基于ICD-11和ICF脊髓损伤患者运动康复干预方案及其健康效益:系统综述的系统综述

Exercise rehabilitation interventions for people with spinal cord injury and their health benefits:a systematic review of systematic reviews based on ICD-11 and ICF

目的基于《国际疾病分类第十一次修订本》(ICD-11)和《国际功能、残疾和健康分类》(ICF)对不同类型运动康复及相关干预对脊髓损伤患者身体结构和功能、活动和参与、生活质量的影响的系统综述进行系统综述。方法检索PubMed、Embase、EBSCO、Web of Science、中国知网,收集2015年1月至2023年1月公开发表的有关脊髓损伤患者运动康复及其健康效益的系统综述,进行系统综述。结果最终纳入8篇英文文献,来自加拿大、美国、韩国、澳大利亚、巴西和荷兰,主要来源于物理医学与康复、神经医学与康复、运动干预等领域,发表日期主要集中在2015年至2021年。共涉及165项随机对照试验,2746例参与者,年龄18~65岁。疾病类型包括脊髓损伤(完全性、不完全性)、四肢瘫、截瘫(胸椎、腰椎和骶椎损伤)、运动神经元损伤(上、下)。干预包括3类:被动干预,采用运动辅助设备,如动力外骨骼辅助机器人、电自行车等,以及功能性电刺激;主动干预,如步进运动,平地训练、户外行走和进行日常生活活动等;混合干预(主动+被动),运动与功能性电刺激相结合、运动与运动辅助设备相结合。干预频率为每次10~240 min,每周2~18次,干预强度为低~剧烈,持续1~456周。干预场所主要涉及家庭、社区卫生服务中心、运动场馆。干预可改善心血管,提高腿部血流速度;改善肌肉骨骼结构与提高肌肉力量、耐受性、柔韧性;减缓痉挛,提高神经系统的反射兴奋性;提高步态速度,增加步行距离;提高功能独立性水平,如改善排便规律;改善身体健康状况,如降低痉挛程度、减少药物使用(如巴氯芬)、提高感染免疫反应水平、降低患病风险(血管性痴呆和呼吸系统疾病);改善心理状况。结论本研究基于ICD-11和ICF构建脊髓损伤患者参与主动或被动运动康复及相关干预的研究架构。脊髓损伤患者可通过被动干预(运动辅助设备、功能性电刺激)、主动干预(步进运动、户外行走等)、混合干预(运动与功能性电刺激相结合、运动与运动辅助设备相结合)改善身体结构与功能,提高活动和参与水平,改善生活质量与福祉。

Objective Based on the International Classification of Diseases,Eleventh Revision(ICD-11)and the International Classification of Functioning,Disability and Health(ICF),systematic reviews about the effects of different types of exercise rehabilitation and related interventions on body structure and function,activity and participation,and quality of life in people with spinal cord injury(SCI)were systematically reviewed.Methods Systematic reviews of exercise rehabilitation and health benefits in patients with spinal cord injury were searched from PubMed,Embase,EBSCO,Web of Science and CNKI,from January,2015 to January,2023.Results Eight English articles were included,from Canada,the United States,South Korea,Australia,Brazil and Netherlands,derived from the fields of physical medicine and rehabilitation,neuromedicine and rehabilitation,and exercise intervention,with the publication date mainly concentrated from 2015 to 2021.A total of 165 randomized controlled trials were involved,with 2746 participants,aged 18 to 65 years.The diseases were mainly spinal cord injury(complete or incomplete),quadriplegia,paraplegia(thoracic,lumbar and sacral injuries),and motor neuron injury(upper and lower).There were three main types of interventions:passive intervention,using sports assistive devices,such as powered exoskeleton-assisted robots,electric bicycles,etc.,and functional electrical stimulation;active interventions,such as stepping exercises;training on flat ground,outdoor walking,and activities of daily living;mixed intervention(active&passive),such as combination of exercise and functional electrical stimulation,combination of exercise and motor assistive devices.The frequency of intervention was ten to 240 minutes a time,two to 18 times a week,with the intensity of low to vigorous,for one to 456 weeks.The intervention sites mainly involved families,community health service centers and sports venues.The health impact mainly involved improving cardiovascular and increasing blood flow velocity in the legs;improving musculoskeletal structure,as well as muscle strength,tolerance and flexibility;relieving spasms and improving reflex excitability of the nervous system;increasing gait speed and walking distance;improving functional independence,such as bowel regularity;improving physical health,such as reducing spasticity and drug use(e.g.,baclofen),increasing the immune response to infection,and reducing the risk of disease(vascular dementia and respiratory disease);and improving psychological condition.Conclusion Based on ICD-11 and ICF,this study constructed a research framework for active or passive exercise rehabilitation and related interventions in patients with spinal cord injury.Patients with spinal cord injury can improve their body structure and function,increase their activity and participation,and improve their quality of life and well-being through passive interventions(using motor assistive devices,functional electrical stimulation),active interventions(such as stepping exercises,outdoor walking,etc.),and mixed interventions(combining exercise and functional electrical stimulation,exercise and sports assistive devices).