运动性脑震荡的物理治疗：网络荟萃分析和系统综述

摘要(中文译文)

运动相关脑震荡（SRC）基于运动的物理治疗干预措施的有效性及最佳方案仍存在争议，且缺乏对证据的系统性综合。旨在对评估基于运动的物理治疗干预措施促进SRC康复的随机对照试验（RCT）进行网状荟萃分析（NMA），并提供最佳实践建议。检索MEDLINE（PubMed）、Web of Science和Cochrane数据库，检索时间自建库至2024年12月。纳入评估SRC基于运动的物理治疗干预措施并报告症状或康复结局的RCT。排除动物研究、观察性研究及数据无法提取的研究。所有记录由2名评审者独立盲法筛选。采用随机效应模型进行NMA。研究质量采用Cochrane偏倚风险工具评估（PROSPERO注册号：CRD420251011941）。证据等级1级。由2名评审者独立提取数据。结局包括临床康复时间及基于症状或量表的测量指标。共纳入20项RCT，涉及1320名参与者（年龄12至60岁；57%为女性），报告了急性或持续性SRC；关于运动类型和水平的详细信息有限。干预措施包括阈下 aerobic 运动方案（SAEP）、常规护理运动方案（UCEP）、多学科干预、拉伸、严格休息、前庭康复治疗（VRT）以及VRT联合SAEP。多学科干预取得了最大改善（标准化均数差[SMD]=-2.06；P=0.002），其次为VRT联合SAEP及单独VRT。亚组分析显示相似模式：多学科干预在<30岁参与者中最为有效（SMD=-2.42），在持续性症状患者中最为有效（SMD=-2.999）。13项研究偏倚风险为低，3项为中等，4项为高。多学科干预及VBT联合SAEP是促进SRC康复最有效的治疗方法，尤其适用于持续性症状患者及<30岁患者。

Abstract

The effectiveness and optimal exercise-based physical therapy interventions for sport-related concussion (SRC) remain controversial, and a systematic synthesis of the evidence is lacking. To conduct a network meta-analysis (NMA) of randomized controlled trials (RCTs) evaluating exercise-based physical therapy interventions for SRC recovery and provide best-practice recommendations. MEDLINE (PubMed), Web of Science, and Cochrane databases were searched from inception through December 2024. RCTs assessing exercise-based physical therapy interventions for SRC that reported symptom or recovery outcomes were included. Animal studies, observational studies, and studies with nonextractable data were excluded. All records were screened independently and blindly by 2 reviewers. NMA using a random-effects model. Study quality was assessed with the Cochrane Risk of Bias tool (PROSPERO registration: CRD420251011941). Level 1. Two reviewers independently extracted data. Outcomes included clinical recovery time and symptom- or scale-based measures. A total of 20 RCTs with 1320 participants (age, 12 to 60 years; 57% female) reporting acute or persistent SRC were included; details on sport types and levels were limited. Interventions comprised subthreshold aerobic exercise protocol (SAEP), usual care exercise protocol (UCEP), multidisciplinary interventions, stretching, strict rest, vestibular rehabilitation therapy (VRT), and combined VRT plus SAEP. Multidisciplinary interventions achieved the greatest improvements (standardized mean difference [SMD] = -2.06; = 0.002), followed by combined VRT plus SAEP and VRT alone. Subgroup analyses showed similar patterns: multidisciplinary interventions were most effective in participants <30 years old (SMD = -2.42) and in patients with persistent symptoms (SMD = -2.999). Risk of bias was low in 13 studies, moderate in 3, and high in 4. Multidisciplinary interventions and the combination of VBT and SAEP are the most effective treatments for SRC recovery, particularly for patients with persistent symptoms and for those <30 years.

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