经皮神经电刺激疗法对脑卒中偏瘫患者下肢功能康复效果的Meta分析

Rehabilitation effect of transcutaneous electrical nerve stimulation on lower extremity function in patients with stroke and hemiplegia:Meta-analysis

目的:探讨经皮神经电刺激(TENS)对脑卒中偏瘫患者下肢功能的康复效果。方法:查阅中国知网(CNKI)、万方、维普等数据库,根据纳入和排除标准筛选文献,并进行文章质量评价和数据提取,使用RevMan5.3进行Meta分析。结果:Meta分析结果显示,与常规治疗组比较,TENS可显著提高脑卒中偏瘫患者Fugl-Meyer下肢功能评定量表评分[均数差(MD)=4.07,95%CI(3.05,5.08),Z=7.86,P=0.001],改良的Ashworth量表评分[标准化均数差(SMD)=-1.03,95%CI(-1.29,-0.76),Z=7.61,P=0.001]。根据干预时间进行亚组分析显示,TENS干预30min[SMD=-0.80,95%CI(-1.20,-0.39),Z=3.81,P=0.001]、干预60min[SMD=-1.06,95%CI(-1.46,-0.67),Z=5.27,P=0.001]可显著提高患者痉挛评分。根据干预周期进行亚组分析显示,TENS干预≤4周可显著提高患者痉挛评分[SMD=-0.77,95%CI(-1.42,-0.11),Z=2.29,P=0.02]。结论:对脑卒中偏瘫患者下肢进行干预时间为30min且干预周期≤4周的TENS,可显著提高患者下肢功能康复效果。

Objective:To explore rehabilitation effect of transcutaneous electrical nerve stimulation(TENS)on lower extremity function in patients with stroke and hemiplegia.Methods:Databases including China National Knowledge Infrastructure(CNKI),Wanfang,VIP etc.were searched.Literature were screened according to inclusion and exclusion criteria,while article quality assessment and data extraction were performed,and RevMan5.3 software was used to perform Meta analysis.Results:Meta analysis indicated that compared with routine treatment group,TENS can significantly increase scores of Fugl-Meyer assessment-lower extremity[mean difference(MD)=4.07,95%CI(3.05,5.08),Z=7.86,P=0.001]and modifined Ashworth scale[standardized mean difference(SMD)=-1.03,95%CI(-1.29,-0.76),Z=7.61,P=0.001]in patients with stroke and hemiplegia.Subgroup analysis according to intervention duration indicated that TENS intervention for 30 min[SMD=-0.80,95%CI(-1.20,-0.39),Z=3.81,P=0.001]and 60 min[SMD=-1.06,95%CI(-1.46,-0.67),Z=5.27,P=0.001]can significantly increase spasm score in patients with stroke and hemiplegia.Subgroup analysis according to intervention period indicated that TENS intervention≤4 weeks can significantly increase spasm score[SMD=-0.77,95%CI(-1.42,-0.11),Z=2.29,P=0.02]in these patients.Conclusion:TENS of 30min for≤4 weeks can significantly improve rehabilitation effect of lower extemity function in patients with stroke and hemiplegia.