强制性运动联合疗法促进脑卒中患者康复的网状meta分析

Constraint-induced movement combined therapy to promote the recovery of stroke patients:a network meta-analysis

目的系统评价强制性运动疗法联合其他康复技术对脑卒中患者运动能力及日常生活活动能力的干预效果。方法计算机检索Web of Science、PubMed等8个数据库,检索有关(改良)强制性运动疗法(CIMT)干预脑卒中患者的临床随机对照试验。由2名研究者独立筛选文献、提取资料并评价偏倚风险后,采用软件Stata与ADDIS进行分析。结果共纳入26项研究,涉及9种联合干预方案:CIMT+延续性护理(am)、CIMT+生物反馈(bm)、CIMT+推拿(dm)、CIMT+针刺(em)、CIMT+经颅磁刺激(fm)、CIMT+功能性电刺激(gm)、CIMT+音乐疗法(hm)、CIMT+双侧康复(im)、CIMT+运动想象(jm)。结果显示,在FMA评分方面Rank1为最优概率排序为dm>em>gm>am>c;在提高上肢运动功能上,仅bm优于c,其余相互比较差异均无统计学意义(MD=8.31,95%CI:1.73~14.24,P<0.05);各联合干预方案间比较,im和jm的最优概率排序位列前二;在改善ADL上,jm>em>am>c,BI评分在干预4、8个月时,em疗效均位列第一。结论bm在提高上肢运动功能上较常规方案有明显的改善。CIMT的不同联合疗法对改善脑卒中患者运动能力及日常生活活动能力有不同的优势,dm、em显著提高运动功能,bm、im、em有益于提高上肢运动功能,em提高日常生活自理能力最佳。

Objective To systematically review the efficacy of constraint-induced movement combined therapy on exercise ability and daily living in stroke patients.Methods We searched the Web of Science,PubMed,etc,a total of 8 databases to collect the clinical randomized controlled trials(RCTs)of(modified)constraint-induced movement therapy(CIMT)for rehabilitation in stroke patients.The literature was independently screened by two researchers,they extracted data and assessed the risk of bias of included studies.Then,Stata and ADDIS software performed a network meta-analysis.Results A total of 26 studies involving 9 combined interventions[CIMT+continuous care(am),CIMT+biofeedback(bm),CIMT+massage(dm),CIMT+acupuncture(em),CIMT+transcranial magnetic stimulation(fm),CIMT+functional electrical stimulation(gm),CIMT+music therapy(hm),CIMT+bilateral Rehabilitation(im),CIMT+motor imaging(jm)]were included.Regarding the FMA score,Rank1 was used as the optimal probability ranking,the order was dm>em>gm>am>c.As to improving upper limb motor function,only bm was better than the control group,no significant difference was found among other groups(MD=8.31,95%CI:1.73 to 14.24,P<0.05).Comparisons of various combined interventions showed that the optimal probability of im and jm ranked in the top two.In terms of ADL score,the order was jm>em>am>c;while assessed by BI during the intervention at 4 months and 8 months,em ranked first both.Conclusion The results showed that bm has a significant effect on improving upper limb motor function compared with conventional regimens.Different CIMT combined therapies have different advantages in improving motor ability and daily living ability of stroke patients:dm and em could obviously improve motor function;bm,im,and em markedly improved the motor function of the upper limbs,and em was the optimum to improve the ability of self-care in daily life.