《中国康复理论与实践》

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (3): 263-277.doi: 10.3969/j.issn.1006-9771.2019.00.017

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水中运动治疗对脑卒中患者下肢运动功能及日常生活活动能力效果的Meta分析

崔尧1,2,贾威1,2,曾明3,丛芳1,2(),金龙1,2,司凤山1,2,姚斌1,2,萧敦武1,2,张凯1,2   

  1. 1.首都医科大学康复医学院,北京市 100068
    2.中国康复研究中心北京博爱医院,北京市 100068
    3.嘉兴市第二医院,浙江嘉兴市 314000
  • 收稿日期:2019-08-09 修回日期:2019-09-09 出版日期:2020-03-25 发布日期:2020-04-01
  • 通讯作者: 丛芳 E-mail:cong_fang_crrc@sina.com
  • 作者简介:崔尧(1988-),男,汉族,陕西西安市人,硕士,主管治疗师,主要研究方向：康复治疗。|贾威(1983-),男,汉族,辽宁沈阳市人,主管治疗师,主要研究方向：康复治疗。|丛芳(1966-),女,汉族,辽宁大连市人,博士,主任医师,副教授,主要研究方向：康复医学与理疗学。
  • 基金资助:
    1.中国康复研究中心青年基金项目(2014-Q3);2.首都医科大学教学课题(2018JYJX083)

Effects of Aquatic Exercise on Lower-limb Motor Function and Activities of Daily Living for Patients with Stroke: A Meta-analysis

CUI Yao1,2,JIA Wei1,2,ZENG Ming3,CONG Fang1,2(),JIN Long1,2,SI Feng-shan1,2,YAO Bin1,2,XIAO Dun-wu1,2,ZHANG Kai1,2   

  1. 1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
    2. Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
    3. The Second Hospital of Jiaxing City, Jiaxing, Zhejiang 314000, China
  • Received:2019-08-09 Revised:2019-09-09 Published:2020-03-25 Online:2020-04-01
  • Contact: CONG Fang E-mail:cong_fang_crrc@sina.com
  • Supported by:
    China Rehabilitation Research Center Youth Fund(2014-Q3);Capital Medical University Teaching Project(2018JYJX083)

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摘要：

目的 系统评价水中运动治疗对脑卒中患者下肢运动功能及日常生活活动能力的干预效果。 方法 检索Cochrane Library、PEDro、PubMed、EMBASE、Web of Knowledge、Web of Science、OVID、EBSCO、CMCI、CNKI、Wanfang和VIP数据库,筛选脑卒中患者水中运动治疗的随机对照试验(RCTs),进行方法学质量评价,提取相关数据,采用RevMan 5.3软件进行Meta分析。 结果 最终纳入23项RCTs,共861例患者。与对照组相比,水中运动治疗可改善患者Berg平衡量表评分(WMD = 4.61, 95%CI 3.79~5.43, P < 0.001)、计时起立-行走测试成绩(WMD = -1.56, 95%CI -3.07~-0.05, P < 0.05)、功能性前伸测试成绩(WMD = 2.69, 95%CI 1.21~4.16, P < 0.001)、压力中心移动速度(左右) (WMD = -1.38, 95%CI -2.72~-0.05, P < 0.05)、压力中心移动速度(前后) (WMD = -1.64, 95%CI -3.10~ -0.18, P < 0.05)、步速(SMD = 0.33, 95%CI 0.07~0.58, P < 0.05)、2分钟步行测试成绩(WMD = 12.75, 95%CI 4.17~21.34, P < 0.01)、功能性步行量表分级(WMD = 0.94, 95%CI 0.67~1.20, P < 0.001)、膝关节伸肌肌力(WMD = 4.30, 95%CI 1.53~7.07, P < 0.01)、膝关节屈肌肌力(WMD = 4.80, 95%CI 0.29~9.32, P < 0.05)和功能独立性测试评分(WMD = 6.12, 95%CI 3.98~8.27, P < 0.001),但对改良Barthel指数评分无明显改善作用(WMD = 2.92, 95%CI -6.74~12.58, P = 0.55)。 结论 水中运动治疗能够改善脑卒中患者的平衡功能、步行能力和下肢肌力,但对日常生活活动能力的效果不明显。

关键词: 脑卒中, 水中运动治疗, 平衡, 步行, 肌力, 日常生活活动, Meta分析

Abstract:

Objective To evaluate the effects of aquatic exercise on lower-limb motor function and activities of daily living for patients with stroke. Methods The randomized controlled trials (RCTs) about effects of aquatic therapeutic exercise on stroke patients were recalled from the databases of Cochrane Library, PEDro, PubMed, EMBASE, Web of Knowledge, Web of Science, OVID, EBSCO, CMCI, CNKI, Wanfang and VIP. The methodological quality of the included RCTs was evaluated. The data were extracted, and analysed with RevMan 5.3. Results A total of 23 RCTs that represented 861 participants were evaluated. Compared with the control group, aquatic exercise significantly improved the performance of Berg Balance Scale (WMD = 2.69, 95%CI 1.21 to 4.16, P < 0.001), Timed Up and Go Test (WMD = -1.56, 95%CI -3.07 to -0.05, P < 0.05), Functional Reach Test (WMD = 2.69, 95%CI 1.21 to 4.16, P < 0.001), sway velocity of center of pressure (SVCOP) (left/right) (WMD = -1.38, 95%CI -2.72 to -0.05, P < 0.05), SVCOP (anteroposterior) (WMD = -1.64, 95%CI -3.10 to -0.18, P < 0.05), walking speed (SMD = 0.33, 95%CI 0.07 to 0.58, P < 0.05), Two Minute Walk Test (WMD = 12.75, 95%CI 4.17 to 21.34, P < 0.01), Functional Ambulation Category (WMD = 0.94, 95%CI 0.67 to 1.20, P < 0.001), muscle strength of knee extensor (WMD = 4.30, 95%CI 1.53 to 7.07, P < 0.01), muscle strength of knee flexor (WMD = 4.80, 95%CI 0.29 to 9.32, P < 0.05), and Functional Independence Measurement (WMD = 6.12, 95%CI 3.98 to 8.27, P < 0.001), but not significantly in the score of modified Barthel Index (WMD = 2.92, 95%CI -6.74 to 12.58, P = 0.55). Conclusion Aquatic exercise can improve balance, walking and muscle strength of lower extremities of stroke patients, but do not for activities of daily living.

Key words: stroke, aquatic exercise, balance, walking, muscle strength, activities of daily living, meta-analysis

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