镜像疗法对脑卒中患者上肢运动功能和日常生活活动能力影响的Meta分析

Effect of mirror therapy on upper extremity motor function and activities of daily living in stroke patients:a meta-analysis

目的系统评价镜像疗法(MT)干预是否能有效改善脑卒中患者上肢运动功能和日常生活活动能力(ADL),其改善效果是否受到患者年龄和病程的影响,MT的干预周期、时间、频次等影响因素是否对改善上肢运动功能和ADL具有剂量效应。方法检索Embase、Web of Science、PubMed、Cochrane Library、万方数据库、维普和中国知网等7个数据库,时间范围为建库至2023年4月。筛选MT对脑卒中患者上肢运动功能和ADL的随机对照试验。采用物理治疗证据数据库(PEDro)量表进行质量评估,采用RevMan 5.4.1进行Meta分析,采用R软件进行网状Meta分析,绘制网状Meta分析表和累计概率表进行排序比较,采用Stata 17.0软件绘制漏斗图检验结局指标发表偏倚情况。采用GRADE对结局指标进行证据质量评价。结果共纳入13篇文献,涉及532例患者。PEDro评分6~8分。多数文献未完整汇报盲法情况或未实施分配隐藏,可能存在一定局限。MT能够提高脑卒中患者的Fugl-Meyer评定量表上肢部分评分(n=466,MD=6.05,95%CI 3.44~8.66,P<0.001)、(改良)Barthel指数(n=230,MD=9.95,95%CI 6.23~13.68,P<0.001)和功能性独立测量评分(n=147,MD=4.17,95%CI 2.61~5.72,P<0.001)。网状Meta分析显示,MT对于40~59岁,病程≤3个月的脑卒中患者上肢运动功能干预效果更好;干预周期≤4周、单次干预时间≤30 min、每天干预时间>30 min和每天2次的MT干预处方对于脑卒中患者的上肢运动功能改善效果更好。结论MT对脑卒中患者上肢运动功能和ADL有较显著的改善效果,上肢运动功能改善效果受到患者年龄和病程的影响,且与干预的周期、时间和频次存在一定程度的剂量效应。

Objective To systematically review whether mirror therapy(MT)intervention can effectively improve upper extremity motor function and activities of daily living(ADL)in stroke patients;whether its improvement is affected by patients'age and disease course;and whether MT's influencing factors,such as intervention period,time,and frequency,have a dosage effect on upper extremity motor function and ADL.Methods Seven databases were searched,including Embase,Web of Science,PubMed,Cochrane Library,Wanfang data,VIP and CNKI from establishment to April,2023,and randomized controlled trials of MT for upper extremity motor function and ADL in stroke patients were screened.Quality assessment was performed using Physiotherapy Evidence Database(PEDro).Meta-analysis was performed using RevMan 5.4.1,and network meta-analysis was performed using R software,reticulated meta-analysis tables and cumulative probability tables were drawn for ranked comparisons,and funnel plots were drawn to test for publication bias of the outcome indicators using Stata 17.0 software.GRADE was used to evaluate the quality of evidence for the outcome indicators.Results A total of 13 papers(532 patients)were included.The PEDro score ranged from 6 to 8.Most of the literature did not report the blinding completely or did not implement allocation concealment,which might have some limitations.MT could improve the scores of Fugl-Meyer Assessment-Upper Extremities(n=466,MD=6.05,95%CI 3.44~8.66,P<0.001),Barthel index(n=230,MD=9.95,95%CI 6.23~13.68,P<0.001)and Functional Independence Measure(n=147,MD=4.17,95%CI 2.61~5.72,P<0.001)in stroke patients.Network meta-analysis showed that MT was more effective in upper limb motor function intervention for stroke patients aged 40 to 59 years with a disease course less than three months;and an intervention period less than four weeks,single intervention time less than 30 minutes,intervention duration daily more than 30 minutes and intervention twice daily might optimize the effects on upper limb motor function.Conclusion MT is effective on upper limb motor function and ADL in stroke patients,and the effect on upper limb motor function is affected by the age and disease course of the patients,as well as the period,time and frequency of intervention.