5种康复运动对脑卒中患者运动能力有效性的网状Meta分析

Efficacy of five types of rehabilitation exercise therapies on the exercise capacity intervention in stroke patients: a network meta-analysis

目的系统评价八段锦、水中运动、太极拳、体感运动、全身振动训练5种康复运动对脑卒中患者运动能力的干预效果。方法计算机检索Web of Science、PubMed、EMbase、The Cochrane Library、CNKI、CBM、CSJD和WanFang Data数据库,搜集有关5种康复运动干预脑卒中患者运动功能的随机对照试验(RCT),检索时限均从建库至2020年10月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用R软件与ADDIS软件进行网状Meta分析。结果共纳入50个RCT,包括1838例患者。Meta分析结果显示,在脑卒中患者平衡能力方面,5种康复运动均优于常规康复组(P<0.05),八段锦排序最优;在脑卒中患者下肢力量恢复方面,仅水中运动优于常规康复组(P<0.05);脑卒中患者步行功能恢复方面,体感运动、水中运动优于常规康复组(P<0.05),体感运动排序最优。结论当前证据显示,八段锦在提高脑卒中患者平衡能力,体感运动在提高脑卒中患者步行能力,水中运动在提高脑卒中患者下肢力量方面可能更具有优势。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the efficacy of five types of rehabilitation exercises,including Baduanjin,aquatic exercise,Taijiquan,somatosensory exercise and whole body vibration training for the intervention of motor function in stroke patients.Methods Web of Science,PubMed,EMbase,The Cochrane Library,CNKI,CBM,CSJD and WanFang Data databases were electronically searched to collect randomized controlled trials(RCTs)of rehabilitation exercise interventions for motor function in stroke patients from inception to October 2020.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies;then,network meta-analysis was performed by using R and ADDIS software.Results A total of 50 RCTs involving 1838 patients were included.The results of the meta-analysis showed that all five types of rehabilitation exercises were superior to conventional rehabilitation group in terms of balance in stroke patients(P<0.05),with the best ranking occupied by Baduanjin.In terms of lower limb strength,only the aquatic exercise was superior to conventional rehabilitation(P<0.05).In terms of walking function,somatic training and aquatic exercise were superior to conventional rehabilitation(P<0.05),with somatic exercises ranking first.Conclusion Current evidence shows that Baduanjin has an advantage in improving the balance,somatosensory interactive game exercise has an advantage in improving the walking capability and aquatic exercise has an advantage in improving the lower limb strength of stroke patients.Due to limited quality and quantity of the included studies,more high-quality studies are needed to verify the above conclusion.