哪些干预措施可以治疗慢性踝关节不稳定患者的关节源性肌肉抑制?系统评价和荟萃分析。

What interventions can treat arthrogenic muscle inhibition in patients with chronic ankle instability? A systematic review with meta-analysis.

机构信息

Department of Sport Science, Sungkyunkwan University, Suwon-si, Korea.

Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL, USA.

出版信息

Disabil Rehabil. 2024 Jan;46(2):241-256. doi: 10.1080/09638288.2022.2161643. Epub 2023 Jan 17.

Abstract

PURPOSE

To identify, critically appraise, and synthesize the existing evidence regarding the effects of therapeutic interventions on arthrogenic muscle inhibition (AMI) in patients with chronic ankle instability (CAI).

MATERIALS AND METHODS

Two reviewers independently performed exhaustive database searches in Web of Science, PubMed, Medline, CINAHL, and SPORTDiscus.

RESULTS

Nine studies were finally included. Five types of disinhibitory interventions were identified: focal ankle joint cooling (FAJC), manual therapy, fibular reposition taping (FRT), whole-body vibration (WBV), and transcranial direct current stimulation (tDCS). There were moderate effects of FAJC on spinal excitability in ankle muscles ( = 0.55, 95% CI = 0.03-1.08,  = 0.040 for the soleus and  = 0.54, 95% CI = 0.01-1.07,  = 0.046 for the fibularis longus). In contrast, manual therapy, FRT, WBV were not effective. Finally, 4 weeks of tDCS combined with eccentric exercise showed large effects on corticospinal excitability in 2 weeks after the intervention ( = 0.99, 95% CI = 0.14-1.85 for the fibularis longus and  = 1.02, 95% CI = 0.16-1.87 for the tibialis anterior).

CONCLUSIONS

FAJC and tDCS may be effective in counteracting AMI. However, the current evidence of mainly short-term studies to support the use of disinhibitory interventions is too limited to draw definitive conclusions.

摘要

目的

识别、批判性评价和综合现有关于治疗干预对慢性踝关节不稳定(CAI)患者的关节源性肌肉抑制(AMI)影响的证据。

材料和方法

两名审查员独立在 Web of Science、PubMed、Medline、CINAHL 和 SPORTDiscus 中进行了全面的数据库搜索。

结果

最终纳入了 9 项研究。确定了 5 种抑制解除干预类型:踝关节焦点冷却(FAJC)、手法治疗、腓骨复位贴扎(FRT)、全身振动(WBV)和经颅直流电刺激(tDCS)。FAJC 对踝关节肌肉的脊髓兴奋性有中度影响( = 0.55,95%置信区间= 0.03-1.08,  = 0.040 用于比目鱼肌,  = 0.54,95%置信区间= 0.01-1.07,  = 0.046 用于腓骨长肌)。相比之下,手法治疗、FRT 和 WBV 没有效果。最后,4 周 tDCS 联合离心运动在干预后 2 周显示对皮质脊髓兴奋性有较大影响( = 0.99,95%置信区间= 0.14-1.85 用于腓骨长肌,  = 1.02,95%置信区间= 0.16-1.87 用于胫骨前肌)。

结论

FAJC 和 tDCS 可能对对抗 AMI 有效。然而,目前主要是短期研究的证据支持抑制解除干预的使用,不足以得出明确的结论。

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