不同康复疗法改善痉挛型脑瘫患儿运动功能障碍疗效的网状Meta分析

Network Meta-analysis of the effect of different rehabilitation therapies on improving motor dysfunction in children with spastic cerebral palsy

目的系统评价水疗、康复机器人、核心稳定性训练(CST)、全身振动训练(WBV)、重复经颅磁刺激(rTMS)、悬吊训练(SET)、任务导向性训练(TOT)、虚拟现实(VR)8种康复疗法对痉挛型脑瘫患儿运动功能障碍的干预效果,为患儿康复方案的科学选择提供参考依据。方法计算机检索PubMed、The Cochrane Library、Web of Science、EmBase、CNKI、CBM、VIP和WanFang Data数据库,搜集有关8种康复疗法治疗痉挛型脑瘫患儿运动功能障碍的随机对照试验(RCTs),检索时限均为建库至2022年12月。由2名研究者独立进行文献筛选、数据提取及文献质量评价,采用ADDIS 1.16.6软件进行网状Meta分析,采用Stata 16.0软件进行图形绘制。结果共纳入43项RCTs,包括2722例痉挛型脑瘫患儿。网状Meta分析结果显示,在提高GMFM-88评分方面,WBV(MD=18.56,95%CI:34.91~2.45,P<0.05)疗效最佳;在提高GMFM-88 D区评分方面,康复机器人疗效最佳(MD=6.30,95%CI:8.44~4.41,P<0.05);在GMFM-88 E区评分方面,康复机器人疗效最佳(MD=10.03,95%CI:15.03~4.84,P<0.05);在提高BBS评分方面,水疗疗效最佳(MD=11.24,95%CI:22.26~0.20,P<0.05)。结论对于痉挛型脑瘫患儿,WBV是改善其粗大运动功能的最佳康复疗法,康复机器人是改善其站立和步行功能的最佳康复疗法,水疗是改善其平衡功能的最佳康复疗法。

Objective To systematically evaluate the effects of various rehabilitation therapies,including hydrotherapy,rehabilitation robot,core stability training(CST),whole-body vibration training(WBV),repetitive transcranial magnetic stimulation(rTMS),sling exercise training(SET),task-oriented training(TOT)and virtual reality(VR),on motor dysfunction in children with spastic cerebral palsy,so as to provide a reference for the scientific selection of rehabilitation programs for children.Methods Randomized controlled trials(RCTs)of the 8rehabilitation therapies in the treatment of motor dysfunction in children with spastic cerebral palsy were searched from various databases,including PubMed,The Cochrane Library,Web of Science,EmBase,CNKI,CBM,VIP,and WanFang Database,from database inception to December 2022.Two researchers independently conducted literature screening,data extraction,and literature quality evaluation.Network Meta-analysis was performed using ADDIS 1.16.6software,and Stata 16.0software was used for graphic representation.Results A total of 43RCTs involving 2722children with spastic cerebral palsy were included in the analysis.The results of the network Meta-analysis indicated that WBV had the most significant effect in improving the GMFM-88score(MD=18.56,95%CI:34.91-2.45,P<0.05).Rehabilitation robot had the most significant effect in improving dimensions D(MD=6.30,95%CI:8.44-4.41,P<0.05)and E(MD=10.03,95%CI:15.03-4.84,P<0.05)of the GMFM-88score.Additionally,hydrotherapy showed the most significant effect in improving the BBS score(MD=11.24,95%CI:22.26-0.20,P<0.05).Conclusions For children with spastic cerebral palsy,WBV is the most effective rehabilitation therapy to improve gross motor function,rehabilitation robot is the most effective therapy for improving standing and walking function,and hydrotherapy is the most effective therapy for improving balance.