CAJ | 학술논문

目的采用Meta分析评价强制性使用运动疗法用于成人脑卒中后偏瘫侧上肢运动功能障碍的康复疗效.方法电子检索PubMed、EBSCO、Ovid、The Cochrane Central Register of Controlled Trails、Embase、Science Citation Index Expanded、HighWire Press、中国生物医学文献数据库(CBMDisc)、中国知网(CNKI)、维普数据库(VIP),文献检索起止时间均为从建库到2009年9月,同时检索纳入文献的参考文献,纳入强制性使用运动疗法用于成人脑卒中后偏瘫侧上肢运动功能障碍的随机对照试验,进行质量评价及资料提取.统计学分析采用RevMan 5.0.22.0软件.结果共纳入12个随机对照试验(共648例).Meta分析结果显示:与神经发育疗法(NDT)、作业疗法等常规康复疗法相比,(改良)强制性使用运动疗法能更好地提高动作效率,缩短标准化动作时间,WMD=-0.01,95%CI(-0.02,0.00);提升偏瘫侧上肢的使用时间与动作品质,动作活动日志(MAL)-使用患手的时间(AOU)比较,WMD=0.910,95%CI(0.54,1.29),动作活动日志(MAL)-患手的动作品质(QOM)比较,WMD=0.91,95% CI(0.56,1.27);更好地改善偏瘫侧上肢灵活性,手臂动作研究测验(ARAT).抓比较,WMD=0.83,95% CI(0.33,1.32);偏瘫侧上肢运动损害降低更为明显,Fugl-Meyer运动功能评分法(FMA)比较,WMD=5.72,95% CI(0.01,11.44);还不能认为强制性运动疗法比常规康复治疗能更好地提高偏瘫侧上肢执行日常生活活动的独立程度.结论现有资料表明,(改良)强制性使用运动疗法在一定程度上可能较常规康复疗法更有效地促进脑卒中患者偏瘫侧上肢功能恢复,但是鉴于现有研究较少,样本量小,质量不高,病程长短差异大,随访时间、结果测量指标不一致,因此需要开展大样本、多中心、方法科学和规范的高质量随机对照试验进一步验证.
목적 채용Meta분석평개강제성사용운동요법용우성인뇌졸중후편탄측상지운동공능장애적강복료효.방법 전자검색PubMed、EBSCO、Ovid、The Cochrane Central Register of Controlled Trails、Embase、Science Citation Index Expanded、HighWire Press、중국생물의학문헌수거고(CBMDisc)、중국지망(CNKI)、유보수거고(VIP),문헌검색기지시간균위종건고도2009년9월,동시검색납입문헌적삼고문헌,납입강제성사용운동요법용우성인뇌졸중후편탄측상지운동공능장애적수궤대조시험,진행질량평개급자료제취.통계학분석채용RevMan 5.0.22.0연건.결과 공납입12개수궤대조시험(공648례).Meta분석결과현시:여신경발육요법(NDT)、작업요법등상규강복요법상비,(개량)강제성사용운동요법능경호지제고동작효솔,축단표준화동작시간,WMD=-0.01,95%CI(-0.02,0.00);제승편탄측상지적사용시간여동작품질,동작활동일지(MAL)-사용환수적시간(AOU)비교,WMD=0.910,95%CI(0.54,1.29),동작활동일지(MAL)-환수적동작품질(QOM)비교,WMD=0.91,95% CI(0.56,1.27);경호지개선편탄측상지령활성,수비동작연구측험(ARAT).조비교,WMD=0.83,95% CI(0.33,1.32);편탄측상지운동손해강저경위명현,Fugl-Meyer운동공능평분법(FMA)비교,WMD=5.72,95% CI(0.01,11.44);환불능인위강제성운동요법비상규강복치료능경호지제고편탄측상지집행일상생활활동적독립정도.결론 현유자료표명,(개량)강제성사용운동요법재일정정도상가능교상규강복요법경유효지촉진뇌졸중환자편탄측상지공능회복,단시감우현유연구교소,양본량소,질량불고,병정장단차이대,수방시간、결과 측량지표불일치,인차수요개전대양본、다중심、방법 과학화규범적고질량수궤대조시험진일보험증.
Objective To evaluate the effectiveness of constraint-induced movement therapy (CIMT),modified CIMT and forced use in the treatment of the upper limbs of adults after stroke. Methods Published ac-counts of trials of these techniques were located through electronic searches of the following databases: PubMed,EBSCO, Ovid, the Cochrane Central Register of Controlled Trails, EMbase, Science Citation Index (Expanded),HighWire Press, CBMDisc, CCTR, CNKI and VIP from the date of establishment of the databases to September 2009. The bibliographies of the articles thus retrieved were also checked. Results A total of 12 trials involving 648 patients were discovered. Meta-analysis showed that CIMT has been shown to increase movement efficiency, reduce normalized movement time, increase use of the more affected arm, improve the quality of use of the more affected arm and reduce the impact of the affected arm. C1MT showed no significant effect in improving independence in daily life compared with traditional rehabilitation. Conclusions To some extent, (modified) CIMT promotes arm rehabilita-tion after stroke effectively. However, these studies were small and their quality was poor. They had different follow-up points, assessed with different rating scales, and the course of stroke in the studies was also different. So more high-quality and large-scale randomized controlled trials are needed.