神经肌肉本体感觉促进疗法对脑卒中患者平衡、运动和日常生活活动效果的Meta分析

doi:10.3969/j.issn.1006-9771.2021.05.006

摘要/Abstract

摘要： 目的

分析神经肌肉本体感觉促进疗法(PNF)对脑卒中偏瘫患者平衡功能、运动功能和日常生活活动能力(ADL)的效果。

方法

系统检索PubMed、Embase、中国知网、万方数据库、维普数据库中关于采用PNF康复脑卒中患者运动功能、平衡和ADL的随机对照试验，检索日期建库至2019年12月。主要结局指标为Berg平衡量表(BBS)、Fugl-Meyer评定量表(FMA)、改良Barthel指数(MBI)；次要结局指标为功能性前伸测试(FRT)、躯干功能障碍量表(TIS)、计时起立行走测试(TUGT)。两位研究者独立筛选文献，采用Cochrane风险偏倚评估工具进行质量评价，采用RevMan 5.3软件进行分析。

结果

共纳入13篇文献，共786例患者。PNF明显提高后遗症期患者BBS评分(MD = 3.31, 95%CI 2.58~4.04, P < 0.001)，恢复期患者FMA评分(MD = 8.31, 95%CI 5.68~10.97, P < 0.001)，所有患者MBI评分(MD = 6.84, 95%CI 5.20~8.48, P < 0.001)、FRT距离(MD = 1.11, 95%CI 0.39~1.84, P = 0.003)和TIS评分(MD = 1.75, 95%CI 1.19~2.31, P < 0.001)，显著缩短后遗症期患者TUGT时间(MD = -1.86, 95%CI -2.62~-1.10, P < 0.001)。

结论

PNF能显著改善脑卒中偏瘫患者的平衡、运动功能和ADL。但对不同病程患者，效果不一。有待进一步研究。

关键词: 脑卒中, 神经肌肉本体感觉促进疗法, 平衡, 运动, 日常生活活动, Meta分析

Abstract: Objective

To analyze the effects of proprioceptive neuromuscular facilitation (PNF) on balance, motor and activities of daily living (ADL) for stroke patients.

Methods

The randomized controlled trials about the effects of PNF on motor, balance and ADL in stroke patients were retrieved from PubMed, Embase, CNKI, Wanfang data, and VIP, since establishment to December, 2019. The primary outcome measures were Berg Balance Scale (BBS), Fugl-Meyer Assessment (FMA) and modified Bathel Index (MBI). The secondary outcome measures were Functional Reach Test (FRT), Trunk Impairment Scale (TIS), and Timed 'Up and Go' Test (TUGT). The literatures were independently screened by two investigators, and the quality of the articles was evaluated using the Cochrane Library systematic review criteria, and meta-analysis was performed using RevMan 5.3.

Results

A total of 13 articles were included with 786 stroke patients. PNF increased the score of BBS for sequelae patients (MD = 3.31, 95%CI 2.58 to 4.04, P < 0.001), FMA for recovery patients (MD = 8.31, 95%CI 5.68 to 10.97, P < 0.001); as well as MBI score (MD = 6.84, 95%CI 5.20 to 8.48, P < 0.001), FRT distance (MD = 1.11, 95%CI 0.39 to 1.84, P = 0.003) and TIS score (MD = 1.75, 95%CI 1.19 to 2.31, P < 0.001) for all the patients, and decreased TUGT time for sequelae patients (MD = -1.86, 95%CI -2.62 to -1.10, P < 0.001).

Conclusion

PNF can significantly improve balance, motor and ADL for stroke patients. The effectiveness is various with the course of disease. More high-quality researches are needed.

Key words: stroke, proprioceptive neuromuscular facilitation, balance, motor, activities of daily living, meta-analysis

中图分类号:

R743.3

郭辉,王剑桥,苏国栋,王华伟,樊华,樊祥德,张诗麟,刘洋,王月,吕雪琴,刘惠林. 神经肌肉本体感觉促进疗法对脑卒中患者平衡、运动和日常生活活动效果的Meta分析[J]. 《中国康复理论与实践》, 2021, 27(5): 530-541.

Hui GUO,Jian-qiao WANG,Guo-dong SU,Hua-wei WANG,Hua FAN,Xiang-de FAN,Shi-lin ZHANG,Yang LIU,Yue WANG,Xue-qin LÜ,Hui-lin LIU. Effects of Proprioceptive Neuromuscular Facilitation on Balance, Motor and Activities of Daily Living for Stroke Patients: A Meta-analysis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(5): 530-541.

图/表 12

图1

表1

纳入文献的基本特征"

纳入研究	样本量(男/女, n)	年龄 (岁, T/C)	病程 (T/C)	治疗方案		疗程	结局指标
纳入研究	样本量(男/女, n)	年龄 (岁, T/C)	病程 (T/C)	T	C	疗程	结局指标
靳亚鲁 2018^[16]	32/28	(50.3±9.4)/ (44.4±7.2)	(4.10±0.84)/ (4.47±0.97) d	(n = 30) PNF 10 min，常规康复10 min，立位下健肢抗阻迈步训练10 min	(n = 30) 常规康复30 min	5次/周 8周	BBS FMA TUGT FAC
李鹏 2017^[17]	19/21	(57.1±5.6)/ (55.2±3.5)	< 6个月恢复期患者	(n = 19) PNF联合针灸15 min+对照组治疗	(n = 21) 常规护理、药物治疗，康复训练40 min	6次/周 2个月	FMA BBS
刘钰 2018^[18]	27/15	(58.5±7.8)/ (59.1±5.9)	(77.95±10.02)/ (78.00±9.79) d	(n = 22) PNF 30 min+对照组治疗	(n = 20) 常规药物，常规康复治疗30 min，针灸20 min，上、下肢生物反馈各20 min，气压治疗20 min	5次/周 4周	TIS FMA MBI
王帆 2018^[19]	41/21	(69.2±10.9)/ (69.9±9.6)	(69.23±10.85)/ (61.16±49.17) d	(n = 31) PNF 20 min，虚拟现实平衡训练20 min+对照组治疗	(n = 31) 药物治疗，常规康复治疗20 min	6 d/周 3个月	BBS MBI PASS
辛玉甫 2015^[20]	27/13	(50.6±8.2)/ (52.8±6.8)	(6.4±3.2)/ (5.4±3.6)周	(n = 20) PNF抗阻训练+对照组治疗	(n = 20) 小腿三头肌训练20 min，斜板站立，重心转移，步行训练20 min，每天2次	20 d	下肢FMA CSS BBS 10MWT
何艳宇 2018^[21]	67 (未提及)	35~70	2周~2个月	传统康复组(n = 22)：PNF+关节被动活动、关节松动术、感觉训练、上下肢神经促进技术、日常生活能力训练躯干康复组(n = 23)：躯干关节活动度、躯干各方向选择性运动训练、核心肌群训练	(n = 22)参照中国脑卒中诊治指南进行常规治疗	1个月	MBI FMA
余虹 2018^[22]	59/42	(62.5±10.1)/ (60.1±11.1)	(14.00±4.35)/ (12.90±3.31)个月	(n = 51) PNF 颈部运动模式训练+对照组治疗	(n = 50)常规物理治疗	1次/d 5 d/周 4周	TIS BBS TUG
朱志勇 2017^[23]	47/31	(61.2±3.5)/ (60.8±3.6)	偏瘫早期	(n = 39)PNF治疗50 min+对照组治疗	(n = 39)头针及体针治疗30 min	1次/d 2个月	BBS FMA
Hwangbo 2016^[6]	12/18	(59.4±9.1)/ (55.9±9.8)	(11.2±3.6)/ (10.9±3.5)个月	(n = 15) PNF模式颈部运动30 min+对照组治疗	(n = 15) 传统康复治疗30 min	5次/周 6周	BBS TIS
Kim 2015^[24]	10/10	(65.9±6.2)/ (64.1±3.6)	(11.3±1.1)/ (12.3±1.3)个月	(n = 10) PNF水中运动冲刺者模式和滑冰者模式10 s×10个动作×5组+对照组治疗	(n = 10)神经发育疗法30 min	5次/周 6周	TUGT 10MWT BBS FRT
Seo 2015^[25]	11/9	(62.1±6.2)/ (60.5±2.1)	(14.1±7.0)/ (12.2±5.2)个月	(n = 10)运动训练30 min +PNF斜坡步态训练30 min	(n = 10)运动训练30 min+地面步态训练30 min	3次/周 4周	BBS TUGT FRT
林灵飞 2017^[26]	78/48	(64±6.5)/ (63±7.3)	(42±3.5)/ (43±2.5) d	(n = 63) PNF45 min+对照组治疗	(n = 63) 早期康复护理，良肢位摆放，肢体功能锻炼45 min	1次/d 6周	FMA
钟朝平 2018^[27]	49/51	49.3/ 51.2	3.7/3.45年	(n = 50)用减重步行训练+PNF 30 min	(n = 50)按中国脑卒中康复治疗指南方案治疗	1次/d 8周	FMA SL

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表2

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图7

图8

图9

图10

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纳入研究	条目1	条目2	条目4	条目8	条目9	条目10	条目11	总分	质量
靳亚鲁等2018	是	1	1	1	0	1	1	5	中
李鹏等2017	是	0	1	1	0	1	1	4	中
刘钰等2018	是	1	1	1	1	1	1	6	高
王帆等2018	是	1	1	1	0	1	1	5	中
辛玉甫等2015	是	1	1	1	0	1	1	5	中
何艳宇等2018	是	1	1	1	0	1	1	5	中
余虹等2018	是	1	1	1	0	1	1	5	中
朱志勇等2017	是	0	1	1	0	1	1	4	中
Hwangbo等2016	是	1	1	1	1	1	1	6	高
Kim等2015	是	1	1	1	1	1	1	6	高
林灵飞等2017	是	1	1	1	0	1	1	5	中
钟朝平等2018	是	1	1	1	0	1	1	5	中
Seo等2015	是	1	1	1	1	1	1	6	高

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