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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参考文献 45

[1]	米卫东, 王国林, 马玉龙, 等. 中国老年患者围术期缺血性脑卒中防治专家共识[J]. 临床麻醉学杂志, 2022, 38(11): 1200-1209.
	MI W D, WANG G L, MA Y L, et al. Expert consensus on the prevention and treatment of perioperative ischemic stroke in elderly Chinese patients[J]. J Clin Anesthesiol, 2022, 38(11): 1200-1209.
[2]	MERIANS A S, JACK D, BOIAN R, et al. Virtual reality-augmented rehabilitation for patients following stroke[J]. Phys Ther, 2002, 82(9): 898-915. pmid: 12201804
[3]	WANG Y, PENG Q, GUO J, et al. Age-period-cohort analysis of type-specific stroke morbidity and mortality in China[J]. Circ J, 2020, 84(4): 662-669. doi: 10.1253/circj.CJ-19-0803 pmid: 32161200
[4]	GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet Neurol, 2021, 20(10): 795-820. doi: 10.1016/S1474-4422(21)00252-0
[5]	«中国脑卒中防治报告»编写组. «中国脑卒中防治报告2019»概要[J]. 中国脑血管病杂志, 2020, 17(5): 272-281.
	Report on stroke prevention and treatment in China Writing Group. Brief report on stroke prevention and treatment in China, 2019[J]. Chin J Cerebrovas Dis, 2020, 17(5): 272-281.
[6]	倪小佳, 陈耀龙, 蔡业峰. 中西医结合脑卒中循证实践指南(2019)[J]. 中国循证医学杂志, 2020, 20(8): 901-912.
	NI X J, CHEN Y L, CAI Y F. Evidence-based practice guidelines for integrative medicine in the treatment of stroke (2019)[J]. Chin J Evid-Based Med, 2020, 20(8): 901-912.
[7]	王陇德, 彭斌, 张鸿祺, 等. «中国脑卒中防治报告2020»概要[J]. 中国脑血管病杂志, 2022, 19(2): 136-144.
	WANG L D, PENG B, ZHANG H Q, et al. Summary of "China Report on Stroke Prevention and Treatment 2020"[J]. Chin J Cerebrovas Dis, 2022, 19(2): 136-144.
[8]	FUJITA T, SATO A, TOGASHI Y, et al. Identification of the affected lower limb and unaffected side motor functions as determinants of activities of daily living performance in stroke patients using partial correlation analysis[J]. J Phys Ther Sci, 2015, 27(7): 2217-2220. doi: 10.1589/jpts.27.2217 pmid: 26311957
[9]	BRANCO J P, OLIVEIRA S, PÁSCOA PINHEIRO J, et al. Assessing upper limb function: transcultural adaptation and validation of the Portuguese version of the Stroke Upper Limb Capacity Scale[J]. BMC Sports Sci Med Rehabil, 2017, 9: 15. doi: 10.1186/s13102-017-0078-9 pmid: 28785412
[10]	夏渊, 卢悦, 李爱玲, 等. θ节律刺激对脑卒中后患者上肢运动功能和日常生活能力影响的Meta分析[J]. 中国医学物理学杂志, 2022, 39(3): 341-348.
	XIA Y, LU Y, LI A L, et al. Meta-analysis of the effects of theta rhythm stimulation on upper limb motor function and activities of daily living in post-stroke patients[J]. Chin J Med Phys, 2022, 39(3): 341-348.
[11]	ERAIFEJ J, CLARK W, FRANCE B, et al. Effectiveness of upper limb functional electrical stimulation after stroke for the improvement of activities of daily living and motor function: a systematic review and meta-analysis[J]. Syst Rev, 2017, 6(1): 40. doi: 10.1186/s13643-017-0435-5 pmid: 28245858
[12]	CHANG Q Y, LIN Y W, HSIEH C L. Acupuncture and neuroregeneration in ischemic stroke[J]. Neural Regen Res, 2018, 13(4): 573-583. doi: 10.4103/1673-5374.230272
[13]	赵晓慧, 姜琳丽, 王凤娇, 等. 镜像疗法结合肌电生物反馈对脑卒中的影响[J]. 康复学报, 2020, 30(1): 34-39, 45.
	ZHAO X H, JIANG L L, WANG F J, et al. Effect of imaging therapy combined with electronic biofeedback on stroke[J]. Rehabil Med, 2020, 30(1): 34-39, 45.
[14]	RAMACHANDRAN V S, ROGERS-RAMACHANDRAN D, COBB S. Touching the phantom limb[J]. Nature, 1995, 377(6549): 489-490. doi: 10.1038/377489a0
[15]	丁力, 贾杰. "镜像疗法"作为一种康复治疗技术的新进展[J]. 中国康复医学杂志, 2015, 30(5): 509-512.
[16]	ALTSCHULER E L, WISDOM S B, STONE L, et al. Rehabilitation of hemiparesis after stroke with a mirror[J]. Lancet (London, England), 1999, 353(9169): 2035-2036. doi: 10.1016/S0140-6736(99)00920-4
[17]	耿博, 冯翰超, 张健, 等. 基于镜像视觉反馈的康复训练治疗老年脑卒中偏瘫患者疗效研究[J]. 康复学报, 2020, 30(4): 270-274.
	GENG B, FENG H C, ZHANG J, et al. Efficacy study of rehabilitation training based on mirror visual feedback in elderly stroke hemiplegic patients[J]. Rehabil Med, 2020, 30(4): 270-274.
[18]	GURBUZ N, AFSAR S I, AYAŞ S, et al. Effect of mirror therapy on upper extremity motor function in stroke patients: a randomized controlled trial[J]. J Phys Ther Sci, 2016, 28(9): 2501-2506. doi: 10.1589/jpts.28.2501 pmid: 27799679
[19]	李梦晓, 冯丽娟, 张福蓉, 等. 镜像视觉反馈疗法在康复训练中的研究进展[J]. 中国康复理论与实践, 2017, 23(12): 1403-1406. doi: 10.3969/j.issn.1006-9771.2017.12.007
	LI M X, FENG L J, ZHANG F R, et al. Research progress of mirror visual feedback therapy in rehabilitation training[J]. Chin J Rehabil Theory Pract, 2017, 23(12): 1403-1406.
[20]	彭娟, 杨仕彬, 李爱玲, 等. 镜像疗法改善脑卒中偏瘫患者上肢功能障碍的Meta分析[J]. 中华物理医学与康复杂志, 2018, 40(11): 844-853.
	PENG J, YANG S B, LI A L, et al. Meta-analysis of mirror therapy for improving upper limb function in stroke hemiplegic patients[J]. Chin J Phys Med Rehabil, 2018, 40(11): 844-853.
[21]	PAGE M J, MOHER D, BOSSUYT P M, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews[J]. BMJ, 2021, 372: n160.
[22]	邱卓英, 李伦, 陈迪, 等. 基于世界卫生组织国际健康分类家族康复指南研究:理论架构和方法体系[J]. 中国康复理论与实践, 2020, 26(2): 125-135. doi: 10.3969/j.issn.1006-9771.2020.02.001
	QIU Z Y, LI L, CHEN D, et al. Research on Rehabilitation Guidelines using World Health Organization Family International Classifications: framework and approaches[J]. Chin J Rehabil Theory Pract, 2020, 26(2): 125-135.
[23]	LUDYGA S, GERBER M, PÜHSE U, et al. Systematic review and meta-analysis investigating moderators of long-term effects of exercise on cognition in healthy individuals[J]. Nat Hum Behav, 2020, 4(6): 603-612. doi: 10.1038/s41562-020-0851-8 pmid: 32231280
[24]	黄冬枚, 陆敏灵, 王韵, 等. 改良镜像疗法对脑卒中患者患侧上肢康复与焦虑、抑郁的影响[J]. 中国康复医学杂志, 2019, 34(6): 699-701, 621.
	HUANG D M, LU M L, WANG Y, et al. Effects of modified mirror therapy on upper limb rehabilitation, anxiety, and depression in stroke patients[J]. Chin J Rehabil Med, 2019, 34(6): 699-701, 621.
[25]	凌晴, 胡世红, 王田尧, 等. 镜像疗法促进脑卒中上肢功能恢复和皮质脊髓束重塑的弥散张量成像研究[J]. 中国康复理论与实践, 2021, 27(1): 31-36. doi: 10.3969/j.issn.1006-9771.2021.01.004
	LING Q, HU S H, WANG T Y, et al. Diffusion tensor imaging study on the promotion of upper limb function recovery and cortical spinal tract remodeling by mirror therapy in stroke patients[J]. Chin J Rehabil Theory Pract, 2021, 27(1): 31-36.
[26]	鲁璟. 镜像疗法对脑卒中偏瘫后患者上肢功能和日常生活活动能力的影响[J]. 护士进修杂志, 2018, 33(6): 487-489.
	LU J. Effects of mirror therapy on upper limb function and activities of daily living in patients with post-stroke hemiplegia[J]. J Nurs Train, 2018, 33(6): 487-489.
[27]	孙凤宝, 章晓峰, 刘勇, 等. 多模态镜像疗法对脑卒中患者上肢及手功能的效果[J]. 中国康复理论与实践, 2023, 29(1): 77-81. doi: 10.3969/j.issn.1006-9771.2023.01.011
	SUN F B, ZHANG X F, LIU Y, et al. Effects of multimodal mirror therapy on upper limb and hand function in stroke patients[J]. Chin J Rehabil Theory Pract, 2023, 29(1): 77-81.
[28]	陶峰, 朱洁, 杨雷, 等. 镜像疗法对亚急性期脑卒中偏瘫患者日常生活活动能力和上肢运动功能的影响[J]. 中国康复医学杂志, 2019, 34(7): 841-843.
	TAO F, ZHU J, YANG L, et al. Effects of mirror therapy on activities of daily living and upper limb motor function in subacute stroke patients[J]. Chin J Rehabil Med, 2019, 34(7): 841-843.
[29]	郑银花, 许卓, 李品梅, 等. 镜像疗法提高中老年女性脑卒中患者上肢功能的疗效[J]. 中国老年学杂志, 2014, 34(3): 776-777.
	ZHENG Y H, XU Z, LI P M, et al. Efficacy of mirror therapy in improving upper limb function in middle-aged and elderly female stroke patients[J]. Chin J Gerontol, 2014, 34(3): 776-777.
[30]	CHINNAVANI E, PRIYA Y, RAGUPATHY R, et al. Effectiveness of mirror therapy on upper limb motor functions among hemiplegic patients[J]. Bangladesh J Med Sci, 2020, 19(2): 208-213. doi: 10.3329/bjms.v19i2.44997
[31]	YAVUZER G, SELLES R, SEZER N, et al. Mirror therapy improves hand function in subacute stroke: a randomized controlled trial[J]. Arch Phys Med Rehabil, 2008, 89(3): 393-398. doi: 10.1016/j.apmr.2007.08.162
[32]	PARK J Y, CHANG M, KIM K M, et al. The effect of mirror therapy on upper-extremity function and activities of daily living in stroke patients[J]. J Phys Ther Sci, 2015, 27(6): 1681-1683. doi: 10.1589/jpts.27.1681
[33]	SAMUELKAMALESHKUMAR S, REETHAJANETSUREKA S, PAULJEBARAJ P, et al. Mirror therapy enhances motor performance in the paretic upper limb after stroke: a pilot randomized controlled trial[J]. Arch Phys Med Rehabil, 2014, 95(11): 2000-2005. doi: 10.1016/j.apmr.2014.06.020
[34]	KIM K, LEE S, KIM D, et al. Effects of mirror therapy combined with motor tasks on upper extremity function and activities daily living of stroke patients[J]. J Phys Ther Sci, 2016, 28(2): 483-487. doi: 10.1589/jpts.28.483 pmid: 27065534
[35]	WU C Y, HUANG P C, CHEN Y T, et al. Effects of mirror therapy on motor and sensory recovery in chronic stroke: a randomized controlled trial[J]. Arch Phys Med Rehabil, 2013, 94(6): 1023-1030. doi: 10.1016/j.apmr.2013.02.007
[36]	岳雨珊, 黄杰, 谢斌, 等. 镜像疗法改善脑卒中患者上肢功能障碍的系统评价[J]. 中华物理医学与康复杂志, 2013, 35(2): 97-106.
	YUE Y S, HUANG J, XIE B, et al. Systematic review on the improvement of upper limb function in stroke patients by mirror therapy[J]. Chin J Phys Med Rehabil, 2013, 35(2): 97-106.
[37]	白钟飞, 张子未, 王惠芳, 等. 镜像疗法改善脑卒中后上肢运动功能和日常生活活动的Meta分析[J]. 中国康复理论与实践, 2016, 22(12): 1384-1394. doi: 10.3969/j.issn.1006-9771.2016.12.005
	BAI Z F, ZHANG Z W, WANG H F, et al. Meta-analysis of mirror therapy for improving upper limb motor function and activities of daily living in post-stroke patients[J]. Chin J Rehabil Theory Pract, 2016, 22(12): 1384-1394.
[38]	李遥, 逄慧敏, 李嘉琳, 等. 镜像视觉反馈疗法对脑卒中偏瘫患者影响的Meta分析[J]. 中国医药导刊, 2021, 23(8): 586-592.
	LI Y, PANG H M, LI J L, et al. Meta-analysis of the effects of mirror visual feedback therapy on stroke hemiplegic patients[J]. Chin J Med Guide, 2021, 23(8): 586-592.
[39]	李宁宁, 勾丽洁, 王凯旋. 镜像神经元系统的基础研究与临床应用现状[J]. 中国康复医学杂志, 2019, 34(2): 243-247.
	LI N N, GOU L J, WANG K X. Research progress and clinical application of the mirror neuron system[J]. Chin J Rehabil Med, 2019, 34(2): 243-247.
[40]	梅程瑶, 倪隽, 单春雷. 脑卒中运动障碍后脑区恢复与功能联接机制研究进展[J]. 中国康复医学杂志, 2018, 33(2): 239-243.
[41]	JAAFAR N, CHE DAUD A Z, AHMAD ROSLAN N F, et al. Mirror therapy rehabilitation in stroke: a scoping review of upper limb recovery and brain activities[J]. Rehabil Res Pract, 2021, 20219487319.
[42]	CLARK B, WHITALL J, KWAKKEL G, et al. The effect of time spent in rehabilitation on activity limitation and impairment after stroke[J]. Cochrane Database Syst Rev, 2021, 10(10): CD012612.
[43]	江婉婷, 王兴, 王光旭, 等. 抗阻运动对中老年女性下肢肌肉力量及功能干预效果的Meta分析[J]. 首都体育学院学报, 2019, 31(3): 272-280.
	JIANG W T, WANG X, WANG G X, et al. Meta-analysis of the effects of resistance exercise on lower limb muscle strength and functional intervention in middle-aged and elderly women[J]. J Capital Univ Phys Educ Sports, 2019, 31(3): 272-280.
[44]	DALEY A, STOKES-LAMPARD H, THOMAS A, et al. Exercise for vasomotor menopausal symptoms[J]. Cochrane Database Syst Rev, 2014, 2014(11): CD006108.
[45]	陈蓉. «中国绝经管理与绝经激素治疗指南2023版»解读[J]. 协和医学杂志, 2023, 14(3): 514-519.
	CHEN R. Interpretation of the "China Menopause Management and Hormone Therapy Guidelines 2023"[J]. Med J Peking Union Med College Hospital, 2023, 14(3): 514-519.

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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