远程康复应用于卒中后功能康复有效性的系统评价再评价

Effectiveness of Telerehabilitation Applied to Functional Recovery after Stroke:an Overview of Systematic Reviews

背景远程康复(TR)是一种新兴的康复服务提供模式,其基于通信、远程感知与控制、虚拟现实/增强和计算机技术实现跨越地区的康复医疗服务,但目前TR运用于卒中后功能康复的有效性尚不明确,且相关研究方法学质量良莠不齐,较少有研究者对其进行系统性地评价。目的对关于TR应用于卒中后功能康复有效性的系统评价/Meta分析进行再评价。方法于2021年8月,计算机检索PubMed、Web of Science、The Cochrane Library、维普中文科技期刊全文数据库、万方数据知识服务平台、中国知网和中国生物医学文献数据库,获取有关TR应用于卒中后功能康复有效性的系统评价/Meta分析,检索时限为建库至2021年8月。由2名研究者独立筛选文献、提取资料后,采用AMSTAR 2量表对纳入文献方法学质量进行评价,采用GRADE系统对纳入文献结局指标进行证据质量分级。采用描述性分析法对TR应用于卒中后功能康复的有效性进行分析。结果共纳入10项系统评价/Meta分析,AMSTAR 2评价结果显示:2项研究方法学质量为高,3项研究方法学质量为低,5项研究方法学质量为极低。未报告前期研究方案、排除研究清单与理由、原始研究发表偏倚及其资金来源等是导致研究方法学质量较低的主要原因。GRADE证据质量评价结果显示:10项系统评价/Meta分析涉及的7种结局指标、41个证据体中,8个GRADE分级为中级,23个GRADE分级为低级,10个GRADE分级为极低级。TR在一定程度上促进了卒中后患者日常生活活动能力、运动功能、生活质量、抑郁症状、言语功能等的改善,与“面对面”的康复治疗或常规护理具有同等疗效,甚至部分TR疗法的干预效果优于传统康复疗法。结论TR可促进卒中患者功能康复,但考虑到目前关于TR应用于卒中后功能康复有效性的系统评价/Meta分析的方法学质量和结局指标可靠程度大多偏低,仍需严格、规范、全面开展高质量的随机对照试验来提供证据支持。本研究结果可为未来TR研究的选题、设计及成果报告提供借鉴。

Background Telerehabilitation(TR)is an emerging model of rehabilitation service delivery based on communication technology,remote sensing and control technology,virtual reality technology and computer technology to to achieve cross-regional rehabilitation medical services.However,the effectiveness of TR in functional rehabilitation after stroke is still unclear,the methodological quality of related studies is uneven,and few researchers have systematically evaluated it.Objective To re-evaluate the systematic reviews/meta-analyses on the effectiveness of TR for functional rehabilitation after stroke.Methods In August 2021,PubMed,Web of science,the Cochrane Library,VIP,WanFang Data,CNKI and CBM were retrieved by computer for systematic reviews/meta-analyses on the effectiveness of TR applied to functional rehabilitation after stroke from the establishment of the database to August 2021.After the literature screen and data extract by two researchers independently,the methodological quality of the included literature was evaluated by AMSTAR 2 scale,and the evidence quality of the outcome index was graded by GRADE system.Descriptive analysis was used to analyze the effectiveness of TR in functional rehabilitation after stroke.Results A total of 10 systematic reviews/meta-analyses were included,and the results of the AMSTAR 2 review showed that 2 systematic reviews were of high quality,3 were of low quality,and 5 were of very low quality.The main reasons for the low methodological quality were the failure to report the preliminary study protocol,the list and reasons for excluded studies,the publication bias of the original study and the funding sources.The GRADE evidence quality assessment resulted in 10 systematic reviews addressing seven outcome measures,41 bodies of evidence,with eight grade graded as intermediate,23 grade graded as low,and 10 grade graded as very low.TR promoted the improvement of activities of daily living,motor function,quality of life,depressive symptoms and speech function of stroke patients to a certain extent,and had the same curative effect as face-to-face rehabilitation therapy or routine treatment,and even some TR rehabilitation effects were better than traditional rehabilitation therapy.Conclusion TR can promote the functional rehabilitation of stroke patients,but considering that the methodological quality and reliability of outcome measures of current systematic reviews/meta-analyses on the effectiveness of TR applied to functional recovery after stroke are mostly low,strict,standardized and comprehensive high-quality randomized controlled trials are still needed to provide evidence support;The results of this study can provide reference for the topic selection,research design and results report of future TR research.