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์ง„๋™์ž๊ทน์ด ์ค‘์ถ”์‹ ๊ฒฝ๊ณ„ ์งˆํ™˜ ํ™˜์ž์˜ ์‹ ์ฒด์  ๊ธฐ๋Šฅ ํšŒ๋ณต์— ๋ฏธ์น˜๋Š” ํšจ๊ณผ: ๋ฌด์ž‘์œ„๋Œ€์กฐ์—ฐ๊ตฌ์— ๋Œ€ํ•œ ๋ฉ”ํƒ€๋ถ„์„

Abstract

Objectives

The central nervous system (CNS) diseases cause serious damage to motor and sensory functions. The individuals with CNS disease have great limitations in activities of daily living and social participation. This meta-analysis was conducted to investigate the effect of vibratory stimulation on physical function recovery in individuals with CNS disease.

Methods

Data were collected through data search engines such as PubMed, CINAHL, MEDLINE from 2005 to 2017. The PEDro scale was used to assess the quality of study. The sample size, mean and standard deviation in the studies were analyzed by meta-analysis.

Results

Ten studies were selected for analysis and all studies had PEDro score of 6 points or more. Three hundred fourteen participants were included. The outcome data were categorized as physical functions focused on community participation such as โ€œbalance functionโ€ and โ€œupper & lower function and gait function.โ€ The effect sizes of the selected studies were statistically insignificant in heterogeneity. The effect sizes of combined outcomes and โ€œupper & lower function and gait functionโ€ were 0.356 and 0.421 as indicated by a โ€œmedium effect sizeโ€ and the effect size of โ€œbalance functionโ€ was 0.223 as indicated by a โ€œsmall effect size.โ€

Conclusions

We found that vibratory stimulation has the advantage of enhancing physical function in CNS rehabilitation field. However, there was no superior effect than other types of intervention.

์„œ ๋ก 

์ค‘์ถ”์‹ ๊ฒฝ๊ณ„(central nervous system, CNS) ์งˆํ™˜ ํ™˜์ž์—๊ฒŒ ๋‚˜ํƒ€๋‚˜๋Š” ๋น„์ •์ƒ์ ์ธ ์‹ ์ฒด ์ฆ์ƒ์€ ๊ทผ์œก์˜ ์œ„์•ฝ, ๋น„์ •์ƒ์ ์ธ ๊ทผ ๊ธด์žฅ๋„, ํ˜‘์‘์žฅ์• , ๊ฐ๊ฐ์†์ƒ ๋“ฑ์ด ์žˆ๋‹ค. ๊ทธ ๊ฒฐ๊ณผ, ์šด๋™ ๊ธฐ๋Šฅ์˜ ์†Œ์‹ค ๋ฐ ๊ด€์ ˆ ์›€์ง์ž„ ์ •๋ณด ๊ฐ์†Œ๋กœ ์ธํ•œ ์šด๋™๊ณ„ํš ์žฅ์• ๋ฅผ ๊ฐ€์ ธ์˜จ๋‹ค. ์ด๋Ÿฌํ•œ ์šด๋™ ๊ณ„ํš ์†Œ์‹ค์€ ์‹ ์ฒด์˜ ๊ธฐ๋Šฅ์  ์›€์ง์ž„์„ ๋ฐฉํ•ดํ•˜๊ฒŒ ๋˜๊ณ  ์ผ์ƒ์ƒํ™œ์˜ ์ฐธ์—ฌ์— ํฐ ์žฅ์• ๋ฅผ ๋ฐœ์ƒ์‹œํ‚จ๋‹ค[1-3].
์ง€๊ธˆ๊นŒ์ง€ ๋งˆ๋น„๋œ ์‹ ์ฒด์˜ ๊ธฐ๋Šฅ์„ ํ–ฅ์ƒ์‹œํ‚ค๊ธฐ ์œ„ํ•œ ์žฌํ™œ ํ›ˆ๋ จ์€ ์šด๋™์˜ ์žฌํ•™์Šต์„ ์œ„ํ•œ ์šด๋™ ํ›ˆ๋ จ์— ์ง‘์ค‘๋˜์–ด ์™”๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ์ตœ๊ทผ์— ์—ฌ๋Ÿฌ ์—ฐ๊ตฌ๋ฅผ ํ†ตํ•˜์—ฌ ์ธ์œ„์ ์ธ ์ฒด์„ฑ๊ฐ๊ฐ(somatosensory) ์ž๊ทน์ด ์‹ ์ฒด ๊ธฐ๋Šฅ ํ–ฅ์ƒ์— ๊ธ์ •์  ์˜ํ–ฅ์„ ๋ฏธ์นœ๋‹ค๋Š” ๊ฒƒ์ด ๋ณด๊ณ ๋˜๊ณ  ์žˆ๋‹ค[4-6]. ํŠนํžˆ ์ฒด์„ฑ๊ฐ๊ฐ์„ ์ž๊ทนํ•˜๋Š” ์ง„๋™์ž๊ทน์€ ๋‹ค์–‘ํ•œ ์šด๋™๋ฐฉ๋ฒ•๊ณผ ์ƒ๊ด€์—†์ด ์ œ๊ณต์ด ์šฉ์ดํ•˜๊ณ  ์ž๊ทน์˜ ํ˜์˜ค์„ฑ๊ณผ ๊ฐ™์€ ๋ถ€์ž‘์šฉ์ด ์ ์–ด ์ตœ๊ทผ ์˜๋ฃŒ ์žฌํ™œ๋ถ„์•ผ์—์„œ ํ™œ๋ฐœํ•œ ์—ฐ๊ตฌ๊ฐ€ ์ด๋ฃจ์–ด์ง€๊ณ  ์žˆ๋‹ค[7].
๋จผ์ € ์‹ ๊ฒฝ ๋ฐ ์šด๋™์žฌํ™œ ํ˜„์žฅ์—์„œ ์ง„๋™์ž๊ทน์˜ ์ค‘์žฌํšจ๊ณผ๋ฅผ ์กฐ์‚ฌํ•œ ์—ฐ๊ตฌ๋“ค์„ ๋ณด๋ฉด, ์ง„๋™์˜ ์ œ๊ณต ํ˜•ํƒœ์— ๋”ฐ๋ผ ์ „์‹ (whole body)์— ์ง„๋™์ž๊ทน์„ ์ œ๊ณตํ•˜๋Š” ๋ฐฉ์‹๊ณผ ๊ตญ์†Œ์ ์œผ๋กœ๋Š” ์‚ฌ์ง€์˜ ๊ทผ์œก๊ณผ ํž˜์ค„ ๋“ฑ์— ์ž๊ทน์„ ์ œ๊ณตํ•˜๋Š” ํ˜•ํƒœ๊ฐ€ ์žˆ๋‹ค[5,8,9]. ์ตœ๊ทผ์—๋Š” ์ง„๋™์˜ ๋ฐฉ์‹์„ ๊ธฐ๊ณ„์ ์ธ ์ŒํŒŒ์ง„๋™(mechanical acoustic vibration)์œผ๋กœ ๊ตฌํ˜„ํ•˜์—ฌ ์ง„ํญ์˜ ์ •ํ™•๋„๋ฅผ ๋†’์ด๋Š” ์—ฐ๊ตฌ๋ฅผ ์‹œํ–‰ํ•˜์˜€๋‹ค[10]. ์ง„๋™์ž๊ทน์„ ์ ์šฉ ๋ฐ›๋Š” ๋Œ€์ƒ์ž๋“ค์˜ ๊ฒฝ์šฐ, ์—ฐ๊ตฌ์˜ ์ƒ๋‹น ๋ถ€๋ถ„์ด ์ •์ƒ์ธ๊ณผ ๋…ธ์ธ์˜ ๊ทผ๋ ฅ๊ณผ ์‹ ์ฒด๋Šฅ๋ ฅ ํ–ฅ์ƒ์„ ์œ„ํ•ด ์ง„๋™์ž๊ทน์ด ์ œ๊ณต๋˜์—ˆ๋‹ค[11,12]. ์ค‘์ถ”์‹ ๊ฒฝ๊ณ„ ์งˆํ™˜ ํ™˜์ž๋“ค์˜ ์‹ ๊ฒฝ์žฌํ™œ์„ ์œ„ํ•ด ์ ์šฉ๋œ ์ง„๋™์ž๊ทน ์—ฐ๊ตฌ๋“ค์˜ ๊ฒฝ์šฐ, ์งˆํ™˜ ๊ตฐ์€ ๋‡Œ์กธ์ค‘, ์ฒ™์ˆ˜์†์ƒ, ๋‡Œ์„ฑ๋งˆ๋น„, ๋‹ค๋ฐœ์„ฑ ๊ฒฝํ™”์ฆ, ํŒŒํ‚จ์Šจ์”จ๋ณ‘ ๋“ฑ ๋‹ค์–‘ํ•˜์˜€๊ณ [13-16], ํ™˜์ž์—๊ฒŒ ๋ฏธ์น˜๋Š” ํšจ๊ณผ๋ฅผ ์ธก์ •ํ•˜๋Š” ์š”์ธ์œผ๋กœ๋Š” ์‹ ๊ฒฝ์˜ ๊ธฐ์งˆ์ ์ธ ๋ณ€ํ™”๋ฅผ ๊ด€์ฐฐํ•˜๊ฑฐ๋‚˜ ๋‹จํŽธ์ ์ธ ๊ทผ๋ ฅ์˜ ๋ณ€ํ™” ๋˜๋Š” ๋น„์ •์ƒ์ ์ธ ๊ทผ ๊ธด์žฅ๋„์˜ ๋ณ€ํ™”๋“ค๊ณผ ๋”๋ถˆ์–ด ์‹ ์ฒด์  ๊ธฐ๋Šฅ์˜ ๋ณ€ํ™”๋ฅผ ๊ด€์ฐฐํ•˜์˜€๋‹ค[6,8,17].
์ง„๋™์ž๊ทน์˜ ๊ธฐ๋Šฅ์ ์ธ ์‹คํšจ์„ฑ์„ ์•Œ์•„๋ณด๊ธฐ ์œ„ํ•ด์„œ๋Š” ์ง„๋™์ž๊ทน์„ ๋™์›ํ•œ ์ค‘์žฌ๊ฐ€ ์‹ค์ œ ํ™˜์ž์˜ ๊ธฐ๋Šฅ์— ์–ด๋– ํ•œ ์˜ํ–ฅ์„ ๋ฏธ์น˜๋Š”์ง€ ์‚ดํŽด๋ด์•ผ ํ•œ๋‹ค. ํŠนํžˆ ์ค‘์ถ”์‹ ๊ฒฝ๊ณ„ ์งˆํ™˜ ๋ฐœ๋ณ‘ ํ›„ ํ™˜์ž์˜ ์น˜๋ฃŒ ๋ชฉํ‘œ๊ฐ€ ๊ฐ€์ • ๋ฐ ์ง€์—ญ์‚ฌํšŒ๋กœ ๋ณต๊ท€์ธ ๋งŒํผ ์‹ ์ฒด์  ๊ธฐ๋Šฅ์˜ ํšŒ๋ณต์€ ํ™˜์ž๋“ค์˜ ์‚ถ์˜ ์งˆ์— ๋งค์šฐ ์ค‘์š”ํ•œ ์š”์ธ์ด๋‹ค. ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ์ค‘์ถ”์‹ ๊ฒฝ๊ณ„ ์งˆํ™˜ ํ™˜์ž์˜ ์ž„์ƒ ์žฌํ™œ ํ˜„์žฅ์—์„œ ์ง„๋™์ž๊ทน์˜ ์ค‘์žฌ ํšจ๊ณผ๋ฅผ ํ†ตํ•ฉ์ ์œผ๋กœ ์•Œ์•„๋ณด๊ธฐ ์œ„ํ•˜์—ฌ, ์ž„์ƒ์—์„œ ์ž˜ ํ†ต์ œ๋œ ๋ฌด์ž‘์œ„๋Œ€์กฐ์—ฐ๊ตฌ์— ๋Œ€ํ•œ ๋ฉ”ํƒ€๋ถ„์„์„ ์‹ค์‹œํ•˜์˜€๋‹ค. ํŠน๋ณ„ํžˆ ์ง€์—ญ์‚ฌํšŒ ์ฐธ์—ฌ์™€ ์ด๋™์— ์ง์ ‘์ ์ธ ์˜ํ–ฅ์„ ๋ฏธ์น˜๋Š” ์‹ ์ฒด์  ๊ธฐ๋Šฅ ์š”์†Œ์— ์ดˆ์ ์„ ๋งž์ถ”์—ˆ๊ณ , ๊ตญ์ œ ๊ธฐ๋Šฅยท์žฅ์• ยท๊ฑด๊ฐ• ๋ถ„๋ฅ˜์ฒด๊ณ„(International Classification of Functioning, Disability and Health, ICF)์˜ ์‹ ์ฒด ๊ธฐ๋Šฅ ๋ฐ ๊ตฌ์กฐ๋กœ ๋ถ„๋ฅ˜๋˜๋Š” โ€œ๊ท ํ˜• ๊ธฐ๋Šฅโ€๊ณผ ํ™œ๋™ ๋ฐ ์ฐธ์—ฌ๋กœ ๋ถ„๋ฅ˜๋˜๋Š” โ€œ์ƒยทํ•˜์ง€ ๊ธฐ๋Šฅ ๋ฐ ๋ณดํ–‰๊ธฐ๋Šฅโ€์— ๋ฏธ์น˜๋Š” ํšจ๊ณผ๋ฅผ ๋ถ„์„ํ•˜์˜€๋‹ค[18]. ๋ณธ ์—ฐ๊ตฌ์˜ ๋ชฉ์ ์€ ์ง„๋™์ž๊ทน์ด ์ค‘์ถ”์‹ ๊ฒฝ๊ณ„ ์งˆํ™˜ ํ™˜์ž์˜ ์‹ ์ฒด์  ๊ธฐ๋Šฅ ํŠนํžˆ ๊ท ํ˜• ๊ธฐ๋Šฅ๊ณผ ์ƒยทํ•˜์ง€ ๊ธฐ๋Šฅ ๋ฐ ๋ณดํ–‰๊ธฐ๋Šฅ ํšŒ๋ณต์— ๋ฏธ์น˜๋Š” ํšจ๊ณผ๋ฅผ ๋ฉ”ํƒ€๋ถ„์„์„ ํ†ตํ•˜์—ฌ ํ†ต๊ณ„์ ์œผ๋กœ ์•Œ์•„๋ณด๊ณ ์ž ํ•˜์˜€๋‹ค.

์—ฐ๊ตฌ ๋ฐฉ๋ฒ•

์—ฐ๊ตฌ ์„ค๊ณ„

๋ณธ ๋ฉ”ํƒ€๋ถ„์„์€ ์ค‘์ถ”์‹ ๊ฒฝ๊ณ„ ์งˆํ™˜ ํ™˜์ž๋ฅผ ๋Œ€์ƒ์œผ๋กœ ์ง„๋™์ž๊ทน ์ค‘์žฌ๋ฅผ ์ œ๊ณตํ•œ ๋ฌด์ž‘์œ„๋Œ€์กฐ ์ž„์ƒ์‹คํ—˜์—ฐ๊ตฌ๋ฅผ ๋Œ€์ƒ์œผ๋กœ ํ•˜์˜€๋‹ค. ๋…๋ฆฝ๋ณ€์ธ์€ ๋‹ค์–‘ํ•œ ์ข…๋ฅ˜์˜ ์ง„๋™์ž๊ทน ์ค‘์žฌ ์ •๋ณด๋ฅผ ์ถ”์ถœํ•˜์˜€๊ณ  ์ข…์†๋ณ€์ธ์€ ์‹ ์ฒด์ ์ธ ๊ธฐ๋Šฅ์„ ์ธก์ •ํ•œ ์ธก์ •์น˜๋งŒ ์ถ”์ถœํ•˜์˜€๋‹ค. ๊ฐ ์—ฐ๊ตฌ์˜ ์ข…์†๋ณ€์ธ์€ ๊ตญ์ œ ๊ธฐ๋Šฅยท์žฅ์• ยท๊ฑด๊ฐ• ๋ถ„๋ฅ˜์ฒด๊ณ„์˜ ๊ธฐ์ค€์— ๋”ฐ๋ผ โ€œ์‹ ์ฒด ๊ธฐ๋Šฅ ๋ฐ ๊ตฌ์กฐ: ๊ฐ๊ฐ ๊ธฐ๋Šฅโ€์œผ๋กœ ๋ถ„๋ฅ˜๋˜๋Š” โ€œ๊ท ํ˜• ๊ธฐ๋Šฅโ€๊ณผ โ€œํ™œ๋™๊ณผ ์ฐธ์—ฌโ€ ์˜์—ญ์œผ๋กœ ๋ถ„๋ฅ˜๋˜๋Š” โ€œ์ƒยทํ•˜์ง€ ๊ธฐ๋Šฅ ๋ฐ ๋ณดํ–‰ ๊ธฐ๋Šฅโ€์œผ๋กœ ๋‚˜๋ˆ„์–ด ๋ถ„์„ํ•˜์˜€๋‹ค.

๋ถ„์„๋Œ€์ƒ ๋ฐ ์ž๋ฃŒ์ˆ˜์ง‘

์—ฐ๊ตฌ๋Œ€์ƒ ์ž๋ฃŒ๋ฅผ ์ˆ˜์ง‘ํ•˜๊ธฐ ์œ„ํ•˜์—ฌ 2005๋…„ 1์›”๋ถ€ํ„ฐ 2017๋…„ 3์›”๊นŒ์ง€ ์˜์–ด๋กœ ๊ฒŒ์žฌ๋œ ๊ตญ์™ธ ์—ฐ๊ตฌ๋ฅผ ๋Œ€์ƒ์œผ๋กœ ํ•˜์˜€๋‹ค. ๋ฌธํ—Œ์„ ๊ฒ€์ƒ‰ํ•˜๊ธฐ ์œ„ํ•˜์—ฌ PubMed, CINAHL, MEDLINE๊ณผ ๊ฐ™์€ ๋ฐ์ดํ„ฐ๋ฒ ์ด์Šค ๊ฒ€์ƒ‰์—”์ง„์„ ์‚ฌ์šฉํ•˜์˜€๋‹ค. ๋ฌธํ—Œ ์ˆ˜์ง‘์„ ์œ„ํ•œ ๊ฒ€์ƒ‰ ์ „๋žต์€ ์˜ํ•™์ฃผ์ œ์šฉ์–ด(medical subject heading, MeSH)์™€ ์ฃผ์š” ๊ฐœ๋…์–ด๋ฅผ ์‚ฌ์šฉํ•˜์˜€๋‹ค. ํŠนํžˆ ์˜ํ•™์ฃผ์ œ์šฉ์–ด์˜ ์ค‘์ถ”์‹ ๊ฒฝ๊ณ„ ์งˆํ™˜์˜ ๋ฒ”์ฃผ์—์„œ ์˜๋ฃŒ์žฌํ™œ ํ˜„์žฅ์—์„œ ์ž์ฃผ ์ ‘ํ•˜๋Š” ์งˆํ™˜ ๊ตฐ์œผ๋กœ ๋‡Œ์กธ์ค‘, ์™ธ์ƒ์„ฑ๋‡Œ์†์ƒ, ์ฒ™์ˆ˜์†์ƒ, ๋‹ค๋ฐœ์„ฑ๊ฒฝํ™”์ฆ, ํŒŒํ‚จ์Šจ์”จ๋ณ‘์€ ์ง์ ‘์ ์ธ ์ง„๋‹จ๋ช…์„ ์‚ฌ์šฉํ•˜์˜€๋‹ค. ๊ฒ€์ƒ‰์„ ์œ„ํ•œ ์ฃผ์ œ์–ด ๋ฐ ์ „๋žต์€ [vibrat*] AND [rehabilit* OR therapy OR intervention] AND [stroke OR โ€œtraumatic brain injuryโ€ OR โ€œSpinal cord injuryโ€ OR โ€œmultiple sclerosisโ€ OR Parkinson* OR neuro* OR cereb*]๋ฅผ ์‚ฌ์šฉํ•˜์˜€๋‹ค. ๊ฒ€์ƒ‰๋˜๊ณ  ์ˆ˜์ง‘๋œ ์—ฐ๊ตฌ์— ๋Œ€ํ•œ ์„ ์ • ๊ณผ์ •์€ ๋‘ ๋ช…์˜ ์—ฐ๊ตฌ์ž๊ฐ€ ๋…๋ฆฝ์ ์œผ๋กœ ์ง„ํ–‰ํ•˜์˜€๊ณ  ๋ถˆ์ผ์น˜ํ•˜๋Š” ๋ถ€๋ถ„์€ ํ† ์˜๋ฅผ ํ†ตํ•ด ์„ ์ •ํ•˜์˜€๋‹ค. ๊ฒ€์ƒ‰ ๊ธฐ์ค€์— ๋ถ€ํ•ฉํ•˜์—ฌ ๋ถ„์„์„ ์‹ค์‹œํ•œ ์ตœ์ข…์ ์ธ ์—ฐ๊ตฌ๋Š” 10ํŽธ์ด์—ˆ๋‹ค(Figure 1).

๋Œ€์ƒ ๋…ผ๋ฌธ ์„ ์ • ๊ธฐ์ค€

์ตœ์ข…์ ์œผ๋กœ ๋ถ„์„ํ•˜๊ธฐ ์œ„ํ•œ ๋…ผ๋ฌธ์„ ์„ ์ •ํ•˜๊ธฐ ์œ„ํ•˜์—ฌ ๋‹ค์Œ๊ณผ ๊ฐ™์€ ๊ธฐ์ค€์„ ์ ์šฉํ•˜์˜€๋‹ค. (1) ์‹ ์ฒด์  ๊ธฐ๋Šฅ์„ ํ‘œ์ค€ํ™”๋œ ํ‰๊ฐ€๋„๊ตฌ๋กœ ์ธก์ •ํ•˜๊ณ  ๊ฒฐ๊ณผ๋ฅผ ํ•œ ๊ฐ€์ง€ ์ด์ƒ ๋ณด๊ณ ํ•œ ์—ฐ๊ตฌ, (2) ๋™๋ฌผ์—ฐ๊ตฌ, ์‚ฌ๋ก€์—ฐ๊ตฌ, ๋‹จ์ผ๋Œ€์ƒ์—ฐ๊ตฌ, ์ข…์„ค, ์ฒด๊ณ„์  ๋ฌธํ—Œ์—ฐ๊ตฌ๊ฐ€ ์•„๋‹Œ ์‹คํ—˜์—ฐ๊ตฌ, (3) ๋ฌด์ž‘์œ„ ๋Œ€์กฐ ์ž„์ƒ์‹คํ—˜ ์—ฐ๊ตฌ, (4) ํšจ๊ณผํฌ๊ธฐ ์‚ฐ์ถœ์„ ์œ„ํ•ด ํ‰๊ท , ํ‘œ์ค€ํŽธ์ฐจ, ๋Œ€์ƒ์ž ์ˆ˜๋ฅผ ์ œ์‹œํ•˜๋Š” ์—ฐ๊ตฌ, (5) ์˜์–ด๋กœ ์ถœํŒ๋œ ์—ฐ๊ตฌ, (6) ์ง„๋™์ž๊ทน์„ ์ฃผ๋œ ์ค‘์žฌ๋กœ ์‚ฌ์šฉํ•œ ์—ฐ๊ตฌ, (7) ๋Œ€์ƒ์ž๊ฐ€ ์ค‘์ถ”์‹ ๊ฒฝ๊ณ„ ์งˆํ™˜ ํ™˜์ž๋กœ ์‹คํ—˜๊ตฐ-๋Œ€์กฐ๊ตฐ์˜ ๋™์งˆ์„ฑ์ด ํ™•๋ณด๋œ ์—ฐ๊ตฌ, (8) PEDro score 6์  ์ด์ƒ์ธ ์—ฐ๊ตฌ๋ฅผ ์„ ์ •ํ•˜์˜€๋‹ค.

์งˆ์  ๋ฉ”ํƒ€๋ถ„์„ ๋ฐฉ๋ฒ•

๋Œ€์ƒ ๋…ผ๋ฌธ์˜ ์—ฐ๊ตฌ์˜ ์งˆ ํ‰๊ฐ€๋ฅผ ์œ„ํ•˜์—ฌ ๋‘ ๋ช…์˜ ์—ฐ๊ตฌ์ž๊ฐ€ PEDro scale์„ ์ง„ํ–‰ํ•˜์˜€๋‹ค. ๋‘ ๋ช…์˜ ์—ฐ๊ตฌ์ž์˜ ๋ถ„์„ ์ ์ˆ˜๊ฐ€ ์ผ์น˜ํ•˜์ง€ ์•Š์„ ๋•Œ๋Š” ํ† ์˜๋ฅผ ๊ฑฐ์ณ ์ตœ์ข…์ ์ธ PEDro score๋ฅผ ์‚ฐ์ถœํ•˜์˜€๋‹ค. PEDro scale์—์„œ๋Š” ๋…ผ๋ฌธ์˜ ๋‚ด๋ถ€ ํƒ€๋‹น๋„๋ฅผ ๋ถ„์„ํ•  ์ˆ˜ ์žˆ๋Š” 10๊ฐ€์ง€์˜ ํ‰๊ฐ€ ํ•ญ๋ชฉ์ด ์žˆ๊ณ  ์ ์ˆ˜์— ๋”ฐ๋ผ 1-10๋“ฑ๊ธ‰์œผ๋กœ ๋ถ„๋ฅ˜๋œ๋‹ค. ์ด๋•Œ โ€˜9-10๋“ฑ๊ธ‰โ€™์€ โ€˜๋งค์šฐ ์ข‹์Œโ€™, โ€˜6-8๋“ฑ๊ธ‰โ€™์€ โ€˜์ข‹์Œโ€™, โ€˜4-5๋“ฑ๊ธ‰โ€™์€ โ€˜๋ณดํ†ตโ€™, โ€˜3๋“ฑ๊ธ‰โ€™ ์ดํ•˜๋Š” โ€˜๋‚˜์จโ€™์œผ๋กœ ๋ถ„๋ฅ˜ํ•˜์˜€๋‹ค[19]. ๋ณธ ๋ฉ”ํƒ€๋ถ„์„์—์„œ๋Š” ์ตœ์ข…์ ์œผ๋กœ 6๋“ฑ๊ธ‰ ์ด์ƒ์ธ โ€˜์ข‹์Œโ€™๊ณผ โ€˜๋งค์šฐ ์ข‹์Œโ€™์œผ๋กœ ๋ถ„๋ฅ˜๋œ ์—ฐ๊ตฌ๋งŒ์„ ์„ ์ •ํ•˜์˜€๋‹ค.

๋ถ„์„ ๋Œ€์ƒ ์—ฐ๊ตฌ์˜ ์ผ๋ฐ˜์  ํŠน์ง•

๋ณธ ์—ฐ๊ตฌ์—์„œ ์ตœ์ข…์ ์œผ๋กœ ์„ ์ •๋˜๊ณ  ๋ถ„์„๋œ ๋…ผ๋ฌธ์€ 10ํŽธ์ด์—ˆ๋‹ค. ๋ถ„์„๋œ ์—ฐ๊ตฌ์— ์ฐธ์—ฌํ•œ ๋Œ€์ƒ์ž๋Š” ์ด 314๋ช…์ด์—ˆ๊ณ , ๋Œ€์ƒ์ž์˜ ์ง„๋‹จ์œผ๋กœ ๋ถ„๋ฅ˜ํ•˜์˜€์„ ๋•Œ ๋‡Œ์กธ์ค‘ 5ํŽธ, ๋‹ค๋ฐœ์„ฑ๊ฒฝํ™”์ฆ 3ํŽธ, ์ฒ™์ˆ˜์†์ƒ 1ํŽธ, ํŒŒํ‚จ์Šจ์”จ๋ณ‘ 1ํŽธ์ด์—ˆ๋‹ค. ์ค‘์žฌ๋กœ ์‚ฌ์šฉ๋œ ์ง„๋™์˜ ์ข…๋ฅ˜๋ณ„๋กœ ๋ถ„๋ฅ˜ํ•ด ๋ณด๋ฉด ์ „์‹ ์ง„๋™์ž๊ทน(whole body vibration, WBV)์ด 7ํŽธ์œผ๋กœ ๊ฐ€์žฅ ๋งŽ์•˜๊ณ  ์ƒยทํ•˜์ง€ ๊ตญ์†Œ์ง„๋™์ž๊ทน(focal vibration, FV)์ด 3ํŽธ์ด์—ˆ๋‹ค. ์ ์šฉ ๋ถ€์œ„ ๋ณ„๋กœ ๋ถ„๋ฅ˜ํ•ด ๋ณด๋ฉด ์ „์‹  ์ž๊ทน์ด 7ํŽธ, ์ƒ์ง€ ์ž๊ทน 1ํŽธ, ํ•˜์ง€ ์ž๊ทน 2ํŽธ์ด์—ˆ๋‹ค. ์ค‘์žฌ ๊ธฐ๊ฐ„์€ ๋‹จ๊ธฐ๊ฐ„ 1ํšŒ์„ฑ ์ž๊ทน์—์„œ ์ตœ๋Œ€ 8์ฃผ ๋™์•ˆ ์‹ค์‹œํ•˜์˜€๊ณ , ์ฃผ๋‹น 3ํšŒ์—์„œ 7ํšŒ๊นŒ์ง€ ์‹ค์‹œํ•˜์˜€๋‹ค. ํšŒ๊ธฐ ๋‹น ์ž๊ทน ์ œ๊ณต ์‹œ๊ฐ„์€ ์—ฐ๊ตฌ๋ณ„๋กœ ํŽธ์ฐจ๊ฐ€ ํฐ๋ฐ ์งง๊ฒŒ๋Š” 45์ดˆ์”ฉ 4๋ฒˆ ์ œ๊ณตํ•˜๋Š” ๋ฐฉ์‹์—์„œ ๊ธธ๊ฒŒ๋Š” 4์‹œ๊ฐ„ ๋™์•ˆ ์ž๊ทน์„ ์ œ๊ณตํ•˜์˜€๋‹ค. ํšจ๊ณผํฌ๊ธฐ๋ฅผ ์‚ฐ์ถœํ•˜๊ธฐ ์œ„ํ•œ ์‹ ์ฒด์  ๊ธฐ๋Šฅ ๊ฒ€์‚ฌ ์ธก์ •์น˜์˜ ์ข…๋ฅ˜ ๋ณ„๋กœ ๋ถ„๋ฅ˜ํ•ด ๋ณด๋ฉด ๊ท ํ˜•๊ธฐ๋Šฅ ๊ฒ€์‚ฌ 4ํŽธ, ์ƒ์ง€๊ธฐ๋Šฅ ๊ฒ€์‚ฌ 1ํŽธ, ํ•˜์ง€๊ธฐ๋Šฅ ๊ฒ€์‚ฌ 2ํŽธ, ์ƒ์ง€์™€ ํ•˜์ง€ ํ†ตํ•ฉ๊ฒ€์‚ฌ 1ํŽธ, ๋ณดํ–‰๊ธฐ๋Šฅ ๊ฒ€์‚ฌ๊ฐ€ 7ํŽธ์ด์—ˆ๋‹ค. ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ๊ตญ์ œ ๊ธฐ๋Šฅยท์žฅ์• ยท๊ฑด๊ฐ• ๋ถ„๋ฅ˜์ฒด๊ณ„์— ๊ทผ๊ฑฐํ•˜์—ฌ ๊ท ํ˜•๊ธฐ๋Šฅ ์ธก์ •์น˜ 4ํŽธ, ์ƒยทํ•˜์ง€ ๊ธฐ๋Šฅ ๋ฐ ๋ณดํ–‰๊ธฐ๋Šฅ ์ธก์ •์น˜ 10ํŽธ์„ ๋ถ„๋ฅ˜ํ•˜์—ฌ ๋ถ„์„ํ•˜์˜€๋‹ค. ํ•œ ์—ฐ๊ตฌ์—์„œ ๊ท ํ˜•๊ธฐ๋Šฅ๊ณผ ์ƒยทํ•˜์ง€ ๊ธฐ๋Šฅ ๊ฒ€์‚ฌ๋ฅผ ๋™์‹œ์— ์ ์šฉํ•˜์˜€์„ ๊ฒฝ์šฐ์—๋Š” ์ค‘๋ณตํ•˜์—ฌ ์—ฐ๊ตฌ์˜ ํŽธ์ˆ˜๋ฅผ ์ œ์‹œํ•˜์˜€๋‹ค. ๋ถ„์„๋œ ๋ชจ๋“  ๋…ผ๋ฌธ์€ ๋ฌด์ž‘์œ„ ๋Œ€์กฐ ์ž„์ƒ์‹คํ—˜์„ค๊ณ„ ์—ฐ๊ตฌ์˜€๊ณ , PEDro score์— ๋”ฐ๋ฅธ ์งˆ์  ์ˆ˜์ค€์œผ๋กœ ๋ถ„๋ฅ˜ํ•ด ๋ณด๋ฉด 6์  ์—ฐ๊ตฌ 1ํŽธ, 7์  ์—ฐ๊ตฌ 4ํŽธ, 8์  ์—ฐ๊ตฌ 4ํŽธ, 9์  ์—ฐ๊ตฌ 1ํŽธ์ด์—ˆ๋‹ค(Table 1).

๊ณ„๋Ÿ‰์  ๋ฉ”ํƒ€๋ถ„์„ ๋ฐฉ๋ฒ•

๋ถ„์„ ๋Œ€์ƒ์œผ๋กœ ์„ ์ •๋œ ๋…ผ๋ฌธ์˜ ํ†ตํ•ฉ์  ํšจ๊ณผํฌ๊ธฐ์™€ ํ†ต๊ณ„์  ๋™์งˆ์„ฑ, ์ถœํŒ ํŽธ์˜ ๊ฒ€์ •์„ ์œ„ํ•ด ๊ณ„๋Ÿ‰์  ๋ฉ”ํƒ€๋ถ„์„์„ ์‹ค์‹œํ•˜์˜€๋‹ค. ๋ถ„์„์„ ์œ„ํ•ด Comprehensive Meta-Analysis 3.0 ํ”„๋กœ๊ทธ๋žจ์„ ์‚ฌ์šฉํ•˜์˜€๋‹ค.
ํšจ๊ณผํฌ๊ธฐ์˜ ๋™์งˆ์„ฑ ๊ฒ€์ •์„ ์œ„ํ•˜์—ฌ Q ํ†ต๊ณ„๋Ÿ‰์„ ์‚ฌ์šฉํ•˜์˜€๋‹ค. Q ํ†ต๊ณ„๋Ÿ‰์˜ p ๊ฐ’์ด 0.1๋ณด๋‹ค ํฌ๋ฉด ์—ฐ๊ตฌ๋“ค ๊ฐ„์˜ ํšจ๊ณผํฌ๊ธฐ์˜ ์ด์งˆ์„ฑ์ด ์ ๋‹ค๊ณ  ํŒ๋‹จํ•˜์˜€๋‹ค[20]. ๊ทธ๋Ÿฌ๋‚˜ Q ํ†ต๊ณ„๋Ÿ‰์œผ๋กœ ์—ฐ๊ตฌ๋“ค ๊ฐ„์˜ ์ด์งˆ์„ฑ์„ ํŒ๋‹จํ•˜์—ฌ ํšจ๊ณผ๋ชจํ˜•์„ ๊ฒฐ์ •ํ•˜๋Š” ๊ฒƒ์€ ํ†ต๊ณ„์  ๊ทผ๊ฑฐ์˜ ํ•œ๊ณ„๊ฐ€ ์žˆ๋‹ค. ํšจ๊ณผ๋ชจํ˜•์˜ ์„ ํƒ์€ ํ†ต๊ณ„์  ๊ฒ€์ฆ์— ๊ทผ๊ฑฐ๋ฅผ ๋‘๊ธฐ๋ณด๋‹ค ์—ฐ๊ตฌ์ž๊ฐ€ ์—ฐ๊ตฌ์˜ ๋Œ€์ƒ์ž, ์ค‘์žฌ ๋ฐ ๊ฐœ์ž…๋ฐฉ๋ฒ• ๋“ฑ์„ ๊ณ ๋ คํ•˜์—ฌ, ์—ฐ๊ตฌ ๊ฐ„ ๋ชจ์ง‘๋‹จ ํšจ๊ณผํฌ๊ธฐ์˜ ์œ ์‚ฌ์„ฑ์„ ํŒ๋‹จํ•˜์—ฌ์•ผ ํ•œ๋‹ค[21]. ๊ทธ๋Ÿฌ๋ฏ€๋กœ ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” Q ํ†ต๊ณ„๋Ÿ‰์„ ํ†ตํ•ด ํšจ๊ณผํฌ๊ธฐ์˜ ์ด์งˆ์„ฑ์„ ํŒ๋‹จํ•˜๊ณ  ํšจ๊ณผ๋ชจํ˜• ์„ ํƒ์€ ์—ฐ๊ตฌ์ž๊ฐ€ ๋ถ„์„ ๋Œ€์ƒ์ด ๋˜๋Š” ์—ฐ๊ตฌ๋“ค์˜ ์—ฐ๊ตฌ ์„ค๊ณ„, ์—ฐ๊ตฌ๋Œ€์ƒ, ์ค‘์žฌ ๋ฐ ๊ฐœ์ž…๋ฐฉ๋ฒ•, ๋ณ€์ธ ์ธก์ •์˜ ์ฐจ์ด ๋“ฑ์„ ๊ณ ๋ คํ•˜์—ฌ ๊ณ ์ •ํšจ๊ณผ๋ชจํ˜•(fixed effect model) ๋˜๋Š” ๋žœ๋คํšจ๊ณผ๋ชจํ˜•(random effect model)์œผ๋กœ ์„ ํƒํ•˜์˜€๋‹ค.
๋ถ„์„ ๋…ผ๋ฌธ๋“ค์˜ ํ†ตํ•ฉ์  ํšจ๊ณผํฌ๊ธฐ ์‚ฐ์ถœ์„ ์œ„ํ•ด์„œ๋Š” ์—ฐ๊ตฌ์˜ ์‹คํ—˜ ๋Œ€์ƒ์ž ์ˆ˜, ์ง‘๋‹จ์˜ ํ‰๊ท , ํ‘œ์ค€ํŽธ์ฐจ, t ๊ฐ’, p ๊ฐ’ ๋“ฑ์„ ์‚ฌ์šฉํ•˜์˜€๋‹ค. ํšจ๊ณผํฌ๊ธฐ๋ฅผ ์‚ฐ์ถœํ•  ์ข…์†๋ณ€์ธ์€ ํ†ตํ•ฉ๋œ ์‹ ์ฒด์  ๊ธฐ๋Šฅ ํšจ๊ณผํฌ๊ธฐ์™€ ๊ตญ์ œ ๊ธฐ๋Šฅยท์žฅ์• ยท๊ฑด๊ฐ• ๋ถ„๋ฅ˜์ฒด๊ณ„์˜ โ€˜์‹ ์ฒด๊ธฐ๋Šฅ ๋ฐ ๊ตฌ์กฐ: ๊ฐ๊ฐ ๊ธฐ๋Šฅโ€™์œผ๋กœ ๋ถ„๋ฅ˜๋˜๋Š” โ€˜๊ท ํ˜•๊ธฐ๋Šฅโ€™์˜ ํšจ๊ณผํฌ๊ธฐ, โ€˜ํ™œ๋™ ๋ฐ ์ฐธ์—ฌโ€™๋กœ ๋ถ„๋ฅ˜๋˜๋Š” โ€˜์ƒํ•˜์ง€ ๊ธฐ๋Šฅ ๋ฐ ๋ณดํ–‰๊ธฐ๋Šฅโ€™์˜ ํšจ๊ณผํฌ๊ธฐ๋กœ ์‚ฐ์ถœํ•˜์—ฌ ๋ถ„์„ํ•˜์˜€๋‹ค. ํšจ๊ณผํฌ๊ธฐ๋Š” Cohen [22]์ด ์ œ์‹œํ•œ ๊ธฐ์ค€์— ๋”ฐ๋ผ ํšจ๊ณผํฌ๊ธฐ ๊ฐ’์ด 0.2 ์ดํ•˜์ผ ๊ฒฝ์šฐ ์ž‘์€ ํšจ๊ณผํฌ๊ธฐ, 0.5์ผ ๊ฒฝ์šฐ ์ค‘๊ฐ„ ์ •๋„์˜ ํšจ๊ณผํฌ๊ธฐ, 0.8 ์ด์ƒ์ผ ๋•Œ๋Š” ํฐ ํšจ๊ณผํฌ๊ธฐ๋กœ ํ•ด์„ํ•˜์˜€๋‹ค. ์‚ฐ์ถœ๋œ ํšจ๊ณผํฌ๊ธฐ๋Š” ์ˆฒ ๊ทธ๋ฆผ(forest plot)์„ ํ†ตํ•ด ๊ฒฐํ•ฉ ์ถ”์ •์น˜์™€ ์‹ ๋ขฐ๊ตฌ๊ฐ„์„ ์‹œ๊ฐํ™”ํ•˜์˜€๋‹ค.
์ถœํŒ ํŽธ์˜ ๊ฒ€์ •์„ ์œ„ํ•ด์„œ๋Š” ๊น”๋•Œ๊ธฐ ์ ๋„ํ‘œ๋ฒ•(funnel plot)๊ณผ Fail-safe number ๊ฐ’์„ ํ™œ์šฉํ•˜์˜€๋‹ค. ๊น”๋•Œ๊ธฐ ์ ๋„ํ‘œ๋ฒ•์€ ํšจ๊ณผํฌ๊ธฐ๋ฅผ ์ค‘์‹ฌ์œผ๋กœ ์ ๋“ค์ด ์–‘์ธก์— ๋Œ€์นญ์ ์œผ๋กœ ๊ท ๋“ฑํ•˜๊ฒŒ ๋ถ„ํฌํ•˜๋Š”์ง€๋ฅผ ์กฐ์‚ฌํ•˜์˜€๊ณ , Failsafe number ๊ฐ’์€ number ๊ฐ’์ด ์ž‘๊ณ  p ๊ฐ’์ด 0.05๋ณด๋‹ค ํฌ๋ฉด ์ถœํŒ ํŽธ์˜๊ฐ€ ์กด์žฌํ•˜๋Š” ๊ฒƒ์œผ๋กœ ํ•ด์„ํ•˜์˜€๋‹ค[23].

์—ฐ๊ตฌ ๊ฒฐ๊ณผ

๊ณ„๋Ÿ‰์  ๋ฉ”ํƒ€๋ถ„์„ ๊ฒฐ๊ณผ

ํ†ต๊ณ„์  ๋™์งˆ์„ฑ ๊ฒ€์ •

๋ถ„์„ ๋…ผ๋ฌธ๋“ค์˜ ๋™์งˆ์„ฑ ๊ฒ€์ •์„ ์œ„ํ•˜์—ฌ Q ํ†ต๊ณ„๋Ÿ‰์„ ์ œ์‹œํ•˜์˜€๋‹ค. ํ†ตํ•ฉ์  ํšจ๊ณผํฌ๊ธฐ์— ๋Œ€ํ•œ Q ๊ฐ’์€ 8.887 (df=9, p = 0.448)์ด์—ˆ๊ณ , ๊ท ํ˜•๊ธฐ๋Šฅ ๋ถ„๋ฅ˜ ํšจ๊ณผํฌ๊ธฐ์— ๋Œ€ํ•œ Q ๊ฐ’์€ 0.862 (df=3, p = 0.835), ์ƒยทํ•˜์ง€ ๊ธฐ๋Šฅ ๋ฐ ๋ณดํ–‰๊ธฐ๋Šฅ ๋ถ„๋ฅ˜ ํšจ๊ณผํฌ๊ธฐ์— ๋Œ€ํ•œ Q ๊ฐ’์€ 7.628 (df=9, p = 0.572)๋กœ ์ „๋ฐ˜์ ์ธ ๋ถ„์„ ๋…ผ๋ฌธ์˜ ํšจ๊ณผํฌ๊ธฐ ์ด์งˆ์„ฑ์€ ๋‚ฎ์€ ์ˆ˜์ค€์ด์—ˆ๋‹ค. ํšจ๊ณผ๋ชจํ˜•์˜ ์„ ํƒ์„ ์œ„ํ•˜์—ฌ Q ํ†ต๊ณ„๋Ÿ‰์— ์˜ํ•œ ํšจ๊ณผํฌ๊ธฐ์˜ ์ด์งˆ์„ฑ์€ ๋‚ฎ๊ฒŒ ๋‚˜ํƒ€๋‚˜์ง€๋งŒ, ๋ถ„์„๋œ ๋…ผ๋ฌธ์˜ ์—ฐ๊ตฌ ์„ค๊ณ„์™€ ์‹คํ—˜ ๋Œ€์ƒ์ž๋“ค์˜ ๋™์งˆ์„ฑ์„ ๋‹ด๋ณดํ•  ์ˆ˜ ์—†๊ณ  ํšจ๊ณผ์˜ ์ธก์ • ๋˜ํ•œ ์ ์ˆ˜ ์ฒ™๋„์™€ ์‹œ๊ฐ„ ๋ฐ ๊ฑฐ๋ฆฌ ์ธก์ •์ด ํ˜ผ์žฌ๋˜์–ด ์žˆ์œผ๋ฏ€๋กœ ๋žœ๋คํšจ๊ณผ๋ชจํ˜•์„ ์„ ํƒํ•˜์˜€๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ T2 ์˜ ๊ฐ’์ด 0์ด๋ฏ€๋กœ ๊ณ ์ •ํšจ๊ณผ๋ชจํ˜•๊ณผ ๋žœ๋คํšจ๊ณผ๋ชจํ˜•์˜ ํšจ๊ณผํฌ๊ธฐ๋Š” ๋™์ผํ•˜์˜€๋‹ค(Table 2).

ํ†ตํ•ฉ๋œ ์‹ ์ฒด์  ๊ธฐ๋Šฅ์— ๋ฏธ์น˜๋Š” ์ง„๋™์ž๊ทน ํšจ๊ณผ

์ง„๋™์ž๊ทน์˜ ํ†ตํ•ฉ๋œ ํšจ๊ณผ ๋ถ„์„์€ ์ตœ์ข… ์„ ํƒ๋œ ์—ฐ๊ตฌ 10ํŽธ์—์„œ ์ธก์ •๋œ ๊ท ํ˜•๊ธฐ๋Šฅ๊ณผ ์ƒยทํ•˜์ง€ ๊ธฐ๋Šฅ ๋ฐ ๋ณดํ–‰๊ธฐ๋Šฅ์„ ํ†ตํ•ฉํ•˜์—ฌ ๋ถ„์„ํ•œ ๊ฒƒ์ด๋‹ค. ์ง„๋™์ž๊ทน์˜ ํ†ตํ•ฉ๋œ ํšจ๊ณผ๋ฅผ ๋ถ„์„ํ•˜๊ธฐ ์œ„ํ•œ ์—ฐ๊ตฌ์˜ ๋Œ€์ƒ์ž๋Š” ์‹คํ—˜๊ตฐ์ด 161๋ช…, ๋Œ€์กฐ๊ตฐ์ด 153๋ช…์œผ๋กœ ์ง‘๊ณ„๋˜์—ˆ๊ณ  ํ†ตํ•ฉ๋œ ํšจ๊ณผํฌ๊ธฐ๋Š” 0.356 (์‹ ๋ขฐ๋„ 95%, ์‹ ๋ขฐ๊ตฌ๊ฐ„ 0.171-0.540, p <0.05)์œผ๋กœ ํ†ต๊ณ„์ ์œผ๋กœ ์œ ์˜ํ•œ ์ฐจ์ด๋ฅผ ๋ณด์˜€์œผ๋ฉฐ, โ€˜์ค‘๊ฐ„ ํšจ๊ณผํฌ๊ธฐโ€™๋กœ ํ•ด์„๋  ์ˆ˜ ์žˆ๋‹ค(Figure 2).

๊ท ํ˜•๊ธฐ๋Šฅ์— ๋ฏธ์น˜๋Š” ์ง„๋™์ž๊ทน ํšจ๊ณผ

์ง„๋™์ž๊ทน์ด ๊ท ํ˜•๊ธฐ๋Šฅ์— ๋ฏธ์น˜๋Š” ํšจ๊ณผ๋ฅผ ๋ถ„์„ํ•˜๊ธฐ ์œ„ํ•œ ์—ฐ๊ตฌ์˜ ๋Œ€์ƒ์ž๋Š” ์‹คํ—˜๊ตฐ์ด 77๋ช…, ๋Œ€์กฐ๊ตฐ์ด 73๋ช…์ด์—ˆ๊ณ  ํšจ๊ณผํฌ๊ธฐ๋Š” 0.223 (์‹ ๋ขฐ๋„ 95%, ์‹ ๋ขฐ๊ตฌ๊ฐ„ โ€“0.099-0.545, p >0.05)์œผ๋กœ ํ†ต๊ณ„์ ์œผ๋กœ ์œ ์˜๋ฏธํ•˜์ง€ ์•Š์•˜์œผ๋ฉฐ, โ€˜์ž‘์€ ํšจ๊ณผํฌ๊ธฐโ€™๋กœ ํ•ด์„๋  ์ˆ˜ ์žˆ๋‹ค(Figure 3).

์ƒ ยทํ•˜์ง€ ๊ธฐ๋Šฅ ๋ฐ ๋ณดํ–‰๊ธฐ๋Šฅ์— ๋ฏธ์น˜๋Š” ์ง„๋™์ž๊ทน ํšจ๊ณผ

์ƒยทํ•˜์ง€ ๊ธฐ๋Šฅ ๋ฐ ๋ณดํ–‰ ๊ธฐ๋Šฅ์€ ์„ ํƒ๋œ 10ํŽธ์˜ ๋ชจ๋“  ์—ฐ๊ตฌ์—์„œ ์ธก์ •๋˜์—ˆ๋‹ค. ์ง„๋™์ž๊ทน์ด ์ƒยทํ•˜์ง€ ๊ธฐ๋Šฅ ๋ฐ ๋ณดํ–‰์— ๋ฏธ์น˜๋Š” ํšจ๊ณผ๋ฅผ ๋ถ„์„ํ•˜๊ธฐ ์œ„ํ•œ ์—ฐ๊ตฌ์˜ ๋Œ€์ƒ์ž๋Š” ์‹คํ—˜๊ตฐ์ด 161๋ช…, ๋Œ€์กฐ๊ตฐ์ด 153๋ช…์ด์—ˆ๊ณ  ํšจ๊ณผํฌ๊ธฐ๋Š” 0.421 (์‹ ๋ขฐ๋„ 95%, ์‹ ๋ขฐ๊ตฌ๊ฐ„ 0.196-0.646, p <0.05)๋กœ ํ†ต๊ณ„์ ์œผ๋กœ ์œ ์˜ํ•œ ์ฐจ์ด๋ฅผ ๋ณด์˜€์œผ๋ฉฐ, โ€˜์ค‘๊ฐ„ ํšจ๊ณผํฌ๊ธฐโ€™๋กœ ํ•ด์„๋  ์ˆ˜ ์žˆ๋‹ค(Figure 4).

์ถœํŒ ํŽธ์˜ ๊ฒ€์ •

์ถœํŒ ํŽธ์˜ ๊ฒ€์ •์€ ๊น”๋•Œ๊ธฐ ์ ๋„ํ‘œ๋ฒ•์„ ์‚ฌ์šฉํ•˜์˜€๋‹ค. ์ง„๋™์ž๊ทน์˜ ํ†ตํ•ฉ๋œ ํšจ๊ณผํฌ๊ธฐ๋ฅผ ๋ถ„์„ํ•˜๊ธฐ ์œ„ํ•œ ์—ฐ๊ตฌ๋“ค์—์„œ๋Š” ๊น”๋•Œ๊ธฐ ์ ๋„ํ‘œ์—์„œ 10๊ฐœ์˜ ๋ชจ๋“  ์—ฐ๊ตฌ๊ฐ€ ์˜์—ญ ์•ˆ์— ๋ถ„ํฌํ•˜๊ณ , ๊ฐ’๋“ค์ด ์ขŒ ยท์šฐ ๋Œ€์นญ์ ์ธ ๋ถ„ํฌ๋ฅผ ๋ณด์˜€๋‹ค. Fail-safe number ๊ฐ’์€ 32 (p <0.05)๋กœ ์ถœํŒ ํŽธ์˜๊ฐ€ ์กด์žฌํ•˜์ง€ ์•Š๋Š” ๊ฒƒ์œผ๋กœ ํ•ด์„๋  ์ˆ˜ ์žˆ๋‹ค. ๊ท ํ˜•๊ธฐ๋Šฅ์— ๋Œ€ํ•œ ํšจ๊ณผํฌ๊ธฐ๋ฅผ ๋ถ„์„ํ•˜๊ธฐ ์œ„ํ•œ ์—ฐ๊ตฌ๋“ค์—์„œ๋Š” 4๊ฐœ์˜ ์—ฐ๊ตฌ๊ฐ€ ๊น”๋•Œ๊ธฐ ์ ๋„ํ‘œ์˜ ์˜์—ญ ์•ˆ์— ๋ถ„ํฌํ•˜๋‚˜ ๋Œ€์นญ์ ์ด์ง€ ์•Š๊ณ , Fail-safe number ๊ฐ’์€ 0 (p >0.05)์œผ๋กœ ์ถœํŒ ํŽธ์˜๊ฐ€ ์กด์žฌํ•˜๋Š” ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ์ƒยทํ•˜์ง€ ๊ธฐ๋Šฅ ๋ฐ ๋ณดํ–‰๊ธฐ๋Šฅ์— ๋Œ€ํ•œ ํšจ๊ณผํฌ๊ธฐ๋ฅผ ๋ถ„์„ํ•œ ์—ฐ๊ตฌ๋“ค์—์„œ๋Š” 10๊ฐœ์˜ ์—ฐ๊ตฌ๊ฐ€ ๊น”๋•Œ๊ธฐ ์ ๋„ํ‘œ์˜ ์˜์—ญ ์•ˆ์— ๋ชจ๋‘ ๋ถ„ํฌํ•˜์˜€๊ณ , ๊ฐ’๋“ค์ด ๋Œ€์นญ์ ์ด์—ˆ์œผ๋ฉฐ Fail-safe number ๊ฐ’์€ 27 (p <0.05)๋กœ ์ถœํŒ ํŽธ์˜๊ฐ€ ์กด์žฌํ•˜์ง€ ์•Š๋Š” ๊ฒƒ์œผ๋กœ ํ•ด์„๋  ์ˆ˜ ์žˆ๋‹ค(Figure 5).

๊ณ  ์ฐฐ

๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ์ง„๋™์ž๊ทน์ด ์ค‘์ถ”์‹ ๊ฒฝ๊ณ„ ์งˆํ™˜ ํ™˜์ž๋“ค์˜ ์‹ ์ฒด์  ๊ธฐ๋ŠฅํšŒ๋ณต์— ๋ฏธ์น˜๋Š” ํšจ๊ณผ๋ฅผ ์•Œ์•„๋ณด๊ธฐ ์œ„ํ•ด ๋ฌด์ž‘์œ„ ๋Œ€์กฐ ์ž„์ƒ์‹คํ—˜ ์—ฐ๊ตฌ 10ํŽธ์„ ์„ ์ •ํ•˜์—ฌ ๋ฉ”ํƒ€๋ถ„์„์„ ์‹ค์‹œํ•˜์˜€๋‹ค. ์ง„๋™์ž๊ทน ์ค‘์žฌ์˜ ํšจ๊ณผํฌ๊ธฐ๋ฅผ ์•Œ์•„๋ณด๊ธฐ ์œ„ํ•˜์—ฌ, ํ™˜์ž์˜ ํ™œ๋™๊ณผ ์ฐธ์—ฌ์— ์ดˆ์ ์„ ๋‘์–ด ๊ตญ์ œ ๊ธฐ๋Šฅยท์žฅ์• ยท๊ฑด๊ฐ• ๋ถ„๋ฅ˜์ฒด๊ณ„ ๊ธฐ์ค€์— ๋”ฐ๋ผ ์ข…์†๋ณ€์ธ์„ โ€œ๊ท ํ˜•๊ธฐ๋Šฅโ€๊ณผ โ€œ์ƒยทํ•˜์ง€ ๊ธฐ๋Šฅ ๋ฐ ๋ณดํ–‰๊ธฐ๋Šฅโ€์œผ๋กœ ๋ถ„๋ฅ˜ํ•˜์—ฌ ๋ถ„์„ํ•˜์˜€๋‹ค.
์„ ์ •๋œ ์—ฐ๊ตฌ์˜ ๋ถ„์„ ๊ฒฐ๊ณผ, ์ง„๋™์ž๊ทน ์ค‘์žฌ์— ๋Œ€ํ•œ ํ†ตํ•ฉ ํšจ๊ณผ๋Š” 0.356์œผ๋กœ โ€˜์ค‘๊ฐ„ ํšจ๊ณผํฌ๊ธฐโ€™์˜ ๋ฒ”์ฃผ์˜€๋‹ค. ์ค‘์ถ”์‹ ๊ฒฝ๊ณ„ ์งˆํ™˜ ํ™˜์ž๋“ค์˜ ์žฌํ™œ ํ˜„์žฅ์—์„œ ํšจ๊ณผ ์žˆ๋Š” ์ค‘์žฌ์˜ ๊ทผ๊ฑฐ๋กœ ๋ณด๊ธฐ์—๋Š” ๋‹ค์†Œ ๋‚ฎ์€ ์ˆ˜์ค€์ด๋‹ค. ์ด๋Ÿฌํ•œ ๋ถ„์„ ๊ฒฐ๊ณผ๊ฐ€ ๋‚˜์˜จ ์›์ธ์„ ๊ณ ์ฐฐํ•ด ๋ณด๋ฉด, ๋จผ์ € ๋ถ„์„๋œ ์—ฐ๊ตฌ์˜ ์‹คํ—˜๊ตฐ๊ณผ ๋Œ€์กฐ๊ตฐ์— ์ ์šฉํ•œ ์ค‘์žฌ์˜ ํ˜•ํƒœ์—์„œ ์ฐพ์„ ์ˆ˜ ์žˆ๋‹ค. ๋Œ€๋ถ€๋ถ„์˜ ์—ฐ๊ตฌ์—์„œ ์‹คํ—˜๊ตฐ์—๋Š” ์ง„๋™์ž๊ทน์„ ์ ์šฉํ•˜์˜€๊ณ  ๋Œ€์กฐ๊ตฐ์—๋Š” ๋™์ผํ•œ ํ˜•ํƒœ์˜ ๊ฐ€์งœ(sham) ์ž๊ทน์„ ์ œ๊ณตํ•˜๊ฑฐ๋‚˜ ๋‹ค๋ฅธ ์ข…๋ฅ˜์˜ ์ค‘์žฌ๋ฅผ ์ œ๊ณตํ•˜์˜€๋‹ค. ๋ถ„์„๋œ ์—ฐ๊ตฌ์—์„œ ๋Œ€์กฐ๊ตฐ์— ๊ฐ€์งœ ์ž๊ทน ๋˜๋Š” ์ž๊ทน์„ ์ œ๊ณตํ•˜์ง€ ์•Š์€ ๊ฒฝ์šฐ ์ง„๋™์ž๊ทน์˜ ํšจ๊ณผ๋Š” โ€˜์ค‘๊ฐ„ ํšจ๊ณผํฌ๊ธฐโ€™ ์ด์ƒ์„ ๋‚˜ํƒ€๋‚ด์—ˆ๋‹ค[24-28]. ๊ทธ๋Ÿฌ๋‚˜ ๋Œ€์กฐ๊ตฐ์— ๋‹ค๋ฅธ ํ˜•ํƒœ์˜ ์ค‘์žฌ(์˜ˆ, ์ „๊ธฐ์น˜๋ฃŒ, ์Œ์•… ์šด๋™ ํ›ˆ๋ จ, ๊ฐ€๋ฒผ์šด ์‹ธ์ดํด ๋“ฑ)๋ฅผ ์ œ๊ณตํ•œ ๊ฒฝ์šฐ ์ง„๋™์ž๊ทน ์ ์šฉ ํšจ๊ณผ๋Š” โ€˜์ž‘์€ ํšจ๊ณผํฌ๊ธฐโ€™๋ฅผ ๋‚˜ํƒ€๋‚ด์—ˆ๋‹ค[29-32]. ์ด์™€ ๊ฐ™์€ ๊ฒฐ๊ณผ๋ฅผ ํ† ๋Œ€๋กœ, ์ง„๋™์ž๊ทน์ด ๋‹จ๋…์ ์ธ ์ค‘์žฌ๋กœ ์ œ๊ณต ๋˜๊ฑฐ๋‚˜ ๊ธฐ์กด์˜ ์šด๋™์„ฑ ์ค‘์žฌ์— ์ถ”๊ฐ€๋กœ ์ ์šฉ๋˜์—ˆ์„ ๊ฒฝ์šฐ ํšจ๊ณผ๋ฅผ ๊ธฐ๋Œ€ํ•  ์ˆ˜ ์žˆ์œผ๋‚˜ ๋‹ค๋ฅธ ์ข…๋ฅ˜์˜ ์ธ์œ„์  ์ž๊ทน(์˜ˆ, ์ „๊ธฐ์ž๊ทน, ์Œ์•…์†Œ๋ฆฌ ์ž๊ทน ๋“ฑ)๊ณผ ๋™์‹œ์— ์ œ๊ณต๋˜์—ˆ์„ ๊ฒฝ์šฐ ์ง„๋™์ž๊ทน์ด ์šฐ์›”ํ•œ ์น˜๋ฃŒ ํšจ๊ณผ๊ฐ€ ์žˆ๋‹ค๊ณ  ๋ณผ ์ˆ˜๋Š” ์—†์„ ๊ฒƒ์ด๋‹ค. ๋‘ ๋ฒˆ์งธ๋Š” ํšจ๊ณผ ์ธก์ •์„ ์œ„ํ•ด ์‚ฌ์šฉํ•œ ๊ธฐ๋Šฅ ํ‰๊ฐ€์ฒ™๋„๊ฐ€ ๋Œ€์กฐ๊ตฐ์˜ ์ค‘์žฌ ์ „-ํ›„ ๋ฐ˜๋ณต ์ธก์ • ๊ณผ์ •์—์„œ ํ•™์Šตํšจ๊ณผ(practice effect)์™€ ๊ฐ™์€ ํŽธํ–ฅ์ด ์กด์žฌํ–ˆ์„ ๊ฐ€๋Šฅ์„ฑ์„ ๋ฐฐ์ œํ•  ์ˆ˜ ์—†๋‹ค[29]. ๋งˆ์ง€๋ง‰์œผ๋กœ ํšจ๊ณผํฌ๊ธฐ๋ฅผ ๋ถ„์„ํ•˜๋Š” ๊ธฐ๋Šฅ ํ‰๊ฐ€ ์ฒ™๋„๊ฐ€ ์šด๋™์— ์˜ํ–ฅ์„ ์ฃผ๋Š” ๊ณ ์œ  ์ˆ˜์šฉ์„ฑ ๊ฐ๊ฐ์˜ ๋ณ€ํ™”์™€ ๊ทผ๋ ฅ์˜ ๋ณ€ํ™”, ํ˜‘์‘๋Šฅ๋ ฅ์˜ ๋ณ€ํ™”๋ฅผ ์ง์ ‘์ ์œผ๋กœ ์ธก์ •ํ•˜์ง€ ์•Š์œผ๋ฏ€๋กœ ์ค‘์žฌ ํ›„ ๋ณ€ํ™”์— ๋Œ€ํ•œ ๋ฏผ๊ฐ์„ฑ์ด ๋–จ์–ด์งˆ ์ˆ˜ ์žˆ๋‹ค๋Š” ์˜๊ฒฌ์„ ์ˆ˜์šฉํ•œ๋‹ค[26].
๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ์ง„๋™์˜ ์ข…๋ฅ˜์— ๋”ฐ๋ฅธ ํšจ๊ณผํฌ๊ธฐ์˜ ์ฐจ์ด๋ฅผ ๊ณ„๋Ÿ‰์ ์œผ๋กœ ๋ถ„์„ํ•˜์ง€ ๋ชปํ•˜์˜€๋‹ค. ๋ถ„์„ ๋Œ€์ƒ ์—ฐ๊ตฌ ์ค‘ ๊ตญ์†Œ ์ง„๋™์ž๊ทน ์ค‘์žฌ ์—ฐ๊ตฌ๊ฐ€ 3ํŽธ์œผ๋กœ ์ ์—ˆ๊ธฐ ๋•Œ๋ฌธ์ด๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ์ „์‹  ์ง„๋™์ž๊ทน ์ค‘์žฌ์™€ ๊ตญ์†Œ ์ง„๋™์ž๊ทน ์ค‘์žฌ ์—ฐ๊ตฌ๋“ค์˜ ํšจ๊ณผํฌ๊ธฐ์˜ ๊ฒฝํ–ฅ์„ฑ์„ ๋ถ„์„ํ•ด๋ณด๋ฉด, ์ „์‹  ์ง„๋™์ž๊ทน ์ค‘์žฌ์˜ ํšจ๊ณผํฌ๊ธฐ๋Š” ๋งŽ์€ ํŽธ์ฐจ๋ฅผ ๋ณด์ด๋Š” ๋ฐ˜๋ฉด, ๊ตญ์†Œ ์ง„๋™์ž๊ทน ์ค‘์žฌ ์—ฐ๊ตฌ๋“ค์€ ๋ณดํŽธ์ ์œผ๋กœ ์ค‘๊ฐ„ ํšจ๊ณผํฌ๊ธฐ๋ฅผ ๋‚˜ํƒ€๋‚ด์—ˆ๋‹ค[25,27,28]. ์ด๊ฒƒ์€ ์ „์‹  ์ง„๋™์ž๊ทน์ด ๊ตญ์†Œ ์ง„๋™์ž๊ทน๋ณด๋‹ค ๊ฐ„์ ‘์  ์ž๊ทน์ด๋ผ๋Š” ๊ฒƒ์— ์ดˆ์ ์„ ๋งž์ถœ ํ•„์š”๊ฐ€ ์žˆ๋‹ค. ์ „์‹  ์ง„๋™์ž๊ทน์€ ์ง„๋™ํŒ ์œ„์— ์„œ ์žˆ์„ ๋•Œ ๋ฐ”๋‹ฅ์—์„œ ์ง„๋™์ด ์ œ๊ณต๋˜๋Š” ๊ฒƒ์ด๋ฏ€๋กœ ์ง์ ‘์ ์œผ๋กœ๋Š” ๋ฐœ๋ฐ”๋‹ฅ์— ์ง„๋™์ด ์ œ๊ณต๋˜๊ณ  ์‹ ์ฒด์˜ ๋–จ๋ฆผ์€ ๊ฐ„์ ‘์ ์œผ๋กœ ์ „์‹ ์—์„œ ๊ฒฝํ—˜๋˜๋Š” ๊ฒƒ์ด๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ๊ตญ์†Œ ์ง„๋™์ž๊ทน์€ ๋ชฉํ‘œ๊ฐ€ ๋˜๋Š” ๊ทผ์œก์ด๋‚˜ ๊ทผ์œก๊ตฐ์— ์ง์ ‘์ ์œผ๋กœ ์ง„๋™์ž๊ทน์„ ์ œ๊ณตํ•˜๋ฏ€๋กœ ๋ณด๋‹ค ๋” ์ง์ ‘์ ์ธ ํšจ๊ณผ๊ฐ€ ๋‚˜ํƒ€๋‚  ์ˆ˜ ์žˆ๊ณ  ๊ธฐ๋Šฅ์— ๋ฏธ์น˜๋Š” ์˜ํ–ฅ๋„ ๋” ์ปธ์„ ๊ฒƒ์œผ๋กœ ์‚ฌ๋ฃŒ๋œ๋‹ค. ์ง„๋™์ž๊ทน์˜ ์ฃผํŒŒ์ˆ˜์™€ ์ง„ํญ์˜ ์ฐจ์ด์— ์˜ํ•œ ํšจ๊ณผ ํฌ๊ธฐ ๋ณ€ํ™”์˜ ์ผ๊ด€์„ฑ๊ณผ ์ผ์ •ํ•œ ๊ฒฝํ–ฅ์„ฑ์€ ๋ฐœ๊ฒฌ๋˜์ง€ ์•Š์•˜๋‹ค.
์„ ์ •๋œ ์—ฐ๊ตฌ์˜ ์ง„๋™์ž๊ทน ํšจ๊ณผ๋ฅผ ๊ณ„๋Ÿ‰์ ์œผ๋กœ ๋ถ„์„ํ•˜๊ธฐ ์œ„ํ•ด ์ข…์†๋ณ€์ธ์„ โ€œ๊ท ํ˜•๊ธฐ๋Šฅโ€๊ณผ โ€œ์ƒยทํ•˜์ง€ ๊ธฐ๋Šฅ ๋ฐ ๋ณดํ–‰๊ธฐ๋Šฅโ€์œผ๋กœ ๋ถ„๋ฅ˜ํ•˜์˜€๋‹ค. ๋ถ„์„๊ฒฐ๊ณผ ๊ท ํ˜•๊ธฐ๋Šฅ ๋ถ„๋ฅ˜๋Š” ์ž‘์€ ํšจ๊ณผํฌ๊ธฐ๋กœ ๋ถ„์„๋˜์—ˆ๊ณ , ์ƒยทํ•˜์ง€ ๊ธฐ๋Šฅ ๋ฐ ๋ณดํ–‰๊ธฐ๋Šฅ์€ ์ค‘๊ฐ„ ํšจ๊ณผํฌ๊ธฐ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ์ด์™€ ๊ฐ™์€ ๊ฒฐ๊ณผ๋Š” ์ง„๋™์ž๊ทน์ด ์ค‘์ถ”์‹ ๊ฒฝ๊ณ„ ์งˆํ™˜์—์„œ ๋งˆ๋น„๋œ ๊ทผ์œก์˜ ๊ธฐ๋Šฅ๋ณด๋‹ค ์†์ƒ๋œ ๊ฐ๊ฐ ๊ธฐ๋Šฅ์„ ํฌํ•จํ•˜๋Š” ๊ท ํ˜•๊ธฐ๋Šฅ์— ๋ฏธ์น˜๋Š” ํšจ๊ณผ๊ฐ€ ๋” ๋ฏธ๋น„ํ•˜๋‹ค๊ณ  ๋ณผ ์ˆ˜ ์žˆ๋‹ค. ๋”๋ถˆ์–ด ๊ท ํ˜•๊ธฐ๋Šฅ์„ ์ธก์ •ํ•˜๋Š” ๋„๊ตฌ๊ฐ€ ๊ด€์ฐฐ์„ ํ†ตํ•œ ์„œ์—ด์ฒ™๋„๋กœ ์งˆ์  ์ •๋ณด๋ฅผ ๋‹ด๊ณ  ์žˆ๋Š” ๋ฐ˜๋ฉด์— ๋ณดํ–‰๊ธฐ๋Šฅ์€ ๊ฑฐ๋ฆฌ ๋˜๋Š” ์‹œ๊ฐ„์— ๋Œ€ํ•œ ์–‘์  ์ •๋ณด ๋งŒ ์ œ๊ณตํ•˜๋ฏ€๋กœ ํšจ๊ณผํฌ๊ธฐ์— ์˜ํ–ฅ์„ ๋ฏธ์ณค์„ ๊ฐ€๋Šฅ์„ฑ๋„ ๋ฐฐ์ œํ•  ์ˆ˜ ์—†๋‹ค[27,31,33].
๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ๋Œ€์ƒ์ž์˜ ํ™œ๋™ ๋ฐ ์ฐธ์—ฌ์— ์ดˆ์ ์„ ๋‘๊ณ  ๋Œ€์ƒ์ž์˜ ์‹ ์ฒด์  ๊ธฐ๋Šฅ ์ด์™ธ์˜ ์งˆ์ ์ธ ์ธก์ •์น˜๋Š” ๋ถ„์„ํ•˜์ง€ ์•Š์•˜๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ์งˆ์  ์ธก์ •์น˜์™€ ๊ธฐ๋Šฅ์  ์ธก์ •์น˜๋ฅผ ๋™์‹œ์— ์ธก์ •ํ•œ ์—ฐ๊ตฌ๋“ค์—์„œ ํšจ๊ณผํฌ๊ธฐ์˜ ๊ด€๊ณ„์„ฑ์„ ๊ด€์ฐฐํ•  ์ˆ˜ ์žˆ์—ˆ๋‹ค. ์ง„๋™์ž๊ทน์— ์˜ํ•˜์—ฌ ๊ทผ๋ ฅ์ด ์œ ์˜๋ฏธํ•˜๊ฒŒ ํ–ฅ์ƒ๋œ ์—ฐ๊ตฌ์˜ ๊ฒฝ์šฐ ๋™์‹œ์— ์ธก์ •๋œ ๊ธฐ๋Šฅ์  ์ธก์ •์น˜์˜ ํšจ๊ณผํฌ๊ธฐ๊ฐ€ ์ž‘์•˜๋‹ค[29,33]. ๋ฐ˜๋ฉด์— ๋น„์ •์ƒ์ ์ธ ๊ทผ ๊ธด์žฅ๋„์˜ ์œ ์˜๋ฏธํ•œ ๊ฐ์†Œ๊ฐ€ ๊ด€์ฐฐ๋œ ์—ฐ๊ตฌ์—์„œ๋Š” ๊ธฐ๋Šฅ์  ์ธก์ •์น˜๊ฐ€ ์ค‘๊ฐ„ ํšจ๊ณผํฌ๊ธฐ ์ด์ƒ์„ ๋ณด์˜€๋‹ค[24,25]. ์ด์™€ ๊ฐ™์€ ๊ฒฐ๊ณผ๋ฅผ ํ† ๋Œ€๋กœ ๊ทผ์œก์˜ ์งˆ์  ์š”์†Œ์ธ ๊ทผ๋ ฅ์˜ ํ–ฅ์ƒ๋ณด๋‹ค๋Š” ๋น„์ •์ƒ์ ์ธ ๊ทผ ๊ธด์žฅ๋„์˜ ๊ฐ์†Œ๊ฐ€ ์ƒยทํ•˜์ง€ ๊ธฐ๋Šฅ ํ–ฅ์ƒ์— ๊ธ์ •์ ์ธ ์˜ํ–ฅ์„ ๋ฏธ์นœ๋‹ค๋Š” ๊ฒƒ์„ ์™ธํ˜•์ ์œผ๋กœ ํ™•์ธํ•  ์ˆ˜ ์žˆ์—ˆ๋‹ค. ์•ž์œผ๋กœ์˜ ์—ฐ๊ตฌ์—์„œ๋Š” ์‹ ์ฒด์˜ ๊ธฐ๋Šฅ์— ์˜ํ–ฅ์„ ์ค„ ์ˆ˜ ์žˆ๋Š” ์š”์†Œ์— ๋Œ€ํ•œ ๋ณด๋‹ค ๋” ์‹ฌ๋„ ์žˆ๋Š” ๊ณ„๋Ÿ‰์  ๋ฉ”ํƒ€๋ถ„์„์ด ํ•„์š”ํ•  ๊ฒƒ์ด๋‹ค.
๋ณธ ์—ฐ๊ตฌ์˜ ์ œํ•œ์ ์€ ์ง„๋‹จ ๋ณ„๋กœ ๋ถ„์„ํ•  ์—ฐ๊ตฌ๊ฐ€ ์ ์–ด, ์ง„๋‹จ์„ ํ•˜์œ„ ์ง‘๋‹จ์œผ๋กœ ๋ถ„์„ํ•  ์ˆ˜ ์—†์—ˆ๋‹ค๋Š” ๊ฒƒ๊ณผ ์ง„๋™์ž๊ทน ์ค‘์žฌ์˜ ๊ฐœ๋ณ„์ ์ธ ์ข…๋ฅ˜์— ๋”ฐ๋ผ ๊ณ„๋Ÿ‰์  ๋ฉ”ํƒ€๋ถ„์„์„ ์ง„ํ–‰ํ•  ์ˆ˜ ์—†์—ˆ๋‹ค๋Š” ๊ฒƒ์ด๋‹ค. ๋˜ํ•œ ์ง„๋™์ž๊ทน์— ๋Œ€ํ•œ ๊ท ํ˜•๊ธฐ๋Šฅ์˜ ํšจ๊ณผํฌ๊ธฐ๋ฅผ ๋ถ„์„ํ•œ ์—ฐ๊ตฌ ์ˆ˜๊ฐ€ ์ ์–ด ์ถฉ๋ถ„ํ•œ ๋ถ„์„์ด ์ด๋ฃจ์–ด์ง€์ง€ ๋ชปํ•˜์˜€๋‹ค.

๊ฒฐ ๋ก 

๋ณธ ์—ฐ๊ตฌ์˜ ๋ชฉ์ ์€ ์ง„๋™์ž๊ทน์ด ์ค‘์ถ”์‹ ๊ฒฝ๊ณ„ ์งˆํ™˜ ํ™˜์ž์˜ โ€œ๊ท ํ˜•๊ธฐ๋Šฅโ€๊ณผ โ€œ์ƒยทํ•˜์ง€ ๊ธฐ๋Šฅ ๋ฐ ๋ณดํ–‰๊ธฐ๋Šฅโ€์— ๋ฏธ์น˜๋Š” ํšจ๊ณผ๋ฅผ ๋ฉ”ํ‹ฐ๋ถ„์„์„ ํ†ตํ•ด ์•Œ์•„๋ณด๊ธฐ ์œ„ํ•จ์ด์—ˆ๋‹ค. ๋ถ„์„ ๊ฒฐ๊ณผ ์ง„๋™์ž๊ทน์ด ๊ท ํ˜•๊ธฐ๋Šฅ์— ๋ฏธ์น˜๋Š” ํšจ๊ณผ๋Š” ์ž‘์€ ํšจ๊ณผํฌ๊ธฐ๋ฅผ ๋ณด์˜€๊ณ , ์ƒยทํ•˜์ง€ ๊ธฐ๋Šฅ ๋ฐ ๋ณดํ–‰๊ธฐ๋Šฅ์— ๋ฏธ์น˜๋Š” ํšจ๊ณผ๋Š” ์ค‘๊ฐ„ ํšจ๊ณผํฌ๊ธฐ๋ฅผ ๋‚˜ํƒ€๋‚ด์—ˆ๋‹ค. ํ†ตํ•ฉ๋œ ์‹ ์ฒด์  ๊ธฐ๋Šฅ์— ๋Œ€ํ•œ ํšจ๊ณผ๋Š” ์ค‘๊ฐ„ ํšจ๊ณผํฌ๊ธฐ๋กœ ํ•ด์„๋  ์ˆ˜ ์žˆ๋‹ค. ๋˜ํ•œ ์ง„๋™์ž๊ทน ๋‹จ์ผ ์ค‘์žฌ๋กœ๋Š” ์‹ ๊ฒฝ์žฌํ™œ์ž„์ƒ์—์„œ ์ ์šฉ ํšจ๊ณผ๋ฅผ ๊ธฐ๋Œ€ํ•  ์ˆ˜ ์žˆ๊ฒ ์œผ๋‚˜ ๋‹ค๋ฅธ ์ข…๋ฅ˜์˜ ์ค‘์žฌ๋ณด๋‹ค ์šฐ์›”ํ•œ ํšจ๊ณผ์„ฑ์„ ๊ฐ–๋Š”๋‹ค๊ณ  ๋ณผ ์ˆ˜๋Š” ์—†๋‹ค. ์•ž์œผ๋กœ ์ง„๋‹จ ๊ตฐ๊ณผ ์ง„๋™์ž๊ทน ์ค‘์žฌ์˜ ์ข…๋ฅ˜์— ๋”ฐ๋ฅธ ๋‹ค์–‘ํ•œ ํšจ๊ณผ์„ฑ์„ ์ž…์ฆํ•˜๊ธฐ ์œ„ํ•ด์„œ๋Š” ์งˆ์ ์œผ๋กœ ์šฐ์ˆ˜ํ•œ ์—ฐ๊ตฌ๋“ค์ด ๋”์šฑ ๋งŽ์ด ์‹คํ–‰๋˜์–ด์•ผ ํ•  ๊ฒƒ์œผ๋กœ ์‚ฌ๋ฃŒ๋œ๋‹ค.

Notes

No potential conflict of interest relevant to this article was reported.

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Figureย 1.
Research flow diagram.
jhis-42-3-208f1.tif
Figureย 2.
Combined effect of vibratory stimulation. CI, confidence interval.
jhis-42-3-208f2.tif
Figureย 3.
Effect of vibratory stimulation on balance function. CI, confidence interval.
jhis-42-3-208f3.tif
Figureย 4.
Effect of vibratory stimulation on upper/lower function and gait function. CI, confidence interval.
jhis-42-3-208f4.tif
Figureย 5.
Funnel plots of outcomes. (A) Combined outcomes, (B) Balance function outcomes, and (C) Upper/lower function and gait function outcomes.
jhis-42-3-208f5.tif
Tableย 1.
Characteristics of included studies
No. Study [Reference number] Dx Exp / Con (n) Age (MยฑSD) Intervention Time of intervention Outcome measure (Classification) PEDro score
1 Bosveld et al. [29] SCI 12 51.00 ยฑ 12.10 WBV (50 Hz) 45 Sec, 4 set, 1 Ss FTSTS (ULF&G) 8
12 43.80 ยฑ 13.30 sham
2 Brogardh et al. [30] CVA 16 61.30 ยฑ 8.50 WBV (25 Hz) 40-60 Sec, 12 set, 2 Ss/W, 6 Ws CGS, FGS, 6MWT, TUG (all ULF&G) 7
15 63.90 ยฑ 5.80 sham
3 Chan et al. [24] CVA 15 56.07 ยฑ 11.04 CT+WBV (12 Hz) 10 Ms, 2 set, 1 Ss 10mWT, TUG (all ULF&G) 7
15 54.93 ยฑ 7.45 CT+sham
4 Claerbout et al. [33] MS 20 39.10 ยฑ 8.20 CT+WBV 7-13 Ms, 4-8 set, 4 Ss/W, 3 Ws BBS (Bal), 3MWT (ULF&G), TUG (ULF&G) 7
17 47.60 ยฑ 8.30 CT
5 Costantino et al. [25] CVA 17 62.59 ยฑ 15.39 LMMAV 30 Ms, 3 Ss/W, 4 Ws FMA-UE, JTT (all ULF&G) 8
15 60.47 ยฑ 16.09 sham
6 Guo et al. [26] CVA 15 53.80 ยฑ 6.00 WBV (6-10 Hz) 60 Sec, 10 set, 5 Ss/W, 8 Ws FMA-LE, 10mWT (all ULF&G) 8
15 54.30 ยฑ 6.80 sham
7 Spina et al. [27] MS 10 47.00 ยฑ 12.17 CT+FV 1 Hr, 5 Ss/W, 3 Ws BBS (Bal), FRT (ULF&G), T25FW (ULF&G) 6
10 48.00 ยฑ 12.34 CT+sham
8 van Nes et al. [31] CVA 27 59.70 ยฑ 12.30 CT+WBV (30 Hz) 160 Sec, 5 Ss/W, 6 Ws BBS (Bal), MI (ULF&G), RMI (ULF&G), TCT (Bal) 8
26 62.60 ยฑ 7.60 CT+ETM
9 Volpe et al. [28] PD 20 66.50 CT+FV 1-4 Hr, 5 Ss/W, 8 Ws BBS (Bal), TUG (ULF&G) 9
20 69.50 CT+sham
10 Wolfsegger et al. [32] MS 9 43.00 ยฑ 13.40 WBV (3-5 Hz) 45-60 Sec, 5-7 set, 7 Ss/W, 3 Ws TUG (ULF&G) 7
8 39.30 ยฑ 10.60 sham

MยฑSD, meanยฑstandard deviation; Bal, balance; BBS, berg balance scale; CGS, comfortable gait speed test; Con, control group; CP, cerebral palsy; CT, conventional therapy; CVA, cerebrovascular accident; ETM, exercise therapy on music; Exp, experimental group; FGS, fast gait speed test; FMA-UE, Fugl-Meyer assessment for upper extremity; FMA-LE, Fugl-Meyer assessment for lower extremity; FRT, functional reach test; FTSTS, five times sit-to-stand test; FV, focal vubration; Hr, hour; JTT, Jebsen-Taylor hand function test; LMMAV, local muscle mechano-acoustic vibration; MI, motricity index; Ms, minutes; MS, multiple sclerosis; PD, Parkinsonโ€™s disease; RMI, rivermead motility index; SCI, spinal cord injury; 6MWT, 6 minutes walking test; Ss, sessions; TCT, trunk control test; 10 mWT, 10m walking test; T25FW, timed 25-foot walk; 3MWT, 3 minutes walking test; TUG, timed up and go test; ULF&G, upper/lower function and gait function; WBV, whole-body vibration.

Tableย 2.
Statistical heterogeneity
Study (n) T2 Q df p
Total 10 0 8.887 9 0.448
Bal 4 0 0.862 3 0.835
ULF&G 10 0 7.628 9 0.572

Bal, balance; ULF&G, upper/lower function and gait function.

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