等速肌力训练对脑卒中偏瘫患者上肢运动功能康复影响的Meta分析

Effect of isokinetic muscle strength training on the rehabilitation of upper limb motor function for stroke patients with hemiplegia:a Meta-analysis

目的系统评价等速肌力训练对脑卒中偏瘫患者上肢运动功能康复的影响。方法计算机检索PubMed、CNKI数据库等中有关等速肌力训练对脑卒中偏瘫患者上肢运动功能康复影响的随机对照试验文献,检索时间为建库至2020年10月。按照Cochrane手册推荐的文献质量评价标准对符合纳入研究的文献进行质量评价,采用RevMan 5.3和Stata 15.0软件进行Meta分析。结果最终纳入7篇文献,样本量456例。Meta分析结果显示,等速肌力训练可以提高脑卒中偏瘫患者的肘关节屈伸肌峰力矩(PT)、平均功率(AP)、总功(TW),结局指标均值差(MD)及其95%置信区间(CI)分别为:2.06[95%CI(1.06,3.05),P<0.01]、6.83[95%CI(-0.38,14.03),P<0.05]、1.69[95%CI(-0.23,3.61),P<0.05]、4.03[95%CI(2.79,5.26),P<0.01]、15.38[95%CI(-6.02,36.78),P<0.05]、28.98[95%CI(25.37,32.58),P<0.01]。等速肌力训练可以降低脑卒中偏瘫患者的改良Ashworth量表(MAS)评分,但差异无统计学意义,结局指标MD及其95%CI为-0.02[95%CI(-0.04,0.01),P>0.05]。漏斗图经Egger′s检验结果显示,本研究Meta分析不存在发表偏倚。结论等速肌力训练对脑卒中偏瘫患者上肢运动功能康复有着积极的治疗效果,在今后的研究中仍需要高质量、大样本的临床随机对照试验来进一步验证等速肌力训练改善脑卒中偏瘫患者上肢运动功能康复的疗效。

Objective To systematically evaluate the effect of isokinetic muscle strength training on the rehabilitation of upper limb motor function for stroke patients with hemiplegia.Methods Literature of randomized controlled trials on the effect of isokinetic muscle strength training on the rehabilitation of upper limb motor function for stroke patients with hemiplegia was retrieved from PubMed and CNKI database by computer,and the retrieval time was from the establishment of the database to October 2020.According to the literature quality assessment criteria recommended by the Cochrane manual,the quality of the included literatures was evaluated,and RevMan 5.3 and Stata 15.0 software were used for Meta-analysis.Results Seven articles were included,with a sample size of 456 cases.Meta-analysis results showed that isokinetic muscle strength training could improve the peak torque(PT),average power(AP)and total work(TW)of elbow joints in stroke patients with hemiplegia,the mean difference(MD)of outcome indicators and its 95%confidence interval(CI)were:2.06(95%CI[1.06,3.05],P<0.01),6.83(95%CI[-0.38,14.03],P<0.05),1.69(95%CI[-0.23,3.61],P<0.05),4.03(95%CI[2.79,5.26],P<0.01),15.38(95%CI[-6.02,36.78],P<0.05),28.98(95%CI[25.37,32.58],P<0.01).Isokinetic muscle strength training could reduce the improved Ashworth scale(MAS)score in stroke patients with hemiplegia,but the difference was not statistically significant,the outcome index MD and its 95%CI were-0.02(95%CI[-0.04,0.01],P>0.05).The results of Egger′s test on funnel plots showed that there was no publication bias in the Meta-analysis of this study.Conclusion Isokinetic muscle strength training has a positive therapeutic effect on the rehabilitation of upper limb motor function for stroke patients with hemiplegia.In the future studies,high-quality and large-sample clinical randomized controlled trials would be needed to further verify the effect of isokinetic muscle strength training to improve the rehabilitation of upper limb motor function for stroke patients with hemiplegia.