Effects of core stability exercise on rehabilitation in stroke patients with hemiplegia： a meta-analysis

目的：评估核心稳定性训练在脑卒中偏瘫患者康复中的疗效.方法：以“核心稳定性训练/核心稳定训练/核心稳定性力量训练/核心稳定力量训练”,“脑卒中/中风/脑梗死/脑出血/脑血栓/脑栓塞/脑梗/蛛网膜下腔出血/偏瘫”等为关键词检索PubMed、Embase、Webof Science、Cochrane Library、知网、万方、CBM、维普等中英文数据库中有关核心稳定性训练对脑卒中偏瘫患者康复效果的随机对照试验,然后由双人独立进行文献筛选、数据提取和质量评价,采用RevMan5.3软件进行Meta分析.结果：共纳入11篇随机对照试验,包括704名患者,其中实验组和对照组各为352名.Meta分析结果显示,在常规康复的基础上辅以核心稳定性训练对患者躯干控制能力[MD=10.44,95%CI（8.83-12.04）,P〈0.001],平衡能力[MD=5.6,95%CI（4.81-6.39）,P〈0.001],日常生活活动能力[MD=12.06,95%CI（7.65-16.46）,P〈0.001],步行功能[MD=0.72,95%CI（0.32-1.12）,P〈0.001]以及步速[MD=3.39,95%CI（2.03-4.76）,P〈0.001]的作用效果均优于常规康复治疗,但是在步幅方面[MD=2.52,95%CI（-0.25-5.29）,P=0.07]没有显著差异.结论：在常规康复的基础上辅以核心稳定性训练可提高脑卒中偏瘫患者的躯干控制能力,平衡能力,日常生活活动能力、步行功能以及步速,但是对步幅改善方面还缺乏有效证据.由于本研究纳入的随机对照试验质量均为中等水平,未来还需要进行更多高质量的相关研究以进-步评价核心稳定性训练对脑卒中偏瘫患者的康复效果.

Objective： To evaluate the effects of core stability exercise （CST） on rehabilitation in stroke patients with hemiplegia. Methods： Randomly controlled trials about the effects of CST on rehabilitation in stroke patients with hemiplegia were searched in the database, including PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, CBM and VIP. Search terms include “core stability training / core stability exercise / core stabilization training / core stabilization exercise/ core strength training / core strength exercise” and “stroke / brain ischemia / cerebral infarction / cerebral hemorrhage / intracranial thrombosis / brain hemorrhage / cerebrovascular disorder /cerebrovascular accident, cerebrovascular disease / hemiplegia / hemiparesis/ stroke rehabilitation”. Study screening, data extraction and quality assessment were conducted by two researchers independently. Data was analyzed using RevMan 5.3 software. Results： Totally 11 studies and 704 patients were included with 352 patients in experiment group and 352 in control group. Results of meta-analysis showed that combination of CST and conventional rehabilitation had better effects on trunk control [MD = 10.44, 95% CI （8.83-12.04）, P 〈 0.001], banlace [MD = 5.6, 95% CI （4.81-6.39）, P 〈 0.001], activities of daily living [MD = 12.06, 95% CI （7.65-16.46）, P 〈 0.001], ambulation functional [MD = 0.72, 95% CI （0.32-1.12）, P 〈 0.001] and walking speed [MD = 3.39, 95% CI （2.03-4.76）, P 〈 0.001] than conventional rehabilitation, but there is no clear difference on walking stride [MD = 2.52, 95% CI （-0.25-5.29）, P = 0.07] between two groups. Conclusion： CST together with conventional rehabilitation can better improve trunk control, banlace, activities of daily living, ambulation functional and walking speed in stroke patients compared with conventional rehabilitation, but can not make the walking stride better significantly. However, since the conclusion of this meta-analysis was drawn based on middle quality RCTs, future high quality researchs should be conducted to confirm its positive intervention effects.