Benn Natasha L, Jervis-Rademeyer Hope, Souza Wagner H, Pakosh Maureen, Inness Elizabeth L, Musselman Kristin E
Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada.
Department of Medicine, University of Alberta, Edmonton, Canada.
Arch Phys Med Rehabil. 2025 Mar;106(3):444-458. doi: 10.1016/j.apmr.2024.07.013. Epub 2024 Aug 5.
To assist with clinical decision making, evidence syntheses are needed to demonstrate the efficacy of available interventions and examine the intervention components and dosage parameters. This systematic review and meta-analysis described the efficacy, components and dosage of interventions targeting upright balance control, balance confidence, and/or falls in adults with motor-incomplete spinal cord injury/disease (SCI/D).
A search strategy following the population, intervention, control, outcome framework was developed. Six databases were searched: APA PsychInfo, Cumulative Index to Nursing and Allied Health Literature, Embase, Emcare Nursing, Web of Science CC, and Medline.
Title, abstract, and full-text screening were conducted by 2 researchers independently. Inclusion criteria included the following: (1) adults with chronic, motor-incomplete SCI/D; (2) physical intervention targeting upright postural control; and (3) clinical and/or biomechanical measures of upright balance control and/or balance confidence and/or documentation of falls.
Participant characteristics, balance intervention details, adverse events, and study results were extracted. The Downs and Black Checklist was used to assess methodological quality. Meta-analyses on pre-post intervention outcomes and a meta-regression of dosage were completed. Grading of Recommendations, Assessment, Development, and Evaluations approach was used to evaluate the quality of the evidence.
The search returned 1664 unique studies; 26 were included. Methodological quality was moderate to good. Participants were 500 individuals with SCI/D, aged 18-74 years (males: females = 2.4:1). Minor adverse events were reported in 8 studies (eg, muscle soreness and fatigue). Walking interventions and upright balance training with visual feedback had clinically meaningful and significant pooled effects on improving standing balance control. Only walking interventions had a significant pooled effect on improving balance confidence. There were no significant findings on dosage response. Few studies evaluated the effects of balance interventions on the occurrence of falls.
Walking interventions and upright balance training with visual feedback had greater effects on upright balance control than conventional physiotherapy; however, the quality of the evidence was very low.
为辅助临床决策，需要进行证据综合分析，以证明现有干预措施的疗效，并研究干预措施的组成部分和剂量参数。本系统评价和荟萃分析描述了针对运动不完全性脊髓损伤/疾病（SCI/D）成人的直立平衡控制、平衡信心和/或跌倒的干预措施的疗效、组成部分和剂量。
制定了遵循人群、干预措施、对照、结局框架的检索策略。检索了六个数据库：美国心理学会心理学文摘数据库（APA PsychInfo）、护理及相关健康文献累积索引（Cumulative Index to Nursing and Allied Health Literature）、荷兰医学文摘数据库（Embase）、护理学与健康照护数据库（Emcare Nursing）、科学引文索引扩展版（Web of Science CC）和医学期刊数据库（Medline）。
由两名研究人员独立进行标题、摘要和全文筛选。纳入标准包括：（1）患有慢性、运动不完全性SCI/D的成年人；（2）针对直立姿势控制的物理干预；（3）直立平衡控制和/或平衡信心的临床和/或生物力学测量，以及/或跌倒记录。
提取参与者特征、平衡干预细节、不良事件和研究结果。使用唐斯和布莱克清单评估方法学质量。完成了干预前后结局的荟萃分析和剂量的荟萃回归。采用推荐分级、评估、制定和评价方法（Grading of Recommendations, Assessment, Development, and Evaluations approach，GRADE）评估证据质量。
检索返回1664项独特研究；纳入26项。方法学质量为中等至良好。参与者为500名SCI/D患者，年龄在18 - 74岁之间（男性：女性 = 2.4:1）。8项研究报告了轻微不良事件（如肌肉酸痛和疲劳）。步行干预和有视觉反馈的直立平衡训练对改善站立平衡控制具有临床意义且显著的合并效应。只有步行干预对提高平衡信心有显著的合并效应。在剂量反应方面没有显著发现。很少有研究评估平衡干预对跌倒发生率的影响。
与传统物理治疗相比，步行干预和有视觉反馈的直立平衡训练对直立平衡控制的影响更大；然而，证据质量非常低。
