运动想象疗法对脑卒中后患者上肢运动功能康复效果的系统评价

Efficacy of Mental Practice on Rehabilitation of Hand Function in Patients with Post-stroke: A Systematic Review

目的系统评价运动想象疗法对脑卒中后患者功能康复的效果。方法计算机检索Cochrane Database of Systematic Reviews、MEDLINE、EMbase、PEDro、OpenSIGLE、National Technical Information Service(NTIS)、CNKI、VlP、万方数据库和CBM中关于运动想象疗法改善脑卒中后患者肢体功能障碍的随机对照试验,同时追索纳入文献的参考文献。检索时限均为从建库至2010年10月。由3名研究者根据GRADE系统推荐分级方法,对纳入研究的质量进行严格评价和资料提取,对符合质量标准的RCT进行Meta分析。统计学分析采用RevMan 5.0.25软件和GRAEDpro ler 3.2.2软件。结果共纳入16个RCT。Meta分析四个主要结局的结果显示:Furl-Meyer运动评分量表(FMA)持续8周、6周和4周的运动想象疗法训练对患者上肢运动功能障碍的康复效果与脑卒中后常规康复治疗比较,其差异均有统计学意义[WMD(95%CI)分别为13.89(4.53,23.25)、9.45(3.67,15.23)和7.81(1.96,13.65)],上肢动作研究量表(ARAT)持续6周的运动想象疗法训练对患者上肢运动功能障碍的康复效果与其他脑卒中后康复治疗方法(物理治疗或作业治疗)比较,其差异也有统计学意义[WMD=5.70,95%CI(3.17,8.22),P=0.30]。每个结局的GRADE系统推荐分级均为低等级。结论现有研究显示,运动想象疗法可明显改善患者上肢运动功能,且副作用甚小,操作简便,与脑卒中后其他康复治疗方法相比成本较低,临床医生可将实施运动想象疗法作为强推荐。但鉴于纳入研究较少,样本量小,且质量不高,各研究评价方法变异性较大,并且存在评价时间的不同,故仍需开展大样本、多中心、方法科学和规范的高质量RCT,以求进一步验证运动想象疗法的实施方式与方法对脑卒中后患者肢体功能障碍的康复效果。

Objective To evaluate Mental Imagery on rehabilitation of functions in patients with stroke.Methods Cochrane Central Register of Controlled Trials（CENTRAL）,MEDLINE,EMbase,PEDro（www.pedro.org.au）,OpenSIGLE,National Technical Information Service（NTIS）,CNKI,VIP,Wanfang Data,and CBM were searched for the Randomized controlled trials（RCTs） of Mental Imagery on rehabilitation of functions in patients with stroke from the date of establishment of the databases to October 2010.The bibliographies of the included studies were searched,too.Three independent researchers evaluated the included studies using GRADE.The extracted data were analyzed by RevMan 5.0.25 and GRAEDprofiler 3.2.2.Results A total 16 trials were discovered.Meta-analyses showed that at the end of 4th,6th,and 8th,compared with conventional rehabilitation,the mental practice increased the score measured by FMA（WMD=7.81,95%CI 1.96 to 13.65;WMD=13.89,95%CI 4.53 to 23.25;and WMD=9.45,95%CI 3.67 to 15.23,respectively） and ARAT（WMD=5.70,95%CI 3.17 to 8.22,P=0.30）.The 4 outcomes were all of low quality in the GRADE system.Conclusion The current evidence shows mental practice could improve the upper limb function in patients after stroke,and the side effects of mental practice are not found in meta-analyses.Compared with other rehabilitative therapies,it is simper,of lower input costs,and of low operating costs.The clinicians should recommend it.Due to the limitations of the included studies,more large-sample,high-quality RCTs are required.