Reid Susan A, Farbenblum Joshua, McLeod Shreya
Discipline of Physiotherapy, Faculty of Health Sciences, School of Allied Health, Australian Catholic University, North Sydney, NSW, Australia.
Discipline of Physiotherapy, Faculty of Health Sciences, School of Allied Health, Australian Catholic University, North Sydney, NSW, Australia
Br J Sports Med. 2022 Mar;56(5):292-298. doi: 10.1136/bjsports-2020-103470. Epub 2021 Sep 30.
To investigate the effect of physical interventions (subthreshold aerobic exercise, cervical, vestibular and/or oculomotor therapies) on days to recovery and symptom scores in the management of concussion.
A systematic review and meta-analysis.
Medline, CINAHL, Embase, SportDiscus, Cochrane library, Scopus and PEDro.
Randomised controlled trials of participants with concussion that evaluated the effect of subthreshold aerobic exercise, cervical, vestibular and/or oculomotor therapies on days to recovery/return to activity, symptom scores, balance, gait and/or exercise capacity.
Twelve trials met the inclusion criteria: 7 on subthreshold aerobic exercise, 1 on vestibular therapy, 1 on cervical therapy and 3 on individually tailored multimodal interventions. The trials were of fair to excellent quality on the PEDro scale. Eight trials were included in the quantitative analysis. Subthreshold aerobic exercise had a significant small to moderate effect in improving symptom scores (standardised mean difference (SMD)=0.43, 95% CI 0.18 to 0.67, p=0.001, I=0%) but not in reducing days to symptom recovery in both acutely concussed individuals and those with persistent symptoms (SMD=0.19, 95% CI -0.54 to 0.93, p=0.61, I=52%). There was limited evidence for stand-alone cervical, vestibular and oculomotor therapies. Concussed individuals with persistent symptoms (>2 weeks) were approximately 3 times more likely to have returned to sport by 8 weeks (relative risk=3.29, 95% CI 0.30 to 35.69, p=0.33, I=83%) if they received individually tailored, presentation-specific multimodal interventions (cervical, vestibular and oculo-motor therapy). In addition, the multimodal interventions had a moderate effect in improving symptom scores (SMD=0.63, 95% CI 0.11 to 1.15, p=0.02, I=0%) when compared with control.
Subthreshold aerobic exercise appears to lower symptom scores but not time to recovery in concussed individuals. Individually tailored multimodal interventions have a worthwhile effect in providing faster return to sport and clinical improvement, specifically in those with persistent symptoms.
CRD42020108117.
探讨物理干预措施（阈下有氧运动、颈部、前庭和/或动眼疗法）对脑震荡管理中恢复天数和症状评分的影响。
系统评价和荟萃分析。
Medline、CINAHL、Embase、SportDiscus、Cochrane图书馆、Scopus和PEDro。
对脑震荡参与者进行的随机对照试验，评估阈下有氧运动、颈部、前庭和/或动眼疗法对恢复/恢复活动天数、症状评分、平衡、步态和/或运动能力的影响。
12项试验符合纳入标准：7项关于阈下有氧运动，1项关于前庭疗法，1项关于颈部疗法，3项关于个体化定制的多模式干预。这些试验在PEDro量表上质量为中等至优秀。8项试验纳入定量分析。阈下有氧运动在改善症状评分方面有显著的小到中等效果（标准化均数差（SMD）=0.43，95%可信区间0.18至0.67，p=0.001，I²=0%），但在减少急性脑震荡个体和持续症状个体的症状恢复天数方面无效果（SMD=0.19，95%可信区间-0.54至0.93，p=0.61，I²=52%）。单独的颈部、前庭和动眼疗法的证据有限。有持续症状（>2周）的脑震荡个体如果接受个体化定制的、针对具体表现的多模式干预（颈部、前庭和动眼疗法），到8周时恢复运动的可能性大约是未接受干预个体的3倍（相对危险度=3.29，95%可信区间0.30至35.69，p=0.33，I²=83%）。此外，与对照组相比，多模式干预在改善症状评分方面有中等效果（SMD=0.63，95%可信区间0.11至1.15，p=0.02，I²=0%）。
阈下有氧运动似乎能降低脑震荡个体的症状评分，但不能缩短恢复时间。个体化定制的多模式干预在使患者更快恢复运动和临床改善方面有显著效果，特别是对那些有持续症状的患者。
PROSPERO注册号：CRD42020108117。
