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physioscience 2020; 16(04): 167-175
DOI: 10.1055/a-1098-8140
Originalarbeit

Wirksamkeit manualtherapeutischer Techniken in Kombination mit vestibulärer Rehabilitation nach sportbedingten Gehirnerschütterungen – Eine systematische Übersichtsarbeit randomisiert kontrollierter Studien

Effectiveness of Manual Therapeutic Techniques in Combination with Vestibular Rehabilitation after Sports-Related Concussions – A Systematic Review of Randomized Controlled Trials
Barbara Scheiber
1   FH Gesundheit Tirol/Health University of Applied Sciences Tyrol, Physiotherapie, Innsbruck, Österreich
,
Natalia Schiefermeier-Mach
2   FH Gesundheit Tirol/Health University of Applied Sciences Tyrol, Gesundheits- und Krankenpflege, Innsbruck, Österreich
,
Claudia Wiederin
1   FH Gesundheit Tirol/Health University of Applied Sciences Tyrol, Physiotherapie, Innsbruck, Österreich
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Zusammenfassung

Hintergrund Die Rehabilitation nach leichter, sportbedingter Gehirnerschütterung erfordert eine komplexe Behandlung unter Berücksichtigung der muskuloskelettalen, insbesondere zervikogenen, und vestibulären Beteiligung. Das empfohlene Rehabilitationskonzept der vollständigen Ruhe bis zur Beschwerdefreiheit wird inzwischen neu bewertet. Aktuelle Studien deuten auf positive Auswirkungen einer frühen Mobilisierung und multimodaler Physiotherapie hin. Der medizinische Nutzen ausgewählter manualtherapeutischer Techniken wird in mehreren klinischen Studien untersucht. Bisher konnten jedoch keine eindeutigen Empfehlungen für manualtherapeutische Techniken nach einer Gehirnerschütterung ausgesprochen werden.

Ziel Analyse und Zusammenfassung vorhandener randomisiert kontrollierter Studien (RCTs) zur Untersuchung der Wirksamkeit manualtherapeutischer Techniken in Kombination mit vestibulärer Rehabilitation auf Symptomfreiheit und Wiedererlangung der sportlichen Belastbarkeit bei Patienten nach sportbedingten Gehirnerschütterungen.

Methode Systematische Recherche in den Datenbanken ClinicalTrials.gov, WHO-ICTRP, EBSCO, PubMed und PEDro mit den Suchbegriffen concussion, physiotherapy, manual therapy und mild traumatic brain injury. Eingeschlossen wurden RCTs zur Untersuchung manualtherapeutischer Techniken nach sportbedingten Gehirnerschütterungen oder milden Formen eines Schädelhirntraumas. Die Bewertung der methodischen Qualität erfolgte Anhand der PEDro-Skala.

Ergebnisse Publikationen zu 2 RCTs mit guter und moderater methodischer Qualität (PEDro-Skala: 7–8/10 Punkten) sowie eine Folgestudie wurden inkludiert. Als primärer Outcome-Parameter wurde in allen Studien der Zeitraum der ärztlichen Freigabe zur Rückkehr zum Sport angegeben. Sekundäre Outcome-Parameter bezogen sich auf Symptomfreiheit, Postconcussion Scale, Numeric Pain Rating Scale, Balance Confidence Scale, Dizziness-Handicap-Index, Sport Concussion Assessment Tool 2 und Joint-Position-Error-Test. Die Ergebnisse aller inkludierten Studien ergaben signifikante Unterschiede zugunsten der Interventionsgruppen. Die eingeschlossenen klinischen Studien waren jedoch in Bezug auf Design, Methodik und Auswahl der Techniken heterogen, was einen direkten Vergleich erschwerte.

Schlussfolgerung Abgeschlossene klinische Studien deuten darauf hin, dass manualtherapeutische Techniken als Teil eines multimodalen Rehabilitationsprogramms nach Gehirnerschütterungen und leichten Schädelhirntraumata von Nutzen sein können. Aufgrund der geringen Anzahl an RCTs und deren heterogenen Studiendesigns ist eine Bewertung der Wirksamkeit spezifischer manualtherapeutischer Techniken derzeit nicht möglich. Weitere hochwertige Studien sind erforderlich.

Abstract

Background Rehabilitation after sport-related mild traumatic brain injury/concussion requires complex treatment where a contribution of musculoskeletal, in particular cervicogenic, and vestibular systems has to be taken into account. The recommended rehabilitation concept of complete rest until symptom-free has been re-evaluated. Recent reports suggest positive effects of early mobilization and multimodal physiotherapy. Several clinical studies also investigated medical benefits of selected physiotherapeutic hands-on manual techniques. However, recommendations for manualtherapeutic techniques as a mandatory part of the post-concussion rehabilitation program have not been made so far.

Objective To summarize existing RCTs and to analyse the effectiveness of manualtherapeutic techniques in combination with vestibular rehabilitation on symptom clearance and regaining sporting resilience after sport-related concussion.

Method Systematic research in the databases ClinicalTrials.gov, WHO-ICTRP, EBSCO, PubMed and PEDro. Search terms included concussion, physiotherapy, manual therapy and mild traumatic brain injury. RCTs that investigate manualtherapeutic techniques after sports-related concussions or mild forms of traumatic brain injury were included. The methodological quality was assessed using PEDro scale.

Results Published results of two RCTs with good and moderate methodological quality (PEDro scale: 7–8/10 points) and a follow-up study were included. The primary outcome parameter was the time until return to play release. Secondary outcome parameters comprised the time until symptom-free condition, post concussion scale, numeric pain rating scale, balance confidence Scale, Dizziness Handicap Index, Sport Concussion Assessment Tool 2 and Joint Position Error Test. The results of RCTs showed significant differences in favour of the intervention groups. However, included clinical trials have been rather heterogeneous regarding designs, methodology and selected manual techniques, which made their direct comparison difficult.

Conclusion Completed clinical trials suggest that manualtherapeutic techniques can be beneficial as a part of a multimodal post-concussion rehabilitation program. Due to the small number of RCTs and their heterogeneous study design, it is currently not possible to evaluate the effectiveness or benefit of specific manualtherapeutic techniques. Further high-quality studies are required.

Schlüsselwörter

Gehirnerschütterung - vestibuläre Rehabilitation - manualtherapeutische Techniken

Key words

brain concussion - vestibular rehabilitation - manualtherpeutic techniques


Publication History

Received: 08 January 2020

Accepted: 03 July 2020

Article published online:
28 September 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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