背景:整骨疗法(OMT)已被整骨临床医生用作由神经耳科疾病引起的头晕的主要或辅助治疗。据我们所知,目前没有系统评价提供评估OMT对头晕影响的综合估计.
目的:我们旨在系统评估OMT和类似技术治疗头晕的有效性和安全性。
方法:我们在CINAHL中进行了文献检索,Embase,MEDLINE,联合和补充医学数据库(AMED),EMCare,物理治疗证据数据库(PEDro),PubMed,PsycINFO,整骨医学数字图书馆(OSTMED。DR),和Cochrane中央对照试验注册中心(CENTRAL)从开始到2021年3月,用于随机对照试验(RCT)以及对患有神经耳科疾病引起的头晕的成年患者的前瞻性或回顾性观察性研究。符合条件的研究比较了OMT或OMT类似技术与比较干预的有效性,比如假操纵,一种不同的手动技术,护理标准,或者运动或行为疗法等非药物干预。评估结果包括与头晕相关的残疾,头晕严重程度,头晕频率,跌倒的风险,生活质量(QOL)的提高,并返回工作(RTW)。评估的伤害结果包括全因辍学率(ACD),由于无效而辍学,和不良事件。荟萃分析基于OMT或OMT类似技术与比较干预措施之间的相似性。偏倚风险(ROB)是使用改良版本的Cochrane偏见风险工具进行RCT和Cochrane偏见风险评估的非随机研究-干预(ROBINS-I)进行观察性研究。证据质量是利用建议分级来确定的,评估,发展,和评估(等级)方法。
结果:确定并筛选了3,375项研究,并对其中47条进行了全文审查。其中,12(11个随机对照试验,1观察性研究,n=367名参与者)符合数据提取的纳入标准。中等质量的证据表明,关节OMT技术与头晕相关的残疾减少(所有p<0.01)相关(n=141,平均差[MD]=-11,95%置信区间[CI]=-16.2至-5.9),头晕严重程度(n=158,MD=-1.6,95%CI=-2.4至-0.7),头晕频率(n=136,MD=-0.6,95%CI=-1.1至-0.2)。低质量证据表明关节OMT与ACD发生率无关(比值比[OR]=2.2,95%CI=0.5至10.2,p=0.31)。当数据被汇集为任何类型的OMT技术时,调查结果相似;然而,与头晕和ACD率相关的残疾具有高度异质性(I2=59和46%)。没有研究符合ROB的所有标准。
结论:当前的综述发现中等质量的证据表明,关节OMT技术治疗与头晕相关的残疾减少显著相关,头晕严重程度,和头晕的频率。然而,我们的研究结果应谨慎解释,因为在符合条件的研究中,ROB较高,样本量较小.
Osteopathic manipulative treatment (OMT) has been utilized by osteopathic clinicians as primary or adjunctive management for dizziness caused by neuro-otologic disorders. To our knowledge, no current systematic reviews provide pooled estimates that evaluate the impact of OMT on dizziness.
We aimed to systematically evaluate the effectiveness and safety of OMT and analogous techniques in the treatment of dizziness.
We performed a literature search in CINAHL, Embase, MEDLINE, Allied and Complementary Medicine Database (AMED), EMCare, Physiotherapy Evidence Database (PEDro), PubMed, PsycINFO, Osteopathic Medicine Digital Library (OSTMED.DR), and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to March 2021 for randomized controlled trials (RCTs) and prospective or retrospective observational studies of adult patients experiencing dizziness from neuro-otological disorders. Eligible studies compared the effectiveness of OMT or OMT analogous techniques with a comparator intervention, such as a sham manipulation, a different manual technique, standard of care, or a nonpharmacological intervention like exercise or behavioral therapy. Assessed outcomes included disability associated with dizziness, dizziness severity, dizziness frequency, risk of fall, improvement in quality of life (QOL), and return to work (RTW). Assessed harm outcomes included all-cause dropout (ACD) rates, dropouts due to inefficacy, and adverse events. The meta-analysis was based on the similarities between the OMT or OMT analogous technique and the comparator interventions. The risk of bias (ROB) was assessed utilizing a modified version of the Cochrane Risk of Bias Tool for RCTs and the Cochrane Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) for observational studies. The quality of evidence was determined utilizing the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach.
There were 3,375 studies identified and screened, and the full text of 47 of them were reviewed. Among those, 12 (11 RCTs, 1 observational study, n=367 participants) met the inclusion criteria for data extraction. Moderate-quality evidence showed that articular OMT techniques were associated with decreases (all p<0.01) in disability associated with dizziness (n=141, mean difference [MD]=-11, 95% confidence interval [CI]=-16.2 to -5.9), dizziness severity (n=158, MD=-1.6, 95% CI=-2.4 to -0.7), and dizziness frequency (n=136, MD=-0.6, 95% CI=-1.1 to -0.2). Low-quality evidence showed that articular OMT was not associated with ACD rates (odds ratio [OR]=2.2, 95% CI=0.5 to 10.2, p=0.31). When data were pooled for any type of OMT technique, findings were similar; however, disability associated with dizziness and ACD rates had high heterogeneity (I2=59 and 46%). No studies met all of the criteria for ROB.
The current
review found moderate-quality evidence that treatment with articular OMT techniques was significantly associated with decreased disability associated with dizziness, dizziness severity, and dizziness frequency. However, our findings should be interpreted cautiously because of the high ROB and small sample sizes in the eligible studies.