镜像疗法对脑卒中患者上肢运动功能和日常生活活动能力影响的Meta分析

doi:10.3969/j.issn.1006-9771.2024.03.005

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (3): 281-291.doi: 10.3969/j.issn.1006-9771.2024.03.005

镜像疗法对脑卒中患者上肢运动功能和日常生活活动能力影响的Meta分析

魏辰¹, 王子贤¹, 李淑璠², 王芃², 贾舒祺², 田英¹()

1.沈阳师范大学，辽宁沈阳市 110034
2.上海体育大学，上海市 200438

收稿日期:2023-09-23 修回日期:2024-01-25 出版日期:2024-03-25 发布日期:2024-04-01
通讯作者: 田英 E-mail:tianying@synu.edu.cn
作者简介:魏辰(2000-)，男，汉族，安徽南陵县人，硕士研究生，主要研究方向：运动生物力学。
田英，女，硕士研究生导师，教授，主要研究方向：运动与健康促进。
基金资助:
中国高等教育学会2021年度体育专项课题重点项目(21TYZD04)

Effect of mirror therapy on upper extremity motor function and activities of daily living in stroke patients: a meta-analysis

WEI Chen¹, WANG Zixian¹, LI Shufan², WANG Peng², JIA Shuqi², TIAN Ying¹()

1. Shenyang Normal University, Shenyang, Liaoning 110034, China
2. Shanghai University of Sport, Shanghai 200438, China

Received:2023-09-23 Revised:2024-01-25 Published:2024-03-25 Online:2024-04-01
Contact: TIAN Ying E-mail:tianying@synu.edu.cn
Supported by:
2021 Sports Special Project of China Association of Higher Education(21TYZD04)

摘要/Abstract

摘要：

目的系统评价镜像疗法(MT)干预是否能有效改善脑卒中患者上肢运动功能和日常生活活动能力(ADL)，其改善效果是否受到患者年龄和病程的影响，MT的干预周期、时间、频次等影响因素是否对改善上肢运动功能和ADL具有剂量效应。

方法检索Embase、Web of Science、PubMed、Cochrane Library、万方数据库、维普和中国知网等7个数据库，时间范围为建库至2023年4月。筛选MT对脑卒中患者上肢运动功能和ADL的随机对照试验。采用物理治疗证据数据库(PEDro)量表进行质量评估，采用RevMan 5.4.1进行Meta分析，采用R软件进行网状Meta分析，绘制网状Meta分析表和累计概率表进行排序比较，采用Stata 17.0软件绘制漏斗图检验结局指标发表偏倚情况。采用GRADE对结局指标进行证据质量评价。

结果共纳入13篇文献，涉及532例患者。PEDro评分6~8分。多数文献未完整汇报盲法情况或未实施分配隐藏，可能存在一定局限。MT能够提高脑卒中患者的Fugl-Meyer评定量表上肢部分评分(n = 466, MD =6.05, 95%CI 3.44~8.66, P < 0.001)、(改良)Barthel指数(n = 230, MD = 9.95, 95%CI 6.23~13.68, P < 0.001)和功能性独立测量评分(n = 147, MD = 4.17, 95%CI 2.61~5.72, P < 0.001)。网状Meta分析显示，MT对于40~59岁，病程≤ 3个月的脑卒中患者上肢运动功能干预效果更好；干预周期≤ 4周、单次干预时间≤ 30 min、每天干预时间> 30 min和每天2次的MT干预处方对于脑卒中患者的上肢运动功能改善效果更好。

结论 MT对脑卒中患者上肢运动功能和ADL有较显著的改善效果，上肢运动功能改善效果受到患者年龄和病程的影响，且与干预的周期、时间和频次存在一定程度的剂量效应。

关键词: 脑卒中, 镜像疗法, 上肢, 运动功能, 日常生活活动能力, Meta分析

Abstract:

Objective To systematically review whether mirror therapy (MT) intervention can effectively improve upper extremity motor function and activities of daily living (ADL) in stroke patients; whether its improvement is affected by patients' age and disease course; and whether MT's influencing factors, such as intervention period, time, and frequency, have a dosage effect on upper extremity motor function and ADL.

Methods Seven databases were searched, including Embase, Web of Science, PubMed, Cochrane Library, Wanfang data, VIP and CNKI from establishment to April, 2023, and randomized controlled trials of MT for upper extremity motor function and ADL in stroke patients were screened. Quality assessment was performed using Physiotherapy Evidence Database (PEDro). Meta-analysis was performed using RevMan 5.4.1, and network meta-analysis was performed using R software, reticulated meta-analysis tables and cumulative probability tables were drawn for ranked comparisons, and funnel plots were drawn to test for publication bias of the outcome indicators using Stata 17.0 software. GRADE was used to evaluate the quality of evidence for the outcome indicators.

Results A total of 13 papers (532 patients) were included. The PEDro score ranged from 6 to 8. Most of the literature did not report the blinding completely or did not implement allocation concealment, which might have some limitations. MT could improve the scores of Fugl-Meyer Assessment-Upper Extremities (n = 466, MD = 6.05, 95%CI 3.44~8.66, P < 0.001), Barthel index (n = 230, MD = 9.95, 95%CI 6.23~13.68, P < 0.001) and Functional Independence Measure (n = 147, MD = 4.17, 95%CI 2.61~5.72, P < 0.001) in stroke patients. Network meta-analysis showed that MT was more effective in upper limb motor function intervention for stroke patients aged 40 to 59 years with a disease course less than three months; and an intervention period less than four weeks, single intervention time less than 30 minutes, intervention duration daily more than 30 minutes and intervention twice daily might optimize the effects on upper limb motor function.

Conclusion MT is effective on upper limb motor function and ADL in stroke patients, and the effect on upper limb motor function is affected by the age and disease course of the patients, as well as the period, time and frequency of intervention.

Key words: stroke, mirror therapy, upper extremity, motor function, activities of daily living, meta-analysis

中图分类号:

R743.3

魏辰, 王子贤, 李淑璠, 王芃, 贾舒祺, 田英. 镜像疗法对脑卒中患者上肢运动功能和日常生活活动能力影响的Meta分析[J]. 《中国康复理论与实践》, 2024, 30(3): 281-291.

WEI Chen, WANG Zixian, LI Shufan, WANG Peng, JIA Shuqi, TIAN Ying. Effect of mirror therapy on upper extremity motor function and activities of daily living in stroke patients: a meta-analysis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 281-291.

图/表 11

表1

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纳入文献基本特征"

纳入文献	国家/地区	n(T/C)	性别(男/女)/n		年龄(T/C)/岁	病程(T/C)	干预措施 (T/C)	干预时长	评估工具
纳入文献	国家/地区	n(T/C)	T	C	年龄(T/C)/岁	病程(T/C)	干预措施 (T/C)	干预时长	评估工具
Gurbuz等^[18](2016)	土耳其	16/15	6/10	8/7	(60.90±10.90)/ (60.80±20.00)	(46.10±43.30) d/ (42.40±37.80) d	a+b/a+c	每次20 min，每天1次，每周5 d，共4周	①②
黄冬枚等^[24](2019)	中国	30/30	16/14	18/12	(60.63±7.07)/ (61.57±7.16)	-	a+b/a	每次30 min，每天1次，每周5 d，共2周	①
凌晴等^[25](2021)	中国	21/21	17/4	18/3	(55.10±7.76)/ (56.92±8.52)	(34.91±12.58) d/ (33.95±9.99) d	a+b/a	每次30 min，每天1次，每周5 d，共12周	①
鲁璟^[26](2018)	中国	40/40	28/12	22/18	(54.50±6.30)/ (55.52±7.30)	< 3个月/ < 3个月	a+b/a	每次30 min，每天2次，每周5 d，共4周	①③
孙凤宝等^[27](2023)	中国	20/20	10/10	11/9	(59.85±9.16)/ (55.95±12.30)	(26.65±5.06) d/ (26.10±6.71) d	a+b/a	每次30 min，每天1次，每周5 d，共6周	①③
陶峰等^[28](2019)	中国	25/25	16/9	17/8	(64.05±10.14)/ (62.80±9.49)	(62.40±21.51) d/ (59.10±22.08) d	a+b/a	每次20 min，每天1次，每周5 d，共4周	①③
郑银花等^[29](2014)	中国	30/30	0/30	0/30	(55.15±9.25)/ (54.25±8.30)	< 3个月/< 3个月	a+b/a	每次30 min，每天2次，每周5 d，共4周	①③
Chinnavani等^[30](2020)	马来西亚	13/12	18/7		45~65/45~65	≥ 6个月/≥ 6个月	a+b/a	每次40 min，每天1次，每周3 d，共6周	①②
Yavuzer等^[31](2008)	土耳其	17/19	8/9	9/10	(63.20±9.20)/ (63.30±9.50)	(5.4±2.9)个月/ (5.5±2.5)个月	a+b/a+c	每次30 min，每天1次，每周5 d，共4周	②
Park等^[32](2015)	韩国	15/15	9/6	8/7	(56.20±13.40)/ (56.40±15.10)	(20.1±6.3)个月/ (21.7±12.2)个月	a+b/a+c	每次30 min，每天1次，每周5 d，共4周	②
Samuelkamaleshkumar等^[33](2014)	印度	10/10	8/2	8/2	(48.40±15.60)/ (53.90±11.60)	(3.7±1.1)周/ (4.4±1.4)周	a+b/a	每次30 min，每天2次，每周5 d，共3周	①
Kim等^[34](2016)	韩国	12/13	8/4	8/5	(45.20±4.70)/ (52.60±3.00)	≥ 6个月/≥ 6个月	b/d	每次30 min，每天1次，每周5 d，共4周	①②
Wu等^[35](2013)	中国台湾	16/17	11/5	12/5	(54.77±11.66)/ (53.59±10.21)	(19.31±12.57)个月/ (21.88±15.55)个月	a+b/a	每次90 min，每天1次，每周5 d，共4周	①

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人群(Population)	干预(Intervention)	比较(Comparison)	结局(Outcome)
脑卒中患者首次发病年龄≥ 18岁	干预场所	镜像疗法组与对照组比较镜像疗法干预周期、时间、频次比较不同年龄、病程患者干预比较	身体功能 b7神经肌肉骨骼和运动相关功能活动与参与 d2一般任务和需求 d4行动能力 d5自我照顾 d6家庭生活 d8主要生活领域
	医院
	社区健康服务中心
	干预人员
	康复治疗师
	干预处方
	干预周期
	干预时间
	干预频次

纳入文献	资格标准	随机分配	分配隐藏	基线相似	结果评估施盲	参与率> 85%	意向治疗分析	组间统计结果分析	点测量和差异值	总分
Gurbuz等^[18](2016)	√	√		√		√	√	√	√	6
黄冬枚等^[24](2019)	√	√		√	√	√	√	√	√	7
凌晴等^[25](2021)	√	√		√		√	√	√	√	6
鲁璟^[26](2018)	√	√		√	√	√	√	√	√	7
孙凤宝等^[27](2023)	√	√		√	√	√	√	√	√	7
陶峰等^[28](2019)	√	√		√	√	√	√	√	√	7
郑银花等^[29](2014)	√	√		√		√	√	√	√	6
Chinnavani等^[30](2020)	√	√		√		√	√	√	√	6
Yavuzer等^[31](2008)	√	√		√	√	√	√	√	√	7
Park等^[32](2015)	√	√	√	√		√	√	√	√	7
Samuelkamaleshkumar等^[33](2014)	√	√		√	√	√	√	√	√	7
Kim等^[34](2016)	√	√		√	√	√	√	√	√	7
Wu等^[35](2013)	√	√	√	√	√	√	√	√	√	8

结局指标	纳入研究数	I²/%	Meta分析结果
结局指标	纳入研究数	I²/%	MD (95%CI)	P值
FMA-UE	11(466)^{[18,24⇓⇓⇓⇓⇓-30,33⇓-35]}	83	6.05 (3.44, 8.66)	< 0.001
(改良)Barthel指数	4(230)^{[26⇓⇓-29]}	73	9.95 (6.23, 13.68)	< 0.001
FIM	5(147)^{[18,30⇓-32,34]}	0	4.17 (2.61, 5.72)	< 0.001

结局指标		纳入研究数(样本量)	I²/%	Meta分析结果
结局指标		纳入研究数(样本量)	I²/%	MD (95%CI)	P值
年龄	40~59岁	7(300)^{[25⇓-27,29,33⇓-35]}	83	6.16 (2.87, 9.44)	< 0.001
年龄	60~69岁	3(141)^[18,24,28]	81	6.65 (0.21, 13.10)	0.040
病程	≤ 3个月	7(323)^{[18,25⇓⇓⇓-29,33]}	74	8.27 (5.14, 11.39)	< 0.001
病程	> 3个月	3(83)^[30,34-35]	0	2.51 (0.26, 4.76)	0.030
干预周期	≤ 4周	8(359)^{[18,24,26,28-29,33⇓-35]}	87	6.82 (3.46, 10.18)	< 0.001
干预周期	> 4周	3(107)^[25,27,30]	0	3.38 (1.19, 5.58)	0.003
单次干预时间	≤ 30 min	9(408)^{[18,24⇓⇓⇓⇓-29,33-34]}	86	6.57 (3.69, 9.45)	< 0.001
单次干预时间	> 30 min	2(58)^[30,35]	0	2.57 (-2.76, 7.90)	0.340
每天干预时间	≤ 30 min	6(248)^{[18,24-25,27-28,34]}	57	3.97 (1.89, 6.06)	< 0.001
每天干预时间	> 30 min	5(218)^{[26,29-30,33,35]}	51	8.27 (4.84, 11.69)	< 0.001
干预频次	每天1次	8(306)^{[18,24-25,27-28,30,34-35]}	41	3.65 (1.88, 5.42)	< 0.001
干预频次	每天2次	3(160)^[26,29,33]	16	9.65 (7.44, 11.85)	< 0.001

组别	比较类别	MD(95%CI)	P值
年龄	对照组vs.40~59岁	-6.22 (-10.90, -1.97)	< 0.05
	对照组vs.60~69岁	-6.17 (-13.39, 0.14)	> 0.05
	年龄40~59岁vs.60~69岁	-0.05 (-8.27, 7.89)	> 0.05
病程	对照组vs.≤ 3个月	-8.16 (-11.97, -4.95)	< 0.05
	对照组vs.> 3个月	-2.59 (-8.04, 2.76)	> 0.05
	≤3个月 vs.> 3个月	5.57 (-0.65, 12.21)	> 0.05
干预周期	对照组vs.≤ 4周	-6.73(-10.78, -3.22)	< 0.05
干预周期	对照组vs.> 4周	-4.17 (-10.54, 1.99)	> 0.05
	≤4周vs.> 4周	2.57 (-4.58, 10.0)	> 0.05
单次干预时间	对照组vs.≤ 30 min	-6.55 (-10.35, -3.40)	< 0.05
	对照组vs.> 30 min	-2.76 (-11.24, 5.61)	> 0.05
	≤ 30 min vs.> 30 min	3.81 (-5.06, 13.09)	> 0.05
每天干预时间	对照组vs.≤ 30 min	-4.15 (-8.36, -1.39)	< 0.05
每天干预时间	对照组vs.> 30 min	-7.64 (-12.33, -3.91)	< 0.05
	≤ 30 min vs.> 30 min	-4.23 (-8.75, 2.27)	> 0.05
干预频次	对照组vs.每天1次	-3.64 (-6.76, -1.69)	< 0.05
干预频次	对照组vs.每天2次	-9.90 (-14.68, -6.56)	< 0.05
	每天1次vs.每天2次	-6.29 (-11.0, -1.68)	< 0.05

镜像疗法对脑卒中患者上肢运动功能和日常生活活动能力影响的Meta分析

Effect of mirror therapy on upper extremity motor function and activities of daily living in stroke patients: a meta-analysis

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项目	年龄	病程	干预周期	单次干预时间	每天干预时间	干预频次
A	75.0	98.1	88.9	90.5	53.8	50.3
B	73.3	44.4	56.9	47.1	95.8	99.5
C	0.2	0.7	0.4	12.3	0	0

结局指标	剔除研究	MD	95%CI	P(合并效应)	I²/%
上肢运动功能	Gurbuz等^[18](2016)	5.84	3.13, 8.55	< 0.001	84
上肢运动功能	黄冬枚等^[24]2019	6.65	3.91, 9.39	< 0.001	76
	凌晴等^[25]2021	6.06	3.29, 8.83	< 0.001	84
	鲁璟^[26](2018)	5.36	2.73, 7.98	< 0.001	81
	孙凤宝等^[27](2023)	6.55	3.60, 9.50	< 0.001	83
	陶峰等^[28](2019)	5.63	2.92, 8.35	< 0.001	83
	郑银花等^[29](2014)	5.42	2.98, 7.87	< 0.001	70
	Elanchezhian等^[30](2020)	6.16	3.45, 8.87	< 0.001	84
	Samuelkamaleshkumar等^[33](2014)	5.78	3.15, 8.40	< 0.001	84
	Kim等^[34](2016)	6.59	3.68, 9.51	< 0.001	83
	Wu等^[35](2013)	6.41	3.66, 9.16	< 0.001	84
(改良)Barthel指数	鲁璟等^[26](2018)	10.20	5.38, 15.02	< 0.001	80
	孙凤宝等^[27](2023)	12.11	10.15, 14.07	< 0.001	9
	陶峰等^[28](2019)	9.24	4.32, 14.16	< 0.001	82
	郑银花等^[29](2014)	8.55	4.55, 12.54	< 0.001	53

结局指标	纳入研究	证据质量评价					证据质量
结局指标	纳入研究	研究的局限性	不一致性	间接性	不精确性	发表偏倚	证据质量
上肢运动功能	11^{[18,24⇓⇓⇓⇓⇓-30,33⇓-35]}	严重	不严重	不严重	不严重	不严重	中级
ADL	9^{[18,26⇓⇓⇓⇓⇓ -32,34]}	严重	严重	不严重	不严重	不严重	低级

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