动作观察疗法对脑卒中偏瘫患者上肢功能影响的Meta分析

Effect of Action Observation Therapy on Upper Limb Function in Stroke Patients with Hemiplegia:a Meta-Analysis

目的系统评价动作观察疗法(action observation therapy,AOT)对脑卒中偏瘫患者上肢运动功能的影响。方法通过计算机检索PubMed、Cochrane Library、EMBASE、中国期刊全文数据库(CNKI)、万方和维普数据库中有关AOT用于脑卒中患者康复的随机对照试验(RCT)研究。检索时限:建库至2019年8月31日。干预组在常规康复护理基础上予AOT为主的护理干预,对照组予常规康复护理。由2名研究人员独立筛选文章,评估文章质量,提取数据,使用Rev Man 5.3软件对符合质量标准的研究进行Meta分析,用漏斗图分析每项研究的发表偏倚。结果共纳入15篇文献(英文文献7篇,中文文献8篇)601例患者。干预后Fugl-Meyer上肢部分评分干预组高于对照组[SMD=0.56,95%CI(0.39,0.73),Z=6.43、P<0.05];改良Barthel指数(MBI)评分:干预4周时干预组与对照组相当[MD=9.20,95%CI(-0.07,18.47),Z=1.95、P=0.05],而在干预6~8周时干预组高于对照组[MD=10.24,95%CI(7.41,13.07),Z=7.10、P<0.05]。干预后干预组盒块测试(BBT)评分高于对照组[MD=2.97,95%CI(1.16,4.78),Z=3.22、P<0.05];干预组Wolf运动功能测试(WMFT)评分与对照组相当[MD=0.55,95%CI(-5.06,6.17),Z=0.19、P=0.85]。结论AOT与常规护理比较,可以显著改善脑卒中偏瘫患者上肢功能和手指灵巧度,提高患者日常活动自理能力。

Objective To systematically review the effect of action observation therapy(AOT)on upper limb function in stroke patients with hemiplegia.Methods Databases including PubMed,Cochrane Library,EMBASE,CNKI,Wanfang Database and VIP were searched electronically from inception to August 31,2019 for the randomized controlled trials about the effect of AOT on upper limb function in stroke patients with hemiplegia.The intervention group was given AOT-based nursing intervention on the basis of routine rehabilitation nursing,while the control group only received routine rehabilitation nursing.Two researchers independently screened articles,evaluated the quality of articles,and extracted data.Rev Man 5.3 software was applied for meta-analysis of studies that met the quality standards,and funnel plot was used to analyze the publication bias of each study.Results A total of 15 randomized controlled trials involving 601 patients were included(7 articles in English and 8 articles in Chinese).After intervention,the Fugl-Meyer upper limb score in intervention group was higher than that in control group(SMD=0.56,95%CI(0.39,0.73),Z=6.43,P<0.05).The modified Barthel Index score in intervention group was not different from that in control group at 4 weeks after intervention(MD=9.20,95%CI(-0.07,18.47),Z=1.95,P=0.05),but was higher than that in control group at 6-8 weeks after intervention(MD=10.24,95%CI(7.41,13.07),Z=7.10,P<0.05).The Box and Block Test score in intervention group was higher than that in control group after intervention(MD=2.97,95%CI(1.16,4.78),Z=3.22,P<0.05).There was no significant difference in the Wolf Motor Function Test(WMFT)score between the two groups(MD=0.55,95%CI(-5.06,6.17),Z=0.19,P=0.85).Conclusion Compared with routine nursing care,AOT can improve upper limb function and finger dexterity and enhance self-care ability in daily activities in stroke patients with hemiplegia.