中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2017, Vol. 12 ›› Issue (9): 1443-1450.doi: 10.4103/1673-5374.215255

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

强制性运动疗法治疗急性或亚急性脑卒中：涉及16项随机对照试验的meta分析

  

  • 收稿日期:2017-07-03 出版日期:2017-09-15 发布日期:2017-09-15
  • 基金资助:

    山东省自然科学基金项目（2014ZRB14502）

Constraint-induced movement therapy in treatment of acute and sub-acute stroke: a meta-analysis of 16 randomized controlled trials

Xi-hua Liu1, 2, Juan Huai1, Jie Gao3, Yang Zhang1, Shou-wei Yue1   

  1. 1 Department of Physical Medicine & Rehabilitation, Qilu Hospital, Shandong University, Jinan, Shandong Province, China
    2 Department of Physical Medicine & Rehabilitation, The Affiliated Hospital of Shandong Traditional Chinese Medicine University, Jinan,
    Shandong Province, China
    3 Shandong Institute of Prevention and Control for Endemic Disease, Jinan, Shandong Province, China
  • Received:2017-07-03 Online:2017-09-15 Published:2017-09-15
  • Contact: Shou-wei Yue, Ph.D.,shouweiyue1224@163.com.
  • Supported by:

    This study was supported by the Natural Science Foundation of Shandong Province of China, No. 2014ZRB14502.

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摘要：

 目的：评价强制性运动疗法治疗急性或亚急性脑卒中的效果。

资料来源：以卒中(stroke)，脑血管事件(cerebrovascular accident)，强制性运动疗法(constraint-induced therapy)，强迫使用(forced use)和随机对照试验(RCT)为关键词，在中国知网、万方、维普、CBM、PubMed、Medline、EMbase、Cochrane临床对照试验中心注册数据库和Cochrane协作网系统评价数据库检索截止至2016年3月的关于强制性运动疗法治疗急性或亚急性脑卒中的随机对照试验研究。
资料选择：纳入强制性运动疗法与传统康复疗法(传统职业疗法)治疗急性或亚急性卒中的随机对照试验，其中患者应大于18岁，病程少于6个月，并至少接受一项上肢功能量表评价。对文章质量进行评价，提取合格数据，以Stata 11.0软件进行meta分析。
结局评价指标：上肢Fugl–Meyer运动评价量表评分、手臂动作调查测试量表评分、运动活动量表评分、Wolf运动功能测试量表评分和改良Barthel指数。
结果：共纳入16项前瞻性随机对照试验，包含379例进行强制性运动疗法治疗的患者以及359例使用传统康复疗法治疗的患者。结果表明，与传统康复疗法相比，强制性运动疗法治疗对患者上肢Fugl–Meyer运动评价量表(WMD  = 10.822; 95% CI: 7.419–14.226)、手臂动作调查测试量表(WMD = 10.718; 95% CI: 5.704–15.733)、运动活动量表(WMD = 0.812; 95% CI: 0.331–1.293)和改良Barthel指数评分(WMD = 10.706; 95% CI: 4.417–16.966)影响更为显著。

结论：强制性运动疗法在改善患者上肢功能方面对于急性或亚急性脑卒中更为有效。

orcid:0000-0002-1285-0702(Shou-wei Yue)

关键词: 神经再生, 脑卒中, 强制性运动疗法, Meta分析, 上肢功能, 康复, 强度

Abstract:

OBJECTIVE: The aim of this meta-analysis was to evaluate the clinical efficacy of constraint-induced movement therapy in acute and sub-acute stroke.
DATA SOURCES: The key words were stroke, cerebrovascular accident, constraint-induced therapy, forced use, and randomized controlled trial. The databases, including China National Knowledge Infrastructure,WanFang, Weipu Information Resources System, Chinese Biomedical Literature Database, PubMed, Medline,Embase, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews, were searched for studies on randomized controlled trials for treating acute or sub-acute stroke published before March 2016.
DATA SELECTION: We retrieved relevant randomized controlled trials that compared constraint-induced movement therapy in treatment of acute or sub-acute stroke with traditional rehabilitation therapy (traditional occupational therapy). Patients were older than 18 years, had disease courses less than 6 months, and were evaluated with at least one upper extremity function scale. Study quality was evaluated, and data that met the criteria were extracted. Stata 11.0 software was used for the meta-analysis.
OUTCOME MEASURES: Fugl-Meyer motor assessment of the arm, the action research-arm test, a motor activity log for amount of use and quality of movement, the Wolf motor function test, and a modified Barthel index.
RESULTS: A total of 16 prospective randomized controlled trials (379 patients in the constraint-induced movement-therapy group and 359 in the control group) met inclusion criteria. Analysis showed significant mean differences in favor of constraint-induced movement therapy for the Fugl–Meyer motor assessment of the arm (weighted mean difference (WMD) = 10.822; 95% confidence intervals (95% CI): 7.419–14.226),the action research-arm test (WMD = 10.718; 95% CI: 5.704–15.733), the motor activity log for amount of use and quality of movement (WMD = 0.812; 95% CI: 0.331–1.293) and the modified Barthel index (WMD = 10.706; 95% CI: 4.417–16.966).
CONCLUSION: Constraint-induced movement therapy may be more beneficial than traditional rehabilitation therapy for improving upper limb function after acute or sub-acute stroke.

Key words: nerve regeneration, stroke, constraint-induced movement therapy, meta-analysis, upper extremity function, rehabilitation, intensity, neural regeneration