Neurale Mobilisation: Systematischer Review randomisierter kontrollierter Studien mit einer Analyse der therapeutischen Wirksamkeit[1]

Zusammenfassung

Neurale Mobilisation ist eine bei Pathologien des Nervensystems eingesetzte Behandlungsmodalität. Sie wird als effektive Behandlungsmethode eingestuft, obwohl sich diese Bewertung in erster Linie auf anekdotische Berichte stützt. Der Zweck dieser Arbeit besteht in einem systematischen Review der Fachliteratur, die sich mit der therapeutischen Wirksamkeit der neuralen Mobilisation befasst. Anhand der folgenden Suchbegriffe erfolgte eine Suche nach randomisierten, kontrollierten Studien anhand der Suchwörter neural mobilisation/mobilization, nerve mobilisation/mobilization, neural manipulative physical therapy, physical therapy, neural/nerve glide, nerve glide exercises, nerve/neural treatment, nerve/neural stretching, neurodynamics, and nerve/neural physiotherapy. Um zu ermitteln, welche Artikel sich detailliert mit der neuralen Mobilisation als Behandlungsmodalität beschäftigen, wurden Titel und Abstracts der identifizierten Studien reviewed.

Zur Bewertung der Untersuchungen diente die PEDro-Skala, ein systematisches Werkzeug zur kritischen Analyse randomisierter, kontrollierter Studien und zur Einstufung der methodologischen Qualität. Die methodologische Bewertung ermöglichte eine Analyse der Forschung zur therapeutischen Wirksamkeit der neuralen Mobilisation. Es fanden sich (in 11 Artikeln diskutierte) 10 randomisierte klinische Studien zur therapeutischen Wirksamkeit der neuralen Mobilisation.

Der vorliegende Review betont die quantitativen und qualitativen Mängel der bisherigen Forschung. Die qualitative Analyse der Studien ergab nur wenig Evidenz für die Anwendung der neuralen Mobilisation. Daher sollte neurale Mobilisation in zukünftigen Forschungsprojekten erneut untersucht werden. Dabei wäre auf homogenere Studiendesigns und Pathologien zu achten. Außerdem gilt es, die in den Studien eingesetzten Nervenmobilisationsinterventionen zu standardisieren.

Abstract

Neural mobilisation is a treatment modality used in relation to pathologies of the nervous system. It has been suggested that neural mobilisation is an effective treatment modality, although support of this suggestion is primarily anecdotal. The purpose of this paper was to provide a systematic review of the literature pertaining to the therapeutic efficacy of neural mobilisation. A search to identify randomised controlled trials investigating neural mobilisation was conducted using the key words neural mobilisation/mobilization, nerve mobilisation/mobilization, neural manipulative physical therapy, physical therapy, neural/nerve glide, nerve glide exercises, nerve/neural treatment, nerve/neural stretching, neurodynamics, and nerve/neural physiotherapy.

The titles and abstracts of the papers identified were reviewed to select papers specifically detailing neural mobilisation as a treatment modality. The PEDro scale, a systematic tool used to critique RCTs and grade methodological quality, was used to assess these trials. Methodological assessment allowed an analysis of research investigating therapeutic efficacy of neural mobilisation. 10 randomised clinical trials (discussed in 11 retrieved articles) were identified that discussed the therapeutic effect of neural mobilisation.

This review highlights the lack in quantity and quality of the available research. Qualitative analysis of these studies revealed that there is only limited evidence to support the use of neural mobilisation. Future research needs to re-examine the application of neural mobilisation with use of more homogeneous study designs and pathologies; in addition, it should standardise the neural mobilisation interventions used in the study.

Schlüsselwörter

neurale Mobilisation - Neurodynamik - randomisierte kontrollierte Studien - systematischer Review - therapeutische Wirksamkeit

Key words

neural mobilisation - neurodynamics - randomised conrtolled trial - systematic review - therapeutic efficacy

1 Der englische Originalartikel ist erschienen in: The Journal of Manual & Manipulative Therapy 2008; 16: 8 – 22.

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1 Der englische Originalartikel ist erschienen in: The Journal of Manual & Manipulative Therapy 2008; 16: 8 – 22.