物理治疗技术改善慢性踝关节不稳神经肌肉控制障碍的系统综述

Effect of physical therapy on neuromuscular control dysfunction for chronic ankle instability:a systematic review

目的明确物理治疗技术对慢性踝关节不稳(CAI)所致的神经肌肉控制障碍的干预效应。方法检索2010年10月1日至2020年10月1日PubMed、Web of Science、Cochrane、PEDro、EBSCO和CNKI中CAI物理治疗相关的系统评价、Meta分析、随机对照试验和病例对照研究。对纳入研究进行质量评价后,按牛津循证医学中心(OCEBM)证据水平进行分级。结果共纳入20篇文献。不稳定平面训练为主的运动干预可显著改善CAI患者下肢平衡控制能力(ⅠA)和肌力(ⅡA);外部设备辅助下可提升干预效率(ⅡC),但对肌肉反应(ⅢC)和本体感觉(ⅡD)效果有限。6次及以上的手法治疗可提高下肢平衡能力(ⅠA),而贴扎对踝关节的本体感觉的即刻及短期效应并不显著(ⅠA)。结论以不稳定平面为主的运动干预和手法治疗在改善CAI患者的神经肌肉控制能力方面得到高质量的证据支持,应作为物理治疗的主要干预手段。贴扎及其他辅助具的应用可以作为辅助干预手段,有助于提高整体干预的效率;目前缺少研究支持理疗设备在CAI神经肌肉控制干预中的使用。

Objective To identify the effectiveness of physical therapy on neuromuscular control dysfunction of chronic ankle instability(CAI).Methods CAI physiotherapy-related systematic reviews,meta-analysis,randomized controlled studies and case-controlled studies were systematically searched in PubMed,Web of Science,Cochrane,PEDro,EBSCO and CNKI from October 1 st,2010 to October 1 st,2020.After quality assessment,the research evidence regarding certain intervention was then graded according to the Oxford Center for Evidence-based Medicine.Results A total of 20 articles were included.Intervention based on unstable plane exercise training could significantly improve lower limb balance control ability(ⅠA)and muscle strength(ⅡA)for CAI patients.The efficiency of exercise-based intervention could be further raised(ⅡC)with the aid of external equipment,but either the benefits in muscle reaction(ⅢC)or proprioception(ⅡD)was limited.Six sessions or more of manual therapy could be used to enhance the balance ability of the lower limbs(ⅡB),while taping failed to provide improvements in ankle proprioception in short period or immediately(ⅠA).Conclusion Unstable plane training-based therapeutic exercise and manual therapy could effectively enhance the neuromuscular control with high-quality evidence supporting,which can be primary interventions for CAI patients.Meanwhile,taping and other external devices could be used as adjunct methods to improve the efficiency of physiotherapy program,while there is currently no evidence to support the application of modality treatment in neuromuscular control of CAI.