渐进式前庭眼反射适应训练对慢性外周前庭功能减退患者步态、平衡和生活质量的效果：一项随机对照试验
Efficacy of Incremental Vestibular Ocular Reflex Adaptation Training on Gait, Balance, and Quality of Life in Individuals With Chronic Peripheral Vestibular Hypofunction: A Randomized Controlled Trial.
文献信息
| PMID | 42769628 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Jennifer L Millar |
| 作者单位 | Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. |
| 期刊 | Archives of rehabilitation research and clinical translation |
| SCI 分区 | Q2 |
| IF | 2.5 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 比较完成新型渐进式前庭眼反射（VOR）适应方案或传统前庭康复的前庭功能减退患者在步态、平衡和主观头晕结局指标方面的差异。
设计： 随机、双盲、交叉对照试验，包括6个月随访。
地点： 三级医疗门诊物理治疗。
参与者： N=24例慢性外周前庭功能减退患者。
干预： A组首先使用新型头戴式StableEyes设备完成渐进式VOR适应训练，而B组完成被视为前庭康复标准治疗的传统凝视稳定性练习。3周后，参与者进入3周洗脱期，然后交叉至相反的凝视稳定性训练干预，并开始平衡和步态训练。
主要结局指标： 前庭眼反射的幅度是临床试验的主要结局指标；本文报告的是步态、平衡和主观体验等次要结局指标的结果，这些是前庭疾病患者主要关注的问题。采用线性混合模型（随机截距）分析组间人口学、平衡、步态和主观症状差异，并在适当时采用配对t检验，遵循意向性治疗原则。
结果： 基线时，A组的主观平衡信心评分低于分配至B组的患者（P=.016），神经行为症状较少（P=.029）。然而，在完成任一种/两种凝视稳定性训练后，我们发现两组在任何临床结局（步态、平衡或主观症状）的变化方面均无差异。无论分组如何，个体的步态、平衡信心和总体变化印象均有改善，但这些改善在6个月时未能保持。
结论： 用于凝视稳定性训练的新型渐进式VOR适应方法在改善步态、平衡和主观症状方面与传统前庭康复具有相似的优势，尽管这些改善在6个月时消失。
英文摘要
OBJECTIVE: To compare gait, balance, and subjective measures of dizziness outcomes in patients with vestibular hypofunction completing either a novel, incremental vestibular ocular reflex (VOR) adaptation program or traditional vestibular rehabilitation.
DESIGN: Randomized, double-blinded, crossover-controlled trial including a 6-month follow-up.
SETTING: Tertiary care, outpatient physical therapy.
PARTICIPANTS: N=24 individuals with chronic peripheral vestibular hypofunction.
INTERVENTIONS: Group A first completed incremental VOR adaptation training using the novel, head-mounted StableEyes device, while group B completed traditional gaze stability exercises considered standard of care in vestibular rehabilitation. After 3 weeks, participants entered a 3-week washout period before crossing over to the opposing gaze stability training intervention and starting balance and gait training.
MAIN OUTCOME MEASURES: The magnitude of the vestibulo-ocular reflex was the primary outcome measure of the clinical trial; this paper reports results for the secondary outcome measures of gait, balance, and subjective experience, which are of primary concern to patients with vestibular disorders. Demographic, balance, gait, and subjective symptom differences between the groups were analyzed using a linear mixed model with a random intercept and, when appropriate, paired t tests, following the intent-to-treat principle.
RESULTS: At baseline, group A had lower subjective balance confidence scores (P=.016) and fewer neurobehavioral symptoms (P=.029) than those allocated to group B. However, we found no difference between the groups in the change of any clinical outcome (gait, balance, or subjective symptoms) after completion of either/both types of gaze stability training. Regardless of cohort placement, individuals improved their gait, balance confidence, and global impression of change, yet these improvements were not retained at 6 months.
CONCLUSIONS: The novel incremental VOR adaptation method for gaze stability training offers advantages similar to those of traditional vestibular rehabilitation in improving gait, balance, and subjective symptoms, though these improvements are lost at 6 months.