太极预防老年跌倒的系统评价再评价

目的评估太极预防老年跌倒相关系统评价的方法学质量及其结局指标的证据质量。方法计算机检索PubMed、Web of Science、The Cochrane Library、EMbase、CNKI、WanFang Data、CBM和VIP数据库,收集太极预防老年跌倒相关系统评价/Meta分析,采用AMSTAR 2工具评价所纳入系统评价的方法学质量,并依据GRADE系统进一步对所纳入系统评价的结局指标进行证据质量分级。结果共纳入11篇系统评价/Meta分析,AMSTAR 2评价结果显示10篇研究方法学质量为极低,1篇为低;GRADE评价结果显示纳入的36个结局指标中,10个结局指标质量为中,20个为低,6个为极低。中等质量的结局指标结果显示,太极组在单腿站立时间MD=5.33,95%CI(3.35,7.32),P<0.01;WMD=1.76,95%CI(-7.00,10.52),P<0.01]、起立-行走试验MD=1.04,95%CI(0.67,1.41),P<0.01]、Berg平衡量表评分MD=2.18,95%CI(0.93,3.43),P<0.01]、总跌倒次数RR=0.82,95%CI(0.73,0.92),P<0.01]、跌倒2次的发生率OR=0.69,95%CI(0.49,0.97),P<0.01]和跌倒3次的发生率OR=0.39,95%CI(0.21,0.73),P<0.01]方面均优于对照组。结论目前太极预防老年跌倒的相关系统评价方法学质量较低,证据质量可靠程度一般,无法证实太极能有效预防老年跌倒,有待未来开展更多高质量研究证实。

Tai Chi for preventing falls in the elderly: an overview of systematic reviews

Objectives To assess the methodological quality of systematic reviews of Tai Chi for preventing falls in the elderly and quality of evidence for outcome indicators.Methods PubMed,Web of Science,The Cochrane Library,EMbase,CNKI,WanFang Data,CBM and VIP databases were electronically retrieved.According to the inclusion criteria and exclusion criteria,final articles were selected and relevant literature information was extracted by screening the abstract and full text.The methodological quality of the included systematic reviews was evaluated using AMSTAR 2 tool,and the quality of the outcome indicators of the included systematic reviews was further graded according to the GRADE system.Results A total of 11 systematic reviews/meta-analyses were included.The AMSTAR 2 evaluation showed that 10 studies were in critically-low methodological quality,and 1 study was in low methodological quality.The GRADE evaluation results showed that among the 36 outcome indicators included,there were 10 intermediate quality indicators,20 low-level quality indicators and 6 extremely low-level quality indicators.Among the indicators of intermediate quality,Tai Chi was superior to control group on single-leg stand test(MD=5.33,95%CI 3.35 to 7.32,P<0.01;WMD=1.76,95%CI-7.00 to 10.52,P<0.01),time up and go test(MD=1.04,95%CI 0.67 to 1.41,P<0.01),the berg balance scale(MD=2.18,95%CI 0.93 to 3.43,P<0.01),number of falls(RR=0.82,95%CI 0.73 to 0.92,P<0.01),the incidence of 2-falls(OR=0.69,95%CI 0.49 to 0.97,P<0.01)and the incidence of 3-falls(OR=0.39,95%CI 0.21 to 0.73,P<0.01).Conclusions At present,the methodological quality of relevant systematic reviews of Tai Chi for preventing falls in the elderly is relatively low and the quality of the evidence is insufficient,so it is uncertain that Tai Chi can effectively prevent falls in the elderly,which requires further studies at a high level.