运动联合认知双任务训练对脑卒中患者认知功能与步态功能的Meta分析

Exercise joint cognitive dual-task training on cognitive and gait function in stroke patients:Meta-analysis

目的 系统评价运动联合认知双任务训练对脑卒中患者认知功能与步态功能的改善效果,探究改善脑卒中患者的认知功能和步态功能最佳运动联合认知训练(EJCT)方案。方法 检索Web of Science、PubMed、Cochrane library、Embase、中国知网、万方数据库和中国生物医学文献数据库,检索从建库至2023年11月1日公开发表的运动联合认知双任务训练对脑卒中患者认知功能与步态功能的随机对照试验研究。使用Stata 17.0软件进行传统Meta分析和网状Meta分析。结果 共纳入37项研究,涉及3种EJCT方式,包括EJCT(同时)、VR EJCT(同时)和EJCT(非同时),其中实验组703人,对照组729人,有14篇文献实施了盲法,干预周期平均为5.6周。37项研究PEDro得分平均分为6.32分,SD=1.07,总体上方法学质量良好。网状Meta分析显示,以常规治疗作为对照组,运动联合认知训练(同时进行)改善脑卒中患者认知功能(SMD=1.04,95%CI:0.37~1.71)和步态功能(SMD=0.93,95%CI:0.28~1.57)的效果好于运动联合认知训练(非同时)、虚拟现实训练、运动训练、认知训练。结论 同时进行的运动联合认知双任务训练对脑卒中患者的认知功能和步态功能具有最佳的改善效果。

Objective To evaluate systematically the effect of exercise combined with cognitive dual-task training on the improvement of cognitive function and gait function in stroke patients,and explore the best exercise joint cognitive training program for improving the cognitive function and gait function in stroke patients.Methods Web of Science,PubMed,Cochrane library,Embase,China National Knowledge Infrastructure,Wanfang database and China Biology Medicine disc were searched,and the randomized controlled trials of cognitive function and gait function in stroke patients from the establishment of the database to November 1,2023 were retrieved.Stata17.0 software was used for the traditional Meta analysis and network Meta-analysis.Results A total of 37 studies involving 3 exercise joint cognitive training modalities were included,including the exercise joint cognitive training(concurrent),virtual reality training,and exercise joint cognitive training(concurrent),the exercise joint cognitive training(non-concurrent),with the experimental group(703 cases)and the control group(729 cases),and 14 papers implemented blinding,with a mean intervention period of 5.6 weeks.The mean PEDro score of the 37 studies was 6.32 with SD=1.07,which was generally of good methodological quality.The network Meta-analysis showed that the conventional therapy served as the control group,the exercise joint cognitive training(simultaneously)improved cognitive function in stroke patients(SMD=1.04,95%CI:0.37-1.71)and gait function(SMD=0.93,95%CI:0.28-1.57),the effect of the exercise joint cognitive training(concurrent)was better than that of the exercise combined cognitive training(non-concurrent),virtual reality training,exercise training,and cognitive training.Conclusion Concurrent exercise joint cognitive dual-task training provides the optimal improvement effect on cognitive and gait function of stroke patients.