Chinese Journal of Tissue Engineering Research ›› 2024, Vol. 28 ›› Issue (32): 5217-5224.doi: 10.12307/2024.518
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Su Yuying1, 2, Li Wei1, Shi Yu1, Pan Changbo1
Received:
2023-09-04
Accepted:
2023-10-25
Online:
2024-11-18
Published:
2023-12-29
Contact:
Li Wei, PhD, Professor, Doctoral supervisor, School of Strength and Conditioning Training, Beijing Sport University, Beijing 100086, China
About author:
Su Yuying, Doctoral candidate, School of Strength and Conditioning Training, Beijing Sport University, Beijing 100086, China
Supported by:
CLC Number:
Su Yuying, Li Wei, Shi Yu, Pan Changbo. Effects of different exercise interventions on symptoms and dynamic balance ability of chronic ankle instability: a systematic review and Meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2024, 28(32): 5217-5224.
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2.4 Meta分析结果 2.4.1 运动干预对CAI患者功能评分的影响 干预效果的整体效应量检验:运动干预对CAI患者功能评分研究共纳入40篇文献中的49个效应量[9-15,17,20-21,24-32,34-41,43,45-48,51-54,56,58-59],纳入文献包含1 504例CAI患者。功能评分指标包括AOFAS、CAIT、FADI、AJFAT、FAAM-S和FADI-S。异质性检验(I2=79%,P < 0.000 01)为高度异质性,故采用随机效应模型进行效应量检验。通过对其合并检验后效应量为 SMD=1.11[95%CI(0.86,1.35),P < 0.000 01],达到大效应量,表明合并效应量具有统计学意义,见图5所示。因此,运动干预可以显著改善CAI患者踝关节不稳效果。"
通过亚组分析进一步发现,运动干预对CAI和FAI患者均能改善踝关节不稳效果,并且效果显著,见表3。干预时间方面,≥60 min的干预时间效果优于≥30 min且< 60 min和< 30 min的干预时间。每周干预2次和> 3次的干预时间较每周3次的干预频次效果更好。干预周期方面,12周的干预效果最好,其次是10周的干预。运动干预形式方面,神经肌肉控制训练效果最好,效应量(SMD达到了1.66;其次是常规组合训练,效应量(SMD为1.34。单纯的只进行平衡训练或力量训练改善效果接近。因此,通过神经肌肉控制训练的干预形式、12周的干预周期、每周干预2次、每次大于60 min是改善CAI患者踝关节不稳的最佳方案。"
敏感性分析:此次研究合并效应量后异质性为I2=79%,因此通过敏感性分析探讨是否某一项研究对整体产生较大的影响。通过在整体研究基础上进行逐一剔除的方式来评估每个研究对整体效应量的影响,分析表明剔除某一研究后对整体异质性影响不大,表明Meta分析的结果稳定可靠。 2.4.2 运动干预对CAI患者星形偏移平衡测试的影响 干预效果的整体效应量检验:SEBT是健侧踝关节在网格中心向前侧、后外侧和后内侧3个不同方向进行最大程度伸展来检测患侧踝关节动态稳定性的评价方法。纳入文献中选取前、后内和后外侧3个方向可以较为精确地评价踝关节动态稳定性。采用随机效应模型对3个方向进行合并效应量检验,前侧[SMD=0.66,95%CI(0.44,0.88),P < 0.000 0]、后外侧[SMD=0.91,95%CI(0.68,1.13),P < 0.000 0]和后内侧[SMD=0.74,95%CI(0.55,0.94),P < 0.000 0],前侧和后内侧达到中等效应量,后外侧达到大效应量,见表4。结果表明运动干预可以有效改善CAI患者踝关节的动态稳定性。"
调节变量亚组检验和敏感性分析:通过对SEBT 3个方向的效应量进行亚组分析发现,在干预时间上,除前侧干预≥60 min无显著差异外,其他时间对3个方向SEBT提高均具有显著差异,见表5。≥30 min以上的干预时间对SEBT提高效果优于< 30 min的干预时间,建议采用30 min以上的运动时间。干预频次方面,每周干预2次和每周干预3次对SEBT效应量均能够维持在中等效应量之间,可见每周干预两三次均可以有效提高SEBT,改善踝关节稳定性。干预周期方面,干预8周对SEBT 3个方向均达到大效应量,改善效果最优;其次是6周和12周,效应量介于中等效应量和大效应量之间;4周的干预周期较短,对SEBT 3个方向的改善也最低。干预形式方面,常规组合训练对SEBT 3个方向均不具有显著差异,力量训练对SEBT 3个方向改善效果较低。髋部力量组合训练对后SEBT 内侧改善效果最优;神经肌肉控制训练对SEBT 前侧和后外侧改善效果最优。综合来看,8周干预、每周干预两三次、每次30-60 min干预时间,采用神经肌肉控制训练和髋部力量组合训练对踝关节稳定性改善是最佳的干预方案。"
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