Sánchez-González Juan Luis, Sanz-Esteban Ismael, Menéndez-Pardiñas Mónica, Navarro-López Víctor, Sanz-Mengíbar José Manuel
Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
Department of Physiotherapy, Physical Therapy and Health Sciences Research Group, Universidad Europea de Madrid, Madrid, Spain.
Front Neurol. 2024 Apr 22;15:1391448. doi: 10.3389/fneur.2024.1391448. eCollection 2024.
It is essential to link the theoretical framework of any neurophysiotherapy approach with a detailed analysis of the central motor control mechanisms that influence motor behavior. Vojta therapy (VT) falls within interventions aiming to modify neuronal activity. Although it is often mistakenly perceived as exclusively pediatric, its utility spans various functional disorders by acting on central pattern modulation. This study aims to review the existing evidence on the effectiveness of VT across a wide range of conditions, both in the adult population and in pediatrics, and analyze common therapeutic mechanisms, focusing on motor control modulation.
The goals of this systematic review are to delineate the existing body of evidence concerning the efficacy of Vojta therapy (VT) in treating a broad range of conditions, as well as understand the common therapeutic mechanisms underlying VT with a specific focus on the neuromodulation of motor control parameters.
PubMed, Cochrane Library, SCOPUS, Web of Science, and Embase databases were searched for eligible studies. The methodological quality of the studies was assessed using the PEDro list and the Risk-Of-Bias Tool to assess the risk of bias in randomized trials. Methodological quality was evaluated using the Risk-Of-Bias Tool for randomized trials. Random-effects meta-analyses with 95% CI were used to quantify the change scores between the VT and control groups. The certainty of our findings (the closeness of the estimated effect to the true effect) was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).
Fifty-five studies were included in the qualitative analysis and 18 in the meta-analysis. Significant differences in cortical activity ( = 0.0001) and muscle activity ( = 0.001) were observed in adults undergoing VT compared to the control, as well as in balance in those living with multiple sclerosis ( < 0.03). Non-significant differences were found in the meta-analysis when evaluating gross motor function, oxygen saturation, respiratory rate, height, and head circumference in pediatrics.
Although current evidence supporting VT is limited in quality, there are indications suggesting its potential usefulness for the treatment of respiratory, neurological, and orthopedic pathology. This systematic review and meta-analysis show the robustness of the neurophysiological mechanisms of VT, and that it could be an effective tool for the treatment of balance in adult neurological pathology. Neuromodulation of motor control areas has been confirmed by research focusing on the neurophysiological mechanisms underlying the therapeutic efficacy of VT.https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=476848, CRD42023476848.
将任何神经物理治疗方法的理论框架与对影响运动行为的中枢运动控制机制的详细分析联系起来至关重要。沃伊塔疗法（VT）属于旨在改变神经元活动的干预措施。尽管它常常被错误地认为仅适用于儿科，但通过作用于中枢模式调节，其效用涵盖了各种功能障碍。本研究旨在回顾关于VT在成人和儿科广泛病症中有效性的现有证据，并分析常见的治疗机制，重点关注运动控制调节。
本系统评价的目的是描绘关于沃伊塔疗法（VT）治疗广泛病症疗效的现有证据体系，并了解VT潜在的共同治疗机制，特别关注运动控制参数的神经调节。
在PubMed、Cochrane图书馆、SCOPUS、科学网和Embase数据库中检索符合条件的研究。使用PEDro清单和随机试验偏倚风险工具评估研究的方法学质量。使用随机试验偏倚风险工具评估方法学质量。采用95%置信区间的随机效应荟萃分析来量化VT组和对照组之间的变化分数。使用推荐分级、评估、制定和评价（GRADE）来评估我们研究结果的确定性（估计效应与真实效应的接近程度）。
55项研究纳入定性分析，18项纳入荟萃分析。与对照组相比，接受VT治疗的成人在皮质活动（=0.0001）和肌肉活动（=0.001）方面存在显著差异，患有多发性硬化症的患者在平衡方面也有显著差异（<0.03）。在评估儿科的粗大运动功能、血氧饱和度、呼吸频率、身高和头围时，荟萃分析未发现显著差异。
尽管目前支持VT的证据质量有限，但有迹象表明其在治疗呼吸、神经和骨科疾病方面具有潜在用途。本系统评价和荟萃分析显示了VT神经生理机制的稳健性，并且它可能是治疗成人神经疾病平衡的有效工具。专注于VT治疗效果潜在神经生理机制的研究已证实了运动控制区域的神经调节作用。https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=476848, CRD42023476848
