不同康复方式治疗偏瘫型脑性瘫痪患儿上肢功能障碍疗效的网状meta分析

Effectiveness of different rehabilitation therapies for treating upper extremity dysfunction in children with hemiplegic cerebral palsy:a network meta-analysis

目的探讨网状meta分析方法评价不同康复方式治疗偏瘫型脑性瘫痪(HCP)患儿上肢功能障碍的疗效。方法检索关于强制性运动疗法(CIMT)、手-臂双侧强化训练(BIM)及常规康复训练(CR)改善HCP患儿上肢功能的随机对照研究,检索时限从建库到2019年11月。按照纳入标准进行文献筛选,采用Stata 14.0软件进行网状meta分析。结果在上肢活动度评价中,CIMT+CR与BIM+CR的治疗效果明显优于CR(SMD:3.56,95%CI:0.49~8.64;SMD:5.17,95%CI:0.44~9.37),网状meta分析发现CIMT+BIM(47%)排名等级最高。在上肢参与度评价中,CIMT+CR的治疗效果明显优于CR(SMD:1.83,95%CI:0.33~5.34),网状meta分析发现CIMT+BIM(58%)排名等级最高。结论CIMT+CR在改善HCP患儿上肢活动的疗效优于CR,CIMT+BIM为最有效的康复治疗方法。

Objective To assess the effects of different rehabilitation therapies in treating the upper extremity dysfunction of children patients with hemiplegic cerebral palsy(HCP)by network meta analysis.Methods The randomized controlled trials(RCT)of the constraint induced movement therapy(CIMT),bimanual intensive training(BIM)and convention rehabilitation(CR)on the improvement of upper limb function in children patients with HCP were retrieved from the database establishment to November 2019.The literature was screened according to the inclusion criteria,and network meta analysis was performed by using the Stata 14.0 software.Results In the evaluation of upper extremity activity,the treatment effects of CIMT+CR and BIM+CR were superior to CR(SMD:3.56,95%CI:0.49-8.64 and SMD:5.17,95%CI:0.44-9.37).The network meta analysis found that CIMT+BIM had the highest rank grade(47%).In the evaluation of upper limb participation,the treatment effect of CIMT+CR was significantly superior to that of CR(SMD:1.83,95%CI:0.33-5.34).The network meta analysis found that CIMT+BIM had the highest rank grade(58%).Conclusion CIMT+CR is significantly better than CR in improving upper limb movement in children patients with HCP,and CIMT+BIM is the most effective rehabilitation method.