一项关于颈性眩晕患者关节位置觉和静态站立平衡变化的荟萃分析和系统评价。
A meta-analysis and systematic review of changes in joint position sense and static standing balance in patients with whiplash-associated disorder.
机构信息
Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom.
Lecturer in Physiotherapy, Institute of Health and Social Care, London South Bank University, London, United Kingdom.
出版信息
PLoS One. 2021 Apr 8;16(4):e0249659. doi: 10.1371/journal.pone.0249659. eCollection 2021.
OBJECTIVE
To synthesise and analyse the current evidence regarding changes in joint position sense (JPS) and standing balance in people with whiplash-associated disorder (WAD) taking the presence or absence of dizziness into account.
DATA SOURCES
PubMed, CINAHL Plus, Web of Science, Embase, MEDLINE and APA PsycINFO were searched by two independent reviewers from inception until August 2020 and reference lists of all included studies were also reviewed.
STUDY SELECTION
Only cross-sectional studies that measured JPS and/or standing balance between people with WAD vs. healthy controls (HC) or people with WAD complaining of dizziness (WADD) vs. those not complaining of dizziness (WADND) were selected.
DATA EXTRACTION
Relevant data were extracted using specific checklists and quality assessment was performed using Downs and Black Scale (modified version).
DATA SYNTHESIS
Twenty-six studies were included. For JPS, data were synthesized for absolute error in the primary plane of movement for separate movement directions. For standing balance, data were synthesized for traditional time- and frequency domain sway parameters considering the conditions of eyes open (EO) and eyes closed (EC) separately. For meta-analysis, reduced JPS was observed in people with WAD compared to HC when the head was repositioned to a neutral head position (NHP) from rotation (standardised mean difference [SMD] = 0.43 [95%: 0.24-0.62]) and extension (0.33 [95%CI: 0.08-0.58]) or when the head was moved toward 50° rotation from a NHP (0.50 [0.05-0.96]). Similarly, people with WADD had reduced JPS compared to people with WADND when the head was repositioned to a NHP from rotation (0.52 [0.22-0.82]). Larger sway velocity and amplitude was found in people with WAD compared to HC for both EO (0.62 [0.37-0.88] and 0.78 [0.56-0.99], respectively) and EC (0.69 [0.46-0.91] and 0.80 [0.58-1.02]) conditions.
CONCLUSION
The observed changes of JPS and standing balance confirms deficits in sensorimotor control in people with WAD and especially in those with dizziness.
目的
综合分析当前有关伴颈性眩晕（WAD）患者关节位置觉（JPS）和站立平衡变化的证据，并考虑头晕的存在与否。
资料来源
两位独立审查员从研究开始到 2020 年 8 月在 PubMed、CINAHL Plus、Web of Science、Embase、MEDLINE 和 APA PsycINFO 上进行了检索，并对所有纳入研究的参考文献进行了回顾。
研究选择
仅选择了测量伴 WAD 患者与健康对照组（HC）或伴 WAD 头晕（WADD）患者与不头晕（WADND）患者之间 JPS 和/或站立平衡的横断面研究。
资料提取
使用特定检查表提取相关数据，并使用唐斯和布莱克量表（修订版）进行质量评估。
资料综合
共纳入 26 项研究。对于 JPS，对各个运动方向的原发性运动平面的绝对误差进行了数据综合。对于站立平衡，分别考虑睁眼（EO）和闭眼（EC）条件，对传统的时间和频率域摆动参数进行了数据综合。对于荟萃分析，与 HC 相比，当头从旋转（标准化均数差[SMD] = 0.43 [95%CI：0.24-0.62]）和伸展（0.33 [95%CI：0.08-0.58]）位置重新定位到中立头位置（NHP）或当头从 NHP 向 50°旋转时，WAD 患者的 JPS 降低。同样，与 WADND 患者相比，当头从旋转位置重新定位到 NHP 时，WADD 患者的 JPS 降低（0.52 [0.22-0.82]）。与 HC 相比，WAD 患者在 EO（0.62 [0.37-0.88]和 0.78 [0.56-0.99]）和 EC（0.69 [0.46-0.91]和 0.80 [0.58-1.02]）条件下，EO 和 EC 的摆动速度和幅度均较大。
结论
JPS 和站立平衡的变化证实了 WAD 患者，尤其是头晕患者的感觉运动控制缺陷。
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