运动想象疗法对脑卒中患者步行功能影响的Meta分析

Effects of Motor Imagery on walking function in stroke patients: a Meta-analysis

目的:通过Meta分析评价运动想象疗法(Motor Imagery,MI)对脑卒中患者步行功能的影响。方法:通过计算机对Cochrane Library、MEDLINE、Web of Science、EMBASE、EBSCO、中国生物医学文献数据库、中国知网、维普数据库、万方数据库中运动想象疗法对脑卒中患者步行功能影响的随机对照试验进行检索,并追溯相关文献的参考文献;2名研究人员独立进行文献筛查、数据的提取,评价并纳入文献,采用Revman5.3软件进行Meta分析。结果:共纳入7篇文献,包括259例研究对象;Meta分析结果显示,与常规康复相比,运动想象疗法有助于提高步幅[MD=9.88,95%CI(0.46,19.30),P=0.04]、Fugl-Meyer运动评分量表下肢部分(FMA-LE)评分[MD=2.24,95%CI(0.90,3.58),P=0.001]、功能性步行功能分级(Functional Ambulation Category Scale,FAC)[MD=0.58,95%CI(0.28,0.88),P<0.001],但运动想象疗法不能改善10米最大步行速度[MD=4.24,95%CI(-3.23,11.71),P=0.27]、患侧平均步长[MD=-3.20,95%CI(-10.33,3.93),P=0.38]和健侧平均步长[MD=1.36,95%CI(-3.00,5.71),P=0.54]。结论:运动想象疗法有助于提高步幅、FMA-LE得分和FAC分级,但在10米最大步行速度、患侧平均步长和健侧平均步长方面尚未有明显优势,仍需要多中心、大样本的随机对照研究加以证实。

Objective： To evaluate the effects of Motor Imagery on walking function in stroke patients. Methods： A computerized search was performed on the Cochrane Library, MEDLINE, Web of Science, EMBASE, EBSCO, CBMdisc, CNKI, VIP and WanFang Database, and relevant references were also traced, for Randomized Controlled Trails （RCTs） studying the effects of Motor Imagery on walking function. Two reviewers independently searched databases, extracted data and assessed the quality of included studies. Meta-analysis was conducted using Revman 5.3. Results： Seven RCTs and 259 patients were included in our Meta-analysis. The Meta-analysis showed that compared with conventional rehabilitation, Motor Imagery could improve Stride Length [MD=9.88,95% CI （0.46,19.30）, P=0.04], Fug-Meyer Assessment-Lower Extremity （FMA-LE） score [MD=2.24, 95% CI=（0.90, 3.58）, P=0.001], Functional Ambulation Category Scale （FAC） score [MD=0.58, 95% CI （0.28, 0.88）, P〈0.001]. But Motor Imagery could not increase 10MWS [MD=4.24, 95% CI （-3.23, 11.71）, P=0.27], average step length of paretic side [MD=-3.20, 95% CI （-10.33, 3.93）, P=0.38] and average step length of non-paretic side [MD=1.36, 95% CI （-3.00, 5.71）, P=0.54]. Conclusion： Motor Imagery is effective to improve Stride Length, FMA-LE and FAC scores. While it cannot increase 10MWS, average step length of paretic side and non-paretic side. Multicenter and large sample RCTs are still needed to confirm the effects of Motor Imagery on walking function in stroke patients.