Wieber Juliane, Müller-Rahmel Leon, Reer Rüdiger, Rein Robert, Braunstein Bjoern
Department of Sports and Exercise Medicine, Institute of Human Movement Science University of Hamburg Hamburg Germany.
Department of Exercise Physiology and Sports Medicine Olympic Training Centre Berlin Berlin Germany.
J Exp Orthop. 2024 Jul 24;11(3):e12091. doi: 10.1002/jeo2.12091. eCollection 2024 Jul.
The systematic review and meta-analysis investigated subject-independent test factors that influence the absolute angle error in active knee angle reproduction tests.
Five electronic databases were searched to identify relevant studies published before 20 December 2023. Studies were included that were published in either English or German and that investigated joint proprioception in the healthy knee. Included studies were also required to have participants 18-60 years old and free of lower-limb injury, neurological disorders and diseases affecting joint position sense. Risk of bias was assessed using a Cochrane risk-of-bias tool.
Of the 2023 articles identified, 26 studies (1082 participants) were included in the meta-analysis. The meta-analysis showed a significant pooled standard mean difference in the absolute angular error for body orientation, direction of movement and fatigue. Active knee angle reproduction tests were found to have a lower absolute angular error when performed in the sitting position compared to the prone position (SMD = -0.56; 95% CI = -1.00 to -0.12). The absolute angular error was found to be greater in cases of knee flexion compared to knee extension (SMD = 0.71; 95% CI = 0.18-1.24). General and local muscle fatigue were found to result in a higher absolute angular error (SMD = 1.39; 95% CI = 1.04-1.75).
Hence, fatigue, body orientation and direction of movement influence the extent of the absolute angular error in active knee angle reproduction tests. Practitioners should be aware that the test conditions and the patient's level of fatigue can affect the results of such tests and that directly comparing results obtained using different test protocols may not be appropriate. The test protocol should be well documented and applied consistently in the clinical setting.
Level III, systematic review with meta-analysis.
本系统评价和荟萃分析研究了影响主动膝关节角度重现测试中绝对角度误差的与受试者无关的测试因素。
检索了五个电子数据库，以识别2023年12月20日前发表的相关研究。纳入的研究需以英文或德文发表，且研究健康膝关节的关节本体感觉。纳入的研究还要求参与者年龄在18至60岁之间，无下肢损伤、神经系统疾病以及影响关节位置觉的疾病。使用Cochrane偏倚风险工具评估偏倚风险。
在识别出的2023篇文章中，有26项研究（1082名参与者）纳入了荟萃分析。荟萃分析显示，在身体方位、运动方向和疲劳方面，绝对角度误差存在显著的合并标准均值差异。发现与俯卧位相比，主动膝关节角度重现测试在坐位进行时绝对角度误差更低（标准化均值差= -0.56；95%置信区间= -1.00至-0.12）。发现膝关节屈曲时的绝对角度误差比膝关节伸展时更大（标准化均值差= 0.71；95%置信区间= 0.18 - 1.24）。发现全身和局部肌肉疲劳会导致更高的绝对角度误差（标准化均值差= 1.39；95%置信区间= 1.04 - 1.75）。
因此，疲劳、身体方位和运动方向会影响主动膝关节角度重现测试中绝对角度误差的程度。从业者应意识到测试条件和患者的疲劳程度会影响此类测试的结果，直接比较使用不同测试方案获得的结果可能不合适。测试方案应在临床环境中详细记录并一致应用。
三级，荟萃分析的系统评价。
