反复促通疗法对脑卒中患者运动功能康复效果的Meta分析

A Meta-analysis of the effect of repetitive facilitative exercises on motor function rehabilitation in stroke patients

目的系统评价反复促通疗法对脑卒中患者运动功能康复效果的影响,为脑卒中患者康复治疗方案提供依据。方法检索PubMed、Web of Science、the Cochrane Library、Embase、知网、万方、维普、中国生物医学文献服务系统等8个数据库中对康复期脑卒中患者进行有关反复促通疗法的随机对照试验,检索时限为建库至2023年12月,由2名研究者独立筛选文献,提取资料并评价其质量,使用RevMan 5.4软件进行统计分析。结果最终纳入20篇文献,共1597例患者。Meta分析结果显示:与对照组相比,试验组可提高患者Fugl-Meyer上肢功能评分[MD=7.03,95%CI(4.26,9.81),P<0.00001]、Fugl-Meyer下肢功能评分[MD=6.04,95%CI(4.00,8.08),P<0.00001]、Fugl-Meyer手指功能评分[MD=3.79,95%CI(3.44,4.13),P<0.00001]、改良Barthel指数(MBI)[MD=10.11,95%CI(6.54,13.68),P<0.00001]、平衡能力评分(BBS)[MD=7.48,95%CI(4.94,10.01),P<0.00001],10 m步行时间测试(10MWT)[MD=-4.46,95%CI(-6.92,-2.01),P<0.00001]、步行功能评分(FAC)[MD=1.76,95%CI(1.05,2.47),P<0.00001],以上差异均有统计学意义(P<0.05);两组改良Ashworth痉挛量表评分(MAS)[MD=-0.13,95%CI(-0.37,-0.12),P=0.32],上肢动作研究量表评分(ARAT)[MD=2.98,95%CI(-3.12,9.08),P=0.34],差异无统计学意义。结论反复促通疗法能改善脑卒中患者上下肢运动功能和日常生活活动能力。

Objective To systematically evaluate the effect of repetitive facilitative exercises on the rehabilitation of motor function in stroke patients,and to provide evidence for rehabilitation treatment of stroke patients.Methods Randomized controlled trials(RCTs)on repetitive facilitative exercises for stroke patients during rehabilitation were searched in 8 databases,including PubMed,Web of Science,the Cochrane Library,Embase,China National Knowledge Infrastructure(CNKI),Wanfang,VIP and China Biomedical Literature Service System.The search period was from the establishment of the database to December 2023.Two researchers independently screened literatures,extracted data and evaluated their quality.Statistical analysis was performed using RevMan 5.4 software.Results Twenty literatures with a total of 1597 patients were included.The results of Meta-analysis showed significant differences in the Fugl-Meyer upper limb function score(MD=7.03,95%CI:4.26,9.81;P<0.00001),Fugl-Meyer lower limb function score(MD=6.04,95%CI:4.00,8.08;P<0.00001),Fugl-Meyer finger function score(MD=3.79,95%CI:3.44,4.13;P<0.00001),modified Barthel index(MBI)(MD=10.11,95%CI:6.54,13.68;P<0.00001),Berg balance scale(BBS)score(MD=7.48,95%CI:4.94,10.01;P<0.00001),10-meter walk test(10MWT)(MD=-4.46,95%CI:-6.92,-2.01;P<0.00001)and functional ambulation categories(FAC)score(MD=1.76,95%CI:1.05,2.47;P<0.00001)between control group and experimental group.There were no significant differences in the modified ashworth spasticity scale(MAS)score(MD=-0.13,95%CI:-0.37,-0.12;P=0.32)and the action research arm test(ARAT)score(MD=2.98,95%CI:-3.12,9.08;P=0.34).Conclusion Repetitive facilitative exercises improve the motor function of upper and lower limbs and the ability of daily living in stroke patients.