背景:在运动相关脑震荡后重返赛场后,发生脑震荡和肌肉骨骼损伤的风险增加。虽然有许多评估可供临床医生诊断和在脑震荡后重返比赛期间使用,许多人可能缺乏检测这些亚临床功能变化的能力.目前,关于可靠性没有共识或整理来源,这些评估的有效性和可行性,这使得临床医生和从业人员很难选择最适合他们需求的评估。
目的:本系统综述旨在(1)巩固脑震荡管理过程中运动功能评估的信度和效度,(2)总结其对临床医生和其他最终用户的可行性。
方法:对5个数据库进行系统检索。符合条件的研究是:(1)原始研究;(2)全文英语;(3)具有III级或更高证据的同行评审;(4)评估用于诊断或确定患有脑震荡的运动员或军事人员的下肢运动评估的有效性;(5)评估健康运动员中用于脑震荡管理的下肢运动评估的重测可靠性。可接受的下肢运动评估分为仪器和非仪器,然后分为静态(在固定点附近稳定)。动态(围绕固定点移动),步态,和其他类别。使用COSMIN检查表对每项研究进行评估,以建立方法学和测量质量。
结果:总共确定了1270条记录,删除了637个重复项。分析了633条记录的标题和摘要,其中158项被保留用于全文审查。本次审查共包括67条记录;37条记录评估了可靠性,35条记录评估了下肢运动评估的有效性。审查中包括42项不同的评估,43%的人没有仪器,主观评价。一致的证据支持使用仪器化评估而非仪器化评估,与静态或动态评估相比,基于步态的评估显示出足够的可靠性和有效性。
结论:这些研究结果表明,基于步态的评估应优先于静态或动态平衡评估。实验室设备的使用(即3D运动捕捉,压敏走道)平均表现出足够的信度和效度,但证明可行性差。需要进一步的高质量研究来评估更容易获得的设备(即惯性测量单元)的可靠性和有效性,以填补当前脑震荡管理协议的空白。从业人员可以使用此资源来了解他们所拥有的评估的准确性和准确性,以便就脑震荡的管理做出明智的决定。
背景:本系统综述已在PROSPERO上注册(注册编号:CRD42021256298).
BACKGROUND: There is an increased risk of subsequent concussion and musculoskeletal injury upon return to play following a sports-related concussion. Whilst there are numerous assessments available for clinicians for diagnosis and during return to play following concussion, many may lack the ability to detect these subclinical changes in function. Currently, there is no consensus or collated sources on the reliability, validity and feasibility of these assessments, which makes it difficult for clinicians and practitioners to select the most appropriate assessment for their needs.
OBJECTIVE: This systematic
review aims to (1) consolidate the reliability and validity of motor function assessments across the time course of concussion management and (2) summarise their feasibility for clinicians and other end-users.
METHODS: A systematic search of five databases was conducted. Eligible studies were: (1) original research; (2) full-text English language; (3) peer-reviewed with level III evidence or higher; (4) assessed the validity of lower-limb motor assessments used to diagnose or determine readiness for athletes or military personnel who had sustained a concussion or; (5) assessed the test-retest reliability of lower-limb motor assessments used for concussion management amongst healthy athletes. Acceptable lower-limb
motor assessments were dichotomised into instrumented and non-instrumented and then classified into static (stable around a fixed point), dynamic (movement around a fixed point), gait, and other categories. Each study was assessed using the COSMIN checklist to establish methodological and measurement quality.
RESULTS: A total of 1270 records were identified, with 637 duplicates removed. Titles and abstracts of 633 records were analysed, with 158 being retained for full-text
review. A total of 67 records were included in this review; 37 records assessed reliability, and 35 records assessed the validity of lower-limb
motor assessments. There were 42 different assessments included in the review, with 43% being non-instrumented, subjective assessments. Consistent evidence supported the use of instrumented assessments over non-instrumented, with gait-based assessments demonstrating sufficient reliability and validity compared to static or dynamic assessments.
CONCLUSIONS: These findings suggest that instrumented, gait-based assessments should be prioritised over static or dynamic balance assessments. The use of laboratory equipment (i.e. 3D motion capture, pressure sensitive walkways) on average exhibited sufficient reliability and validity, yet demonstrate poor feasibility. Further high-quality studies evaluating the reliability and validity of more readily available devices (i.e. inertial measurement units) are needed to fill the gap in current concussion management protocols. Practitioners can use this resource to understand the accuracy and precision of the assessments they have at their disposal to make informed decisions regarding the management of concussion.
BACKGROUND: This systematic
review was registered on PROSPERO (reg no. CRD42021256298).