慢性周围性前庭功能减退症患者递增前庭眼反射适应训练与 x1 训练的比较：一项为期两年的随机对照试验。
Comparison of Incremental Vestibulo-ocular Reflex Adaptation Training Versus x1 Training in Patients With Chronic Peripheral Vestibular Hypofunction: A Two-Year Randomized Controlled Trial.
机构信息
Balance and Vision Laboratory, Neuroscience Research Australia, Sydney, Australia (C.N.R., M.C.S., P.D.C., W.V.C.F., C.J.T., A.A.M.); Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia (C.N.R., A.A.M.); Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland (M.C.S.); Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland (M.C.S., A.A.M.); Royal North Shore Hospital, Sydney, Australia (P.D.C.); and School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia (A.A.M.).
出版信息
J Neurol Phys Ther. 2021 Oct 1;45(4):246-258. doi: 10.1097/NPT.0000000000000369.
BACKGROUND AND PURPOSE
A crossover, double-blinded randomized controlled trial to investigate once-daily incremental vestibulo-ocular reflex (VOR) adaptation (IVA) training over 2 years in people with stable and chronic peripheral vestibular hypofunction.
METHODS
Twenty-one patients with peripheral vestibular hypofunction were randomly assigned to intervention-then-control (n = 12) or control-then-intervention (n = 9) groups. The task consisted of either x1 (control) or IVA training, once daily every day for 15 minutes over 6-months, followed by a 6-month washout, then repeated for arm 2 of the crossover. Primary outcome: vestibulo-ocular reflex gain. Secondary outcomes: compensatory saccades, dynamic visual acuity, static balance, gait, and subjective symptoms. Multiple imputation was used for missing data. Between-group differences were analyzed using a linear mixed model with repeated measures.
RESULTS
On average patients trained once daily 4 days per week. IVA training resulted in significantly larger VOR gain increase (active: 20.6% ± 12.08%, P = 0.006; passive: 30.6% ± 25.45%, P = 0.016) compared with x1 training (active: -2.4% ± 12.88%, P = 0.99; passive: -0.6% ± 15.31%, P = 0.68) (P < 0.001). The increased IVA gain did not significantly reduce with approximately 27% persisting over the washout period. x1 training resulted in greater reduction of compensatory saccade latency (P = 0.04) and increase in amplitude (P = 0.02) compared with IVA training. There was no difference between groups in gait and balance measures; however, only the IVA group had improved total Dizziness Handicap Inventory (P = 0.006).
DISCUSSION AND CONCLUSIONS
Our results suggest IVA improves VOR gain and reduces perception of disability more than conventional x1 training. We suggest at least 4 weeks of once-daily 4 days-per-week IVA training should be part of a comprehensive vestibular rehabilitation program.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A356).
背景与目的
本研究为一项交叉、双盲、随机对照试验，旨在探讨在稳定且慢性外周前庭功能减退患者中，每日一次递增前庭眼反射（VOR）适应（IVA）训练持续 2 年的效果。
方法
21 名外周前庭功能减退患者被随机分配至干预-对照（n = 12）或对照-干预（n = 9）组。任务包括 x1（对照）或 IVA 训练，每天 15 分钟，持续 6 个月，然后进行 6 个月的洗脱期，随后进行交叉研究的第 2 臂重复。主要结局：VOR 增益。次要结局：代偿性扫视、动态视力、静态平衡、步态和主观症状。对于缺失数据，采用多重插补法进行处理。采用重复测量线性混合模型分析组间差异。
结果
平均而言，患者每周训练 4 天，每天 1 次。IVA 训练可显著增加 VOR 增益（主动增益：20.6%±12.08%，P = 0.006；被动增益：30.6%±25.45%，P = 0.016），与 x1 训练相比（主动增益：-2.4%±12.88%，P = 0.99；被动增益：-0.6%±15.31%，P = 0.68）差异有统计学意义（P < 0.001）。在洗脱期内，IVA 增益的增加约有 27%持续存在。与 IVA 训练相比，x1 训练可显著降低代偿性扫视潜伏期（P = 0.04）和增加扫视幅度（P = 0.02）。两组在步态和平衡测量方面无差异；然而，仅 IVA 组的总体眩晕残障问卷（Dizziness Handicap Inventory，DHI）评分得到改善（P = 0.006）。
讨论与结论
我们的结果表明，IVA 可改善 VOR 增益，并比常规 x1 训练更能减轻残疾感。我们建议，作为综合前庭康复计划的一部分，至少应进行 4 周、每周 4 天、每日 1 次的 IVA 训练。视频摘要可提供更多来自作者的见解（详见视频，补充数字内容 1，可在以下网址获取：http://links.lww.com/JNPT/A356）。
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