马术治疗对脑性瘫痪儿童粗大运动功能疗效的系统评价与Meta分析

A systematic review and meta-analysis of equine-assisted therapy for the children with cerebral palsy on gross motor function

目的:系统评价马术治疗(EAT)对脑性瘫痪(CP)儿童粗大运动功能的疗效。方法:计算机检索Medline、EmBase、Cochrance、SciVerse ScienceDirect、Web of science、Pubmed、Pedro、万方医学、知网医学、中国生物医学文献服务系统数据库检索时限为建库至2019年8月,由2位评价员对符合纳入标准的文献采用PEDro量表进行质量评估。对纳入的文献进行系统评价,并提取粗大运动功能评估量表(GMFM-66;GMFM-88)的标准分以及GMFM-88中的B(坐)、D(站)、E(走、跑、跳)维度分数等数据,采用Revman5.3软件进行Meta分析。结果:共纳入7篇文献进行系统评价,其中5篇数据纳入Meta分析,共288例。Meta分析显示GMFM-66[SMD=0.52,95%CI(0.28~0.76),P<0.0001]、GMFM-88[SMD=0.56,95%CI(0.25~0.86),P=0.0003]和B维度[SMD=0.31,95%CI(0.02~0.61),P=0.04]、D维度[SMD=0.61,95%CI(0.28~0.95,P=0.0004]、E维度[SMD=0.55,95%CI(0.25~0.85),P=0.0004]。结果表明,实验组与对照组结果差异具有统计学意义,即EAT可以显著改善CP儿童粗大运动功能。结论:基于系统评价及Meta分析结果,EAT可以显著改善CP儿童粗大运动功能,可以作为CP儿童物理治疗的参考治疗方法。

Objective:To investigate the effect of equine-assisted therapy(EAT)for the children with cerebral palsy(CP)on the gross motor function.Methods:Databases including Medline,Embase,Cochrance,SciVerse ScienceDirect,Web of science,Pubmed,Pedro,Wanfang Medicine,CNKI,CBM(sinomed)were searched till August of 2019.Two evaluators independently assessed the risk of bias of included studies by PEDro scale.The data on gross motor function measure(GMFM)-66,GMFM-88,B,D,and E dimensions were extracted in the experimental group and the control group before and after the intervention.Meta analysis was performed using Revman 5.3 software.Results:Seven studies were included in the systematic review,and 5 of them were included in the meta-analysis,with a total of 288 cases.The meta-analysis exhibited the GMFM-66 scale[SMD=0.52,95%CI(0.28-0.76),P<0.0001],GMFM-88 scale[SMD=0.56,95%CI(0.25-0.86),P=0.0003],B dimension[SMD=0.31,95%CI(0.02-0.61),P=0.04],D dimension[SMD=0.61,95%CI(0.28-0.95,P=0.0004],E dimension[SMD=0.55,95%CI(0.25-0.85),P=0.0004].The results showed that the data in the EAT group were statistically different from those in the control group.EAT could significantly improve the gross motor function of CP children.Conclusion:Based on the results of the meta-analysis,EAT can significantly improve the gross motor function of CP children and can be used as a reference treatment method for physical therapy of CP children.