等速肌力训练改善脑卒中后患者下肢功能情况的系统评价和meta分析

Systematic review and meta-analysis of isokinetic muscle training to improve lower limb function in post-stroke patients

目的系统评价等速肌力训练治疗脑卒中后患者膝关节肌力、功能性步行能力及动态平衡的康复效果。方法计算机检索PubMed、Ovid Embase、Web of Science、Cochrane Library、中国知网、维普和万方数据库,检索截止到2022年10月的所有关于脑卒中后下肢等速肌力训练的随机对照试验。运用Endnote X9软件进行文献的整理归纳。使用Cochrane 5.1.0版手册进行质量评价,采用RevMan 5.4软件对文献数据进行meta分析。结果研究共纳入20篇随机对照试验,干预组采用下肢等速肌力训练或结合常规康复训练,对照组采用常规康复训练或/和相关干预措施,共纳入1448例研究对象。Meta分析结果显示:干预组与对照组屈膝峰力矩[均数差(mean difference,MD)=5.85 N·m,95%置信区间(confidence interval,CI)(4.84,6.85)N·m,P<0.00001]、伸膝峰力矩[MD=9.09 N·m,95%CI(4.83,13.36)N·m,P<0.0001]、“起立-行走”计时测试[MD=–4.70 s,95%CI(–6.68,–2.72)s,P<0.00001]、10米步行测试[MD=–4.71 s,95%CI(–9.12,–0.31)s,P=0.04]、下肢运动功能评分[MD=6.61分,95%CI(3.52,9.70)分,P<0.0001]、Berg平衡量表评分[MD=5.61分,95%CI(0.91,10.31)分,P=0.02]差异有统计学意义。结论等速肌力训练可能改善脑卒中后患者的膝关节肌力,提高功能性步行能力,但对于患者运动功能和平衡的改善仍缺乏有力证明。

Objective To systematically review the rehabilitation effect of isokinetic muscle training on knee muscle strength,functional walking ability and dynamic balance in post-stroke patients.Methods PubMed,Ovid Embase,Web of Science,Cochrane Library,China National Knowledge Infrastructure,Chongqing VIP,and Wanfang databases were searched online for randomized controlled trials on isokinetic muscle training of lower limbs in poststroke patients.The retrieval time was from inception to October,2022.Endnote X9 software was used to manage the literature.Cochrane Manual 5.1.0 was used for quality assessment,and RevMan 5.4 software was used for meta-analysis.Results A total of 20 randomized controlled trials were included in the study,with the intervention group using isokinetic muscle training of the lower extremities or combined with conventional rehabilitation training and the control group using conventional rehabilitation training and/or other intervention,with a total of 1448 study subjects.Metaanalysis results showed that the differences in knee flexion peak torque[mean difference(MD)=5.85 N·m,95%confidence interval(CI)(4.84,6.85)N·m,P<0.00001],knee extension peak torque[MD=9.09 N·m,95%CI(4.83,13.36)N·m,P<0.0001],Time Up Go test[MD=–4.70 s,95%CI(–6.68,–2.72)s,P<0.00001],10-meter walking test[MD=–4.71 s,95%CI(–9.12,–0.31)s,P=0.04],Fugl-Meyer Lower Extremity Motor Function Assessment score[MD=6.61,95%CI(3.52,9.70),P<0.0001],and Berg Balance Scale score[MD=5.61,95%CI(0.91,10.31),P=0.02]were statistically significant.Conclusion Isokinetic training may improve knee strength and functional walking ability in post-stroke patients,but there is still no strong evidence of improvement in motor function and balance.