脑卒中幸存者家庭远程康复治疗效果的系统评价

Home-based telerehabilitation for stroke survivors: a systematic review

目的系统评价脑卒中幸存者家庭远程康复的治疗效果。方法计算机检索PubMed、EMbase、Web of Science、Joanna Briggs Institute Library、The Cochrane Library、CNKI、VIP和WanFang Data数据库,搜集有关家庭远程康复治疗脑卒中患者疗效的随机对照试验(RCT),检索时限均从建库至2019年1月1日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入11个RCT,包括793例患者。Meta分析结果显示:家庭远程康复干预1~2年内的BI评分明显高于传统康复[MD=20.22,95%CI(17.10,23.35),P<0.000 01]。在干预2个月内ARAT评分[SMD=0.16,95%CI(-0.14,0.45),P=0.30]、3个月内MBI评分[SMD=0.98,95%CI(-0.33,2.29),P=0.14]及FMA评分[SMD=0.57,95%CI(-0.08,1.23),P=0.09]、6个月内CSI评分[MD=-1.48,95%CI(-3.90,0.94),P=0.23]及BBS评分[MD=1.33,95%CI(-1.15,3.81),P=0.29]等方面,两组差异均无统计学意义。描述性分析结果提示,干预6个月时两组在生命质量方面差异无统计学意义,但在干预2年后,家庭远程康复优于传统康复。结论当前证据显示,家庭远程康复与传统康复疗效相当,但长期(1~2年)家庭远程康复在改善日常生活能力及生命质量的效果可能更好。受纳入研究数量和质量的限制,上述结论尚待开展更多高质量研究予以验证。

Objectives To systematically review the efficacy of home-based telerehabilitation(HTR) for stroke survivors. Methods PubMed, EMbase, Web of Science, Joanna Briggs Institute Library, The Cochrane Library, CNKI,VIP and WanFang Data databases were electronically searched to collect randomized controlled trials(RCTs) on HTR for stroke survivors from inception to January 1 st, 2019. Two reviewers independently screened literature, extracted data, and assessed risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 11 RCTs involving 793 patients were included. The results of meta-analysis showed that: after 1 to 2 years of treatment, BI scores(MD=20.22, 95%CI 17.10 to 23.35, P<0.000 01) in HTR group were higher than those in the traditional rehabilitation group. However, there were no statistical differences between two groups in ARAT scores(SMD=0.16, 95%CI-0.14 to 0.45, P=0.30) after 1 to 2 months of treatment, as well as MBI scores(SMD=0.98, 95%CI-0.33 to 2.29, P=0.14) and FMA scores(SMD=0.57, 95%CI-0.08 to 1.23, P=0.09) after 3 months of treatment, and CSI scores(MD=-1.48, 95%CI-3.90 to 0.94, P=0.23) and BBS scores(MD=1.33, 95%CI-1.15 to 3.81, P=0.29) after 6 months of treatment. The results of descriptive analysis indicated that there was no statistically significant difference in quality of life between the two groups at 6 months after intervention. However, the HTR group was superior to the traditional rehabilitation group after 2 years of treatment. Conclusions Current evidence shows that, compared with traditional rehabilitation, long-term intervention(1-2 years) with HTR can improve the ability to perform activities of daily living and quality of life of stroke survivors. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.