奥塔戈运动项目对脑卒中患者跌倒干预效果的Meta分析

Meta-analysis of Effect of Otago Exercise Program on Stroke Patients

目的:评价奥塔戈运动项目对脑卒中患者跌倒的干预效果。方法:检索PubMed、Cochrane Library、Web of Science、EMbase英文数据库及中国期刊全文数据库、万方数据知识服务平台、维普中文期刊全文数据库和中国生物医学文献数据库,搜集关于奥塔戈运动项目对脑卒中患者跌倒效能及平衡功能影响的随机对照研究(RCTs)。检索时限设定为建库至2018年5月。采用Cochrane协作网中RCT的偏倚风险评价标准进行方法学质量评估,由2位评价者独立进行文献筛选、基本资料提取和偏倚风险评估后,采用RevMan 5.3软件进行Meta分析。结果:最终纳入7个RCTs,均为中文文献,共545例脑卒中患者。Meta分析显示:奥塔戈运动项目干预组脑卒中患者跌倒效能(采用跌倒效能量表或改良版跌倒效能量表评估)[SMD=1.10,95%CI (0.75,1.45),P<0.01]、平衡能力[MD=5.55,95%CI(4.15,6.96),P<0.01]、日常生活活动能力[MD=8.10,95%CI(1.56,14.64),P<0.05]及生活质量[MD=0.13,95%CI(0.05,0.20),P<0.01]较对照组均有明显提高,差异有统计学意义。结论:奥塔戈运动项目干预有利于脑卒中患者跌倒效能和平衡能力的提升,亦可改善其日常生活活动能力及生活质量。由于受到纳入研究的数量及质量限制,以上结论仍需要更多大样本、多中心、高质量的RCTs加以验证。

Objective: To evaluate the effect of Otago exercise program on the patients with stroke. Methods: Randomized controlled trials(RCTs) about Otago exercise program for falls efficacy balance function in patients with stroke were electronically searched in PubMed, Cochrane Library, Web of Science, EMbase, CNKI Chinese Journal Full-text Database, Wanfang Database, VIP Database and Chinese Biomedical Literature Database from the establishment of each database to May, 2018. All data were analyzed with RevMan 5.3 software. Results: A total of seven studies that represented 545 participants were evaluated. Meta-analysis showed that Otago exercise program had positive effects on improving patients’ falls efficacy [SMD=1.10, 95%CI(0.75,1.45),P<0.01] and Berg Balance Scale(BBS) scores [MD=5.55, 95%CI(4.15, 6.96), P<0.01]. It could also improve Modified Barthel Index(MBI) [MD=8.10, 95%CI(1.56, 14.64), P=0.02] and European Quality of Life-5 Dimensions scores(EQ-5 D) [MD=0.13, 95%CI(0.05, 0.20), P=0.002]. However, no statistically significant difference was found on Timed Up and Go Test(TUGT) [MD=-3.39,95%CI(-7.09, 0.31),P=0.07]. Conclusion: Otago exercise program is effective to improve falls efficacy, balance function, daily activities and quality of life of patients with stroke. Due to the limited quantity and quality of included studies, the above conclusion needs to be verified by more high-quality research.