强化平衡训练对脑卒中患者跌倒预防效果的Meta分析

Effects of intensive balance training on fall prevention in stroke patients:A Meta-analysis

目的通过Meta分析评价强化平衡训练对脑卒中患者发生跌倒的预防效果。方法通过检索PubMed、Cochrane Library、Web of Science、EMBASE、中国生物医学数据库、中国期刊全文数据库、万方科技期刊全文数据库、维普中文科技期刊数据库的随机对照试验,检索时间从建库至2020年5月18日,并追溯相关文献的参考文献;按照纳入和排除标准筛选文献并进行质量评价、提取数据。采用RevMan 5.3软件进行Meta分析。结果共纳入9篇文献,包括686例患者;Meta分析结果显示,与常规康复训练相比,强化平衡训练可降低脑卒中患者跌倒的发生率[RR=0.42,95%CI(0.30,0.59),P<0.001]、改善平衡能力BBS评分[MD=4.71,95%CI(2.72,6.70),P<0.001]、计时起立-行走测试评分[MD=-3.10,95%CI(-5.50,-0.70),P=0.01]、Fugl-Meyer运动评分量表下肢部分评分[MD=6.77,95%CI(6.10,7.44),P<0.001]、日常生活能力Barthel指数评分[MD=9.86,95%CI(5.97,13.75),P<0.001]。结论强化平衡训练对脑卒中患者跌倒的发生有一定的预防作用,但仍需要多中心、大样本的随机对照研究来进一步探索强化平衡训练的最佳周期、频率和具体实施方法,基于当前的研究,建议对脑卒中患者尽早增加有目的、有计划的强化平衡训练。

Objective To evaluate the preventive effect of intensive balance training on falls in stroke patients by Meta-analysis.Methods The randomized controlled trials were collected in PubMed,the Cochrane Library,Web of Science,EMBASE,CBM,CNKI,VIP and Wanfang Database,the references of related literatures were traced.The literatures were screened according to the inclusion and exclusion criteria,and the quality was evaluated to extract the data.Meta-analysis was carried out with Rev Man 5.3 software.Results A total of 9 articles were included,including 686 patients.Meta-analysis showed that compared with conventional rehabilitation training,intensive balance training reduced the incidence of falls in stroke patients[RR=0.42,95%CI(0.30,0.59),P<0.001],BBS score[MD=4.71,95%CI(2.72,6.70),P<0.001],TUGT score[MD=-3.10,95%CI(-5.50,-0.70),P=0.01],Fugl-Meyer score[MD=6.77,95%CI(6.10,7.44),P<0.001],Barthel score[MD=9.86,95%CI(5.97,13.75),P<0.001].Conclusion Although intensive balance training has a certain preventive effect on the occurrence of falls in stroke patients,it still needs a multi-center,large sample randomized controlled study to further explore the best cycle,frequency and specific implementation methods of intensive balance training.Based on the current research,we suggest that increase targeted and planned specific balance training for stroke patients as early as possible.