Abstract
ObjectiveTo synthesise and analyse the current evidence regarding changes in joint position sense (JPS) and standing balance in people with whiplash-associated disorder (WAD) taking the presence or absence of dizziness into account.Data sourcesPubMed, CINAHL Plus, Web of Science, Embase, MEDLINE and APA PsycINFO were searched by two independent reviewers from inception until August 2020 and reference lists of all included studies were also reviewed.Study selectionOnly cross-sectional studies that measured JPS and/or standing balance between people with WAD vs. healthy controls (HC) or people with WAD complaining of dizziness (WADD) vs. those not complaining of dizziness (WADND) were selected.Data extractionRelevant data were extracted using specific checklists and quality assessment was performed using Downs and Black Scale (modified version).Data synthesisTwenty-six studies were included. For JPS, data were synthesized for absolute error in the primary plane of movement for separate movement directions. For standing balance, data were synthesized for traditional time- and frequency domain sway parameters considering the conditions of eyes open (EO) and eyes closed (EC) separately. For meta-analysis, reduced JPS was observed in people with WAD compared to HC when the head was repositioned to a neutral head position (NHP) from rotation (standardised mean difference [SMD] = 0.43 [95%: 0.24–0.62]) and extension (0.33 [95%CI: 0.08–0.58]) or when the head was moved toward 50° rotation from a NHP (0.50 [0.05–0.96]). Similarly, people with WADD had reduced JPS compared to people with WADND when the head was repositioned to a NHP from rotation (0.52 [0.22–0.82]). Larger sway velocity and amplitude was found in people with WAD compared to HC for both EO (0.62 [0.37–0.88] and 0.78 [0.56–0.99], respectively) and EC (0.69 [0.46–0.91] and 0.80 [0.58–1.02]) conditions.ConclusionThe observed changes of JPS and standing balance confirms deficits in sensorimotor control in people with WAD and especially in those with dizziness.
Highlights
The present study investigated the role of whiplash-associated disorder (WAD) and dizziness on the afore-mentioned outcomes by comparing people with WAD and healthy controls (HC) and people with WAD presenting with dizziness (WADD) versus those not presenting with dizziness (WADND) due to potential greater deficits in sensorimotor control in those complaining of dizziness
All of the 16 included studies assessed the difference between people with WAD and HC, among which only 2 studies assessed the difference between WAD complaining of dizziness (WADD) and WADND groups [29, 35]
The studies investigating the difference between people with WAD and HC recruited a total of 1068 participants to compare the difference between WAD (N = 601; range: 7–102) and HC (N = 467; range: 11–57) (Table 3)
Summary
The PICOS (P: Patient/population; I: Intervention; C: Comparison; O: Outcome; S: Study design) framework, for which we defined P as ‘WAD’ or ‘WADD’, C as ‘healthy controls’ or ‘WADND’, O as ‘JPS’ or ‘balance’ and S as ‘cross-sectional study design’, was utilized to inform the eligibility criteria. Studies that measured either ‘JPS’, ‘standing balance’ or both in human participants with WAD classified as Grade I, II or III were included. Studies were excluded if they used trajectory registration tasks that required the participant to follow a visual target, such as Figure of 8 [15, 16], The Fly [17, 18], or Zigzag [16] tests, as they measure movement sense and not position sense. In case of duplicate publication or publications with similar data, the original version of the article was included in this review
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