镜像疗法对脑卒中患者下肢运动、平衡功能和步行能力效果的Meta分析

doi:10.3969/j.issn.1006-9771.2020.09.004

摘要/Abstract

摘要：

目的评价镜像疗法对脑卒中患者下肢运动、平衡功能和步行功能的干预效果。
方法检索PubMed、Cochrane Library、EMbase、Medline complete、中国知网、万方、维普和中国生物医学文献数据库中,镜像疗法对脑卒中患者下肢功能干预效果的随机对照试验,对符合质量标准的研究采用RevMan 5.3软件进行Meta分析。
结果共纳入12篇文献,共590例。镜像疗法能改善脑卒中患者Fugl-Meyer评定量表下肢部分评分(MD = 6.67, 95%CI 5.60~7.74; Z = 12.20, P< 0.001)、Brunnstrom分期(MD = 0.55, 95%CI 0.28~0.82;Z = 3.98, P< 0.001)、Berg平衡量表评分(MD = 3.45, 95%CI 1.40~5.50;Z = 3.30, P = 0.001)、简易平衡评定系统测试评分(MD = 1.49, 95%CI 0.65~2.33; Z = 3.48, P< 0.001)、Brunnel平衡量表评分(MD = 0.66, 95%CI 0.10~1.22;Z = 2.32, P = 0.02),对10米步行试验(MD = 0.03, 95%CI -0.04~0.11; Z = 0.88, P = 0.38)、计时起立-行走测试(MD = -1.43, 95%CI -4.31~1.45; Z = 0.97, P = 0.33)结果无明显影响。
结论镜像疗法可改善脑卒中患者下肢运动功能,轻微改善平衡功能,对步行功能的疗效仍需进一步证实。

关键词: 脑卒中, 镜像疗法, 下肢, 运动, 平衡, 步行, Meta分析

Abstract:

Objective To evaluate the effect of mirror therapy on lower-limb motor, balance and walking of stroke patients.
Methods Randomized controlled trails (RCTs) about mirror therapy for lower limb function after stroke were recalled in PubMed, Cochrane Library, EMbase, Medline complete, CNKI, Wanfang Data, VIP and CBMdisc. Meta-analysis was conducted using RevMan 5.3 software for eligible RCTs.
Results A total of twelve studies were retrieved, including 590 patients. Mirror therapy improved the scores of Fugl-Meyer Assessment-Lower Extremity (MD = 6.67, 95%CI 5.60 to 7.74; Z = 12.20, P< 0.001), Brunnstrom stages (MD = 0.55, 95%CI 0.28 to 0.82;Z = 3.98, P< 0.001), Berg Balance Scale (MD = 3.45, 95%CI 1.40 to 5.50;Z = 3.30, P = 0.001), mini-BESTest (MD = 1.49, 95%CI 0.65 to 2.33; Z = 3.48, P< 0.001), Brunnel Balance Assessment (MD = 0.66, 95%CI 0.10 to 1.22;Z = 2.32, P = 0.02). However, it was not significant for 10-meter Walking Test (MD = 0.03, 95%CI -0.04 to 0.11; Z = 0.88, P = 0.38) and Timed "Up and Go" Test (MD = -1.43, 95%CI -4.31 to 1.45; Z = 0.97, P = 0.33).
Conclusion Mirror therapy can improve lower extremity motor function after stroke significantly, and somehow for balance. Further research is needed to explore its effects on walking.

Key words: stroke, mirror therapy, lower limbs, motor, balance, walking, meta-analysis

吴静华,吴菊芬,匡丹,俞惠,华皎. 镜像疗法对脑卒中患者下肢运动、平衡功能和步行能力效果的Meta分析[J]. 《中国康复理论与实践》, 2020, 26(9): 1015-1023.

WU Jing-hua,WU Ju-fen,KUANG Dan,YU Hui,HUA Jiao. Effects of Mirror Therapy on Lower-limb Motor, Balance and Walking after Stroke: A Meta-analysis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(9): 1015-1023.

图/表 14

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纳入文献的基本特征"

纳入研究	国家	n		年龄(岁)		病程		病情	干预措施		干预时间	结局指标
纳入研究	国家	C	T	C	T	C	T	病情	C	T	干预时间	结局指标
陈其强等2019^[8]	中国	55	55	53.90±2.70	53.30±3.10	< 8周	< 8周	Brunnstrom Ⅰ~Ⅳ期	传统治疗	传统治疗+运动为基础镜像疗法	30 min/次,5次/周,共8周	①④
Arya等2019^[9]	印度	17	19	44.53±6.09	48.16±8.36	(18.29±8.08)个月	(13.74±9.45) 个月	Brunnstrom ≥ Ⅱ期	传统治疗	传统治疗+任务为基础镜像疗法	60 min/次,3~4次/周,共12周	①⑥
黎伟雄等2018^[10]	中国	30	30	54.60±9.20	52.90±9.90	(6.70±2.30) d	(7.10±3.40) d	Brunnstrom ≥ Ⅲ期	传统治疗+假镜像疗法(无镜像)	传统治疗+运动为基础镜像疗法	30 min/次,5次/周,共8周	①③
Xu等2017^[11]	中国	23	23	56.09±8.12	53.70±8.98	(45.78±6.50) d	(42.76±5.65) d	Brunnstrom Ⅰ~Ⅳ期	传统治疗+假镜像疗法(无镜像)	传统治疗+运动为基础镜像疗法	30 min/次,5次/周,共4周	②⑥
王海燕等2017^[12]	中国	62	62	53.19±6.02	51.86±5.63	(4.13±1.06) 个月	(3.91±0.78) 个月	Brunnstrom ≥ Ⅲ期	传统治疗	传统治疗+运动为基础镜像疗法	15 min/次,6次/周,共8周	①④
In等2016^[13]	韩国	12	13	54.42±11.44	57.31±10.53	(13.58±5.28) 个月	(12.54±4.14) 个月	Brunnstrom Ⅰ~Ⅳ期	传统治疗+假镜像疗法(无镜像)	传统治疗+运动和任务为基础镜像疗法	60 min/次,5次/周,共4周	③⑥⑦
Kim等2016^[14]	韩国	17	17	54.60±10.20	52.40 ±7.20	(4.50±1.10) 个月	(4.70±1.30) 个月	Ashworth量表 < Ⅲ 期	传统治疗+假镜像疗法(无镜像)	传统治疗+运动为基础镜像疗法	60 min/次,5次/周,共4周	⑤
Lee等2016^[15]	韩国	13	14	53.62±6.29	55.71±6.70	(42.54±33.90)个月	(36.79±26.07)个月	Brunnstrom Ⅰ~Ⅳ期	传统治疗	传统治疗+运动为基础镜像疗法	60 min/次,5次/周,共4周	③⑥⑦
Salem等 2015^[16]	埃及	15	15	59.10±9.10	60.00±8.97	(15.40±1.28)个月	(14.90±1.83)个月	Brunnstrom Ⅰ~Ⅳ 期	假镜像疗法(无镜像)	运动为基础镜像疗法	30 min/次,5次/周,共4周	②⑥
Cha等 2015^[17]	韩国	17	19	57.35±9.38	60.00±7.80	(1.65±0.86) 个月	(1.95±0.62) 个月	Brunnstrom Ⅰ~Ⅳ期	传统治疗+假镜像疗法(无镜像)	传统治疗+运动为基础镜像疗法	40 min/次,5次/周,共4周	③⑦
Mohan等2013^[18]	印度	11	11	59.80±6.70	62.64±17.30	(5.73±3.47) 个月	(7.09±3.18) 个月	Brunnstrom Ⅰ~Ⅴ期	假镜像疗法(无镜像)	运动为基础镜像疗法	30 min/次,5次/周,共4周	①⑤
Sütbeyaz等 2007^[19]	荷兰	20	20	64.70±7.70	62.70±9.70	(3.90±1.90) 个月	(3.50±1.30) 个月	Brunnstrom Ⅰ~Ⅲ期	假镜像疗法(无镜像)	运动为基础镜像疗法	30 min/次,5次/周,共4周	②

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纳入研究	随机序列产生	分配隐藏	对实施者及参与者实施盲法	对结果测评者实施盲法	数据结果的完整性	选择性报告研究结果	其他偏倚来源	证据质量
陈其强等2019^[8]	低偏倚	不清楚	低偏倚	不清楚	低偏倚	低偏倚	不清楚	B
Arya等2019^[9]	低偏倚	低偏倚	低偏倚	低偏倚	低偏倚	低偏倚	低偏倚	A
黎伟雄等2018^[10]	低偏倚	不清楚	低偏倚	不清楚	低偏倚	低偏倚	不清楚	B
Xu等2017^[11]	低偏倚	低偏倚	低偏倚	低偏倚	低偏倚	低偏倚	低偏倚	A
王海燕等2017^[12]	低偏倚	不清楚	低偏倚	不清楚	低偏倚	低偏倚	不清楚	B
In等2016^[13]	低偏倚	不清楚	高偏倚	低偏倚	低偏倚	不清楚	不清楚	B
Kim等2016^[14]	低偏倚	低偏倚	不清楚	低偏倚	低偏倚	低偏倚	不清楚	B
Lee等2016^[15]	低偏倚	不清楚	不清楚	低偏倚	低偏倚	低偏倚	不清楚	B
Salem等2015^[16]	低偏倚	不清楚	高偏倚	低偏倚	低偏倚	不清楚	不清楚	B
Cha等2015^[17]	低偏倚	低偏倚	高偏倚	低偏倚	不清楚	低偏倚	不清楚	B
Mohan等2013^[18]	低偏倚	不清楚	低偏倚	低偏倚	低偏倚	不清楚	不清楚	B
Sütbeyaz等2007^[19]	低偏倚	低偏倚	低偏倚	低偏倚	低偏倚	低偏倚	低偏倚	A