Balance training (proprioceptive training) for patients with rheumatoid arthritis

  • Review
  • Intervention

Authors


Abstract

Background

Patients with rheumatoid arthritis may have an increased risk of falls due to impairments in lower-extremity joints, which may result in either mobility, or postural stability problems. There is evidence in the literature suggesting that balance, agility and coordination training techniques can induce changes in lower-extremity muscle activity patterns that result in improvement in dynamic joint stability.

The mechanoreceptors present in and around the joints are responsible for maintaining postural control and joint position sense. These receptors are integrated to compose the somatosensorial system. In combination with visual and auditory inputs, which improve our spatial perception even further, the systems are able to maintain a stable body posture.

However, there is a lack of information on the efficacy of balance training alone in patients with rheumatoid arthritis.

Objectives

To assess the effectiveness and safety of balance training (proprioceptive training) to improve functional capacity in patients with rheumatoid arthritis.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 4), MEDLINE via PubMed (January 1966 to December 2008), EMBASE (January 1980 to December 2008), LILACS (January 1982 to December 2008), CINAHL (January 1982 to December 2008), PEDro and Scirus (inception to 2008). We also handsearched conference abstracts.

Selection criteria

All eligible randomised controlled trials (RCT) or controlled clinical trials (CCT) comparing balance training (proprioceptive training) with any other intervention or with no intervention.

Data collection and analysis

Two review authors independently assessed titles or abstracts, or both, for inclusion criteria.

Main results

The electronic search identified 864 studies. From this search, 17 studies described general exercises in rheumatoid arthritis patients as the main topic.  After analysing them, we observed that the main interventions were exercises to improve muscle strength, endurance, and dynamic exercises (swimming, walking, etc). As we did not find any studies investigating the effects of balance training alone or in combination with other therapies in patients with rheumatoid arthritis, it was not possible to include any data regarding the chosen topic in this systematic review.

Authors' conclusions

There is no research available examining the efficacy of balance training alone in patients with rheumatoid arthritis. The effectiveness and safety of balance training to improve functional capacity of these patients remains unclear. We suggest that future research should give more importance to balance training by either increasing the number and duration of sessions or investigating its efficacy alone.

摘要

針對類風濕性關節炎患者的平衡訓練(本體感覺訓練)

研究背景

因為下肢關節失能所導致動作或維持姿勢穩定度的問題,類風性關節炎患者可能增加跌倒的危險性. 目前文獻已有證據暗示平衡,靈活度和協調性訓練的技巧可以促使下肢肌肉改變活動型態,進而改善關節的動態穩定度. 關節內或關節周圍的機械性受器負責維持姿勢控制和關節位置覺. 這些受器整合成為體感覺系統. 藉著結合能更進一步改善空間知覺的視覺和聽覺的輸入,體感覺系統更能維持身體姿勢的穩定. 然而,目前缺乏關於單獨平衡訓練在類風濕性關節炎患者的功效的資訊.

研究目的

為了評估類風濕性關節炎患者的平衡訓練(本體覺訓練)以改善功能性能力的成效何安全性

检索策略

我們搜尋了Cochrane Central Register of Controlled Trials (CENTRAL)(Cochrane圖書館 2008年第4期), 經由PubMed查詢MEDLINE(1966年1月至2008年12月),CINAHL(1982年1月至2008年12月),PEDro和Scirus(截至2008年). 我們也手動搜尋了會議摘要.

标准/纳入排除标准

所有比較平衡訓練(本體覺訓練)和其他處置或不處置並符合資格的隨機對照試驗(RCT)或控制臨床實驗(CCT)

数据收集与分析

兩個回顧作者獨立評估標題或摘要,或上述兩者是否符合收錄條件

主要结果

電子搜尋找到了864個研究. 這些研究中,17個研究將類風性關節炎患者一般性的運動作為主要主題. 分析完後,我們觀察了藉運動來改善肌肉力量,耐力和動態運動(游泳,走路,等等) 的主要處置. 雖然我們並沒有找到任何研究調查單獨平衡訓練的效果或結合其他治療針對類風性關節炎的患者,我們並不可能將所有相關的主題含括進這篇系統性回顧.

作者结论

並沒有針對類風性關節炎患者平衡訓練效果的研究. 針對平衡訓練改善這類病人功能性能力的效果和安全性仍未知. 我們建議未來的研究應該更重視藉著增加平衡訓練的次數和每次訓練的時間或單獨研究它的效果.

Plain language summary

Balance training (proprioceptive training) for rheumatoid arthritis.

This summary of a Cochrane review presents what we know from research about the effect of balance training on rheumatoid arthritis.

The review shows that in people with rheumatoid arthritis:

We are unsure of the effects of balance training because no studies met the review's inclusion criteria. Further randomised controlled trials are required to evaluate the effectiveness and safety of balance exercises (proprioceptive training) alone in patients with rheumatoid arthritis

What is rheumatoid arthritis and what is balance training?

When you have rheumatoid arthritis, your immune system, which normally fights infection, attacks the lining of your joints. This makes your joints swollen, stiff and painful. The small joints of your hands and feet are usually affected first. There is no cure for rheumatoid arthritis at present, so the treatments aim to relieve pain and stiffness and improve your ability to move. Patients with rheumatoid arthritis may have an increased risk of falls due to impairments in the legs and feet which can lead to instability.

Balance training is a set of exercises in which participants use their muscles against an external force as a planned movement or in response to an unexpected movement or changes in order to maintain their balance. Balance exercises and positions can include feet together, semi and tandem position, one leg stance, unstable platforms or foams, eyes opened and closed. In addition, balance training can include some coordination and agility exercises such as: shuttle walk, tandem walk, crossover walk, side-to-side walk and figure of eight. 

概要

針對類風濕性關節炎患者的平衡訓練(本體感覺訓練). 這個考科藍回顧的總結呈現了目前我們所知關於平衡訓練在類風濕性關節炎的研究. 這篇回顧展示了類風濕性關節炎患者:我們目前不確定平衡訓練的功效,因為目前沒有研究符合此回顧的納入標準. 需要進一步的隨機對照試驗評估針對類風濕性關節炎患者單獨的平衡運動(本體覺訓練). 什麼是類風濕性關節炎,什麼是平衡訓練. 當你有類風濕性關節炎,你的免疫系統會攻擊你的關節表面,而正常的免疫系統是抵抗感染. 它會使你的關節腫脹,堅硬且疼痛. 你手腳的小關節通常是第一個好發處. 現今沒有類風濕性關節炎的治癒方法,因此治療的目的在於緩解疼痛和僵硬,並改善你的動作能力. 類風濕性關節炎的患者因為小腿和腳的失能所導致的不穩定會增加跌倒的風險. 平衡訓練是一組藉由參予者使用它們的肌肉來對抗外力作為計畫的運動或對未預期的運動的反應或為了增加他們的平衡的運動. 平衡運動和位置可以包含雙腳併攏,半前後站,雙腳前後站,單腳站,動態平台或泡棉軟墊,張眼或閉眼下執行. 除此之外,平衡訓練可以包含一些增加協調性,靈活度的運動,例如折返行走,雙腳交替直線行走,雙腳交叉行走,側走,或走八字型.

翻译注解

Ancillary