O'Malley Nicola, Clifford Amanda M, Conneely Mairéad, Casey Bláthín, Coote Susan
School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.
Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
BMC Neurol. 2021 Sep 29;21(1):378. doi: 10.1186/s12883-021-02402-6.
The implementation of condition-specific falls prevention interventions is proving challenging due to lack of critical mass and resources. Given the similarities in falls risk factors across stroke, Parkinson's Disease (PD) and Multiple Sclerosis (MS), the development of an intervention designed for groups comprising of people with these three neurological conditions may provide a pragmatic solution to these challenges. The aims of this umbrella review were to investigate the effectiveness of falls prevention interventions in MS, PD and stroke, and to identify the commonalities and differences between effective interventions for each condition to inform the development of an intervention for mixed neurological groups.
A systematic literature search was conducted using 15 electronic databases, grey literature searches and hand-screening of reference lists. Systematic reviews of studies investigating the effects of falls prevention interventions in MS, PD and stroke were included. Methodological quality of reviews was assessed using the A MeaSurement Tool to Assess Systematic Reviews 2. A matrix of evidence table was used to assess the degree of overlap. The Grading of Recommendations Assessments, Development and Evaluation framework was used to rate the quality of evidence. Findings were presented through narrative synthesis and a summary of evidence table.
Eighteen reviews were included; three investigating effectiveness of falls prevention interventions in MS, 11 in PD, three in stroke, and one in both PD and stroke. Exercise-based interventions were the most commonly investigated for all three conditions, but differences were identified in the content and delivery of these interventions. Low to moderate quality evidence was found for the effectiveness of exercise-based interventions at reducing falls in PD. Best available evidence suggests that exercise is effective at reducing falls in stroke but no evidence of effect was identified in MS.
The findings suggest that exercise-based interventions are effective at reducing falls in PD, however, the evidence for MS and stroke is less conclusive. A strong theoretical rationale remains for the use of exercise-based interventions to address modifiable physiological falls risk factors for people with MS, PD and stroke, supporting the feasibility of a mixed-diagnosis intervention. Given the high overlap and low methodological quality of primary studies, the focus should be on the development of high-quality trials investigating the effectiveness of falls prevention interventions, rather than the publication of further systematic reviews.
由于缺乏足够的规模和资源，实施针对特定情况的跌倒预防干预措施颇具挑战性。鉴于中风、帕金森病（PD）和多发性硬化症（MS）的跌倒风险因素存在相似性，开发一种针对患有这三种神经系统疾病人群的干预措施可能为应对这些挑战提供切实可行的解决方案。本综合评价的目的是调查MS、PD和中风患者跌倒预防干预措施的有效性，并确定每种疾病有效干预措施之间的共性和差异，以为混合神经系统疾病人群干预措施的开发提供参考。
使用15个电子数据库进行系统的文献检索、灰色文献检索并人工筛选参考文献列表。纳入对MS、PD和中风患者跌倒预防干预措施效果进行研究的系统评价。使用评估系统评价质量的测量工具2评估评价的方法学质量。使用证据表矩阵评估重叠程度。采用推荐分级评估、制定和评价框架对证据质量进行评级。通过叙述性综合和证据表总结呈现研究结果。
纳入18项评价；3项调查MS患者跌倒预防干预措施的有效性，11项针对PD，3项针对中风，1项同时针对PD和中风。基于运动的干预措施是对所有这三种疾病最常研究的干预措施，但在这些干预措施的内容和实施方面存在差异。发现基于运动的干预措施在降低PD患者跌倒方面的有效性证据质量为低到中等。现有最佳证据表明运动对降低中风患者跌倒有效，但未发现运动对MS患者跌倒有效果的证据。
研究结果表明基于运动的干预措施对降低PD患者跌倒有效，然而，MS和中风方面的证据尚无定论。基于运动的干预措施用于解决MS、PD和中风患者可改变的生理跌倒风险因素仍有强有力的理论依据，这支持了混合诊断干预措施的可行性。鉴于原始研究的高重叠性和低方法学质量，应重点开展高质量试验以调查跌倒预防干预措施的有效性，而非发表更多的系统评价。
