与活动受限、日常生活活动受限和参与度下降有关。本研究旨在确定针对 VDB 老年患者的移动性和参与度的物理治疗干预措施的证据质量，并描述所使用的主要和次要结局。
最初于 2017 年 11 月进行了系统的 MEDLINE（PubMed）、Cochrane 图书馆、CINAHL、PEDro、前瞻性引文追踪和手工搜索，并于 2019 年 7 月进行了更新。我们纳入了个体和群组随机对照试验以及具有准实验设计的试验，研究对象为 2007 年至 2017/2019 年间患有 VDB 的≥65 岁个体。对物理治疗和相关干预措施进行了审查，对结果测量没有限制。两名独立研究人员对标题、摘要和全文进行筛选、数据提取和批判性评估。纳入的研究在干预措施和结局测量方面存在异质性。因此，进行了叙述性综合。
共有 20 项随机对照试验和 2 项非随机对照试验，共纳入 1876 名患者，符合纳入标准。纳入的研究在干预措施、结局测量和方法学质量方面存在异质性。12 项研究中检查了前庭康复（VR），5 项研究中检查了计算机辅助 VR（CAVR），3 项研究中检查了太极拳作为 VR（TCVR），1 项研究中检查了管复位手法（CRM），1 项研究中检查了手动治疗（MT）。在身体结构/功能和活动/参与方面发现了混合效应。评估了生活质量和/或跌倒情况，但组间无差异。VR 具有中等质量的证据，优于常规护理，可改善平衡、移动性和症状。
对于患有 VDB 的老年人，任何变化的 VR 以及 CRM 似乎都有效。需要进行高质量的随机试验，为临床决策提供信息。
PROSPERO 2017 CRD42017080291 。
