双任务训练对脑卒中患者移动和平衡功能康复疗效的Meta分析

doi:10.3969/j.issn.1006-9771.2026.07.008

《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (7): 807-816.doi: 10.3969/j.issn.1006-9771.2026.07.008

双任务训练对脑卒中患者移动和平衡功能康复疗效的Meta分析

袁依依¹^,², 田武超³, 张献斌¹, 钞强³, 李永生³, 刘桂新³, 吴万庆¹, 王朴²()

¹ 中山大学生物医学工程学院，广东深圳市 518107
² 中山大学第七附属医院康复医学科，广东深圳市 518107
³ 深圳蓝生脑科医院康复医学科，广东深圳市 518110

收稿日期:2025-08-12 修回日期:2025-10-11 接受日期:2026-04-16 出版日期:2026-07-25 发布日期:2026-07-30
通讯作者: 王朴，E-mail： wangpu@sysush.com
作者简介:袁依依(2004-)，女，汉族，湖南长沙市人，本科生。
王朴(1981-)，男，汉族，湖北武汉市人，副教授、副主任医师，硕士研究生导师，主要研究方向：基于整体观下的脑体互作数字化解析与应用。
基金资助:
广东省基础与应用基础研究基金自然科学基金项目(2026A1515011576);深圳市基础研究专项项目(JCYJ20240813150250045);中山大学临床医学研究5010计划项目(2024010)

Effect of dual task training on mobility and balance in stroke patients: a meta-analysis

Yuan Yiyi¹^,², Tian Wuchao³, Zhang Xianbin¹, Chao Qiang³, Li Yongsheng³, Liu Guixin³, Wu Wanqing¹, Wang Pu²()

¹ School of Biomedical Engineering, Sun Yat-sen University, Shenzhen, Guangdong 518107, China
² Department of Rehabilitation Medicine, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518107, China
³ Department of Rehabilitation Medicine, Shenzhen Lansheng Brain Hospital, Shenzhen, Guangdong 518110, China

Received:2025-08-12 Revised:2025-10-11 Accepted:2026-04-16 Published:2026-07-25 Online:2026-07-30
Supported by:
Guangdong Basic and Applied Basic Research Foundation(2026A1515011576);Shenzhen Basic Research General Program(JCYJ20240813150250045);Sun Yat-sen University Clinical Medicine 5010 Special Program(2024010)

摘要/Abstract

摘要：

目的系统评价双任务训练(DTT)对脑卒中患者行动能力和平衡功能的康复疗效。

方法系统检索中国知网、万方、维普、PubMed、Web of Science、Embase和Cochrane Library数据库，纳入建库至2025年6月发表的关于DTT对比单任务训练对脑卒中患者进行干预的随机对照试验(RCT)。采用Cochrane偏倚风险评估工具、PEDro量表对纳入研究的质量进行评价，采用RevMan 5.4进行Meta分析。

结果共纳入11项RCT，涉及517例患者。PEDro量表评分4~8分。DTT能改善患者Fugl-Meyer评定量表下肢部分评分(MD = 3.70, 95%CI 1.88~5.53, P < 0.001)、Berg平衡量表(BBS)评分(MD = 3.04, 95%CI 1.58~4.49, P < 0.001)、跌倒发生率(OR = 0.32, 95%CI 0.11~0.87, P = 0.025)、单任务步速(MD = 0.08, 95%CI 0.03~0.12, P = 0.002)、双任务步速(MD = 0.13, 95%CI 0.10~0.16, P < 0.001)、计时起立行走测试时间(MD = -2.78, 95%CI -3.85~-1.72, P < 0.001)和改良Barthel指数评分(MD = 4.77, 95%CI 1.88~7.66, P = 0.001)。亚组分析显示，运动-运动DTT在提高BBS评分和单任务步速方面优于认知-运动DTT。

结论双任务训练能够有效提升脑卒中患者的移动能力和平衡功能，且运动任务较认知任务效果更显著。

关键词: 脑卒中, 双任务训练, 移动, 平衡, Meta分析

Abstract:

Objective To systematically review the effect of dual-task training (DTT) on mobility and balance in stroke patients.

Methods CNKI, Wanfang Data, VIP, PubMed, Web of Science, Embase and Cochrane Library were searched for randomized controlled trials (RCT) on DTT in stroke rehabilitation from inception to June, 2025. The quality of the included studies was assessed using the Cochrane Risk of Bias Tool and the PEDro scale. Meta-analysis was performed using RevMan 5.4.

Results A total of eleven RCT involving 517 stroke patients were included, and the scores of PEDro scale were four to eight. DTT was more effective on the score of Fugl-Meyer Assessment-Lower Extremity (MD = 3.70, 95%CI 1.88 to 5.53, P< 0.001) and Berg Balance Scale (BBS) (MD = 3.04, 95%CI 1.58 to 4.49, P < 0.001), fall incidence (OR = 0.32, 95%CI 0.11 to 0.87, P= 0.025), gait speed under a single-task condition (MD = 0.08, 95%CI 0.03 to 0.12, P = 0.002), gait speed under a dual-task condition (MD = 0.13, 95%CI 0.10 to 0.16, P < 0.001), Timed Up and Go Test time (MD = -2.78, 95%CI -3.85 to -1.72, P< 0.001), and score of modified Barthel Index (MD = 4.77, 95%CI 1.88 to 7.66, P= 0.001). Subgroup analysis indicated that motor-motor DTT was more effective than cognitive-motor DTT on BBS scores and single-task gait speed.

Conclusions DTT can improve mobility and balance in stroke patients, especially with motor-motor tasks.

Key words: stroke, dual-task training, mobility, balance, meta-analysis

中图分类号:

R743.3

袁依依, 田武超, 张献斌, 钞强, 李永生, 刘桂新, 吴万庆, 王朴. 双任务训练对脑卒中患者移动和平衡功能康复疗效的Meta分析[J]. 《中国康复理论与实践》, 2026, 32(7): 807-816.

Yuan Yiyi, Tian Wuchao, Zhang Xianbin, Chao Qiang, Li Yongsheng, Liu Guixin, Wu Wanqing, Wang Pu. Effect of dual task training on mobility and balance in stroke patients: a meta-analysis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(7): 807-816.

图/表 9

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纳入文献基本特征"

纳入文献	n(C/T)	性别 (男/女)/n	年龄/岁 (C/T)	平均病程/月 (C/T)	干预频率	干预措施	随访措施	结局指标
Shim等^[23](2012)	16/17	20/13	(61.56±6.17)/(65.59±5.81)	(17.44±3.67)/(16.29±2.62)	每次30 min，每周3次，共6周	C：基础步态训练 T：基础治疗+行走时交替用非瘫痪侧膝/瘫痪侧脚踢球20 m往返，治疗师手持带绳泡沫球控制移动速度	无长期随访	①
Cho等^[24](2015)	11/11	7/15	(58.6±11.86)/(60.0±9.38)	(8.8±4.8)/ (9.1±6.4)	每次30 min，每周5次，共4周	C：虚拟环境行走 T：跑步机行走+虚拟社区环境认知任务，每周切换认知任务(记忆/算术/言语/对话)模拟真实社区的多任务需求	无长期随访	①
Kim等^[25](2015)	20/20	26/14	(48.1±7.5)/(51.0±13.5)	≥ 6/≥ 6	每次30 min，每周3次，共4周	C：跑步机行走+超市实景视频 T：跑步机行走+超市实景视频(100 cm/s)，附加认知任务(记忆5种商品并按键识别)	无长期随访	①
Pang等^[26](2018)	28/28	42/14	(61.2±6.2)/(59.9±6.8)	(66.6±41.6)/ (71.9±63.6)	每次60 min，每周3次，共8周	C：运动任务 T：运动任务(前向行走、TUGT、障碍跨越)+认知任务(命名特定类别词汇、连续减法、记忆并复述物品序列)	干预后8周评估+6个月跌倒监测	②③⑦
Kannan等^[27](2019)	12/12	13/11	(61±4.6)/(57.5±8.04)	(9.09±6.36)/ (8.9±5.39)	每次90 min，共6周	C：定制化平衡训练 T：Wii Fit游戏(泡泡平衡/桌面倾斜/走钢丝/头球)+认知任务(字母数字序列/心算/类比)	无长期随访	①③④⑦
Hong等^[28](2020)	9/8	10/7	(66.22±11.55)/(56.63±8.78)	(15.33±7.47)/ (19±8.38)	每次30 min，每周3次，共4周	C：相同下肢运动任务，无信号灯提示 T：站立位下根据交通信号灯指示移动健侧下肢；随机灯光提示进行三方向髋关节屈曲运动	无长期随访	①③④⑦
杨友玲^[29](2021)	33/34	38/29	(59.15±6.82)/(61.18±7.21)	(9.67±1.95)/(10.00±2.10)	每次60 min，每周5次，共6周	C：常规康复训练60 min T：常规康复训练40 min+认知运动双任务步行训练20 min，双任务为步行同时执行认知任务如倒背月份	无长期随访	①④⑤⑥
王海静等^[30](2021)	14/17	23/8	(62.4±9.5)/(59.4±12.9)	≥ 6/≥ 6	每次45 min，每周5次，共6周	C：常规康复训练60 min T：常规康复训练30 min+双运动任务步行训练15 min，双任务为步行同时执行运动任务(投掷物品、转移物品、手持水杯行走等)	无长期随访	①③④⑥⑦
都丽丽等^[31](2023)	35/35	38/32	(63.74±4.92)/(63.74±4.73)	(2.91±1.36)/ (2.73±1.25)	每次30 min，每天2次，共4周	C：步行训练 T：上午、下午分别进行步行+认知、步行+运动DTT	干预后1年跌倒监测	①②⑦
杨绪强等^[32](2024)	42/42	40/44	(52.31±7.81)/(49.98±6.59)	(1.66±0.46)/ (1.76±0.52)	每次70 min，每周5次，共4周	C：常规康复 T：常规康复+多平面躯干训练(坐位骨盆控制、站位拾物、对角线步行)和DTT(步行中持水杯防洒、连续减法计算)	干预后3个月、6个月评估	①③④ ⑤⑥⑦
王洋等^[33](2025)	37/36	56/17	(59.43±9.58)/(62.78±6.62)	2周~6个月(恢复期)	每次30 min，每周5次，共4周	C：常规康复 T：常规康复+运动-运动DTT，主要任务为奥塔戈运动，次要任务为上肢运动(拿放物品、转移物品、手持水杯)	无长期随访	④⑥⑦

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纳入文献	资格标准	随机分配	分配隐藏	基线相似	受试施盲	评估者施盲	被试流失率≤15%	意向性分析	组间统计比较	变异性测量	总分
Shim等^[23](2012)	√	√		√			√		√	√	5
Cho等^[24](2015)	√	√	√	√	√	√	√		√	√	8
Kim等^[25](2015)	√	√		√		√	√	√	√	√	7
Pang等^[26](2018)	√	√	√	√	√	√	√		√	√	8
Kannan等^[27](2019)	√	√		√			√		√	√	5
Hong等^[28](2020)	√	√		√					√	√	4
杨友玲^[29](2021)	√	√		√			√	√	√	√	6
王海静等^[30](2021)	√	√		√		√	√	√	√	√	7
都丽丽等^[31](2023)	√	√		√			√	√	√	√	6
杨绪强等^[32](2024)	√	√		√			√	√	√	√	6
王洋等^[33](2025)	√	√		√			√		√	√	5

结局指标	纳入研究数/n	异质性		效应模型	Meta分析结果
结局指标	纳入研究数/n	I²	P值	效应模型	MD/OR (95%CI)	P值
FMA-LE	2^[29,32]	68%	0.079	随机	3.70(1.88~5.53)	< 0.001
BBS	6^{[27-30,32-33]}	60%	0.022	随机	3.04(1.58~4.49)	< 0.001
跌倒发生率^a	2^[28,31]	0%	0.331	固定	0.32(0.11~0.87)	0.025
单任务步速	7^{[23-25,29-32]}	67%	0.006	随机	0.08(0.03~0.12)	0.002
双任务步速	4^[24,29-31]	14%	0.322	固定	0.13(0.10~0.16)	< 0.001
TUGT	4^{[27-28,30,32]}	0%	0.466	固定	-2.78(-3.85~-1.72)	< 0.001
MBI	4^{[29-30,32-33]}	83%	< 0.001	随机	4.77(1.88~7.66)	0.001

干预类型	纳入研究数/n	异质性		效应模型	Meta分析结果
干预类型	纳入研究数/n	I²	P值	效应模型	MD(95%CI)	P值
运动-认知	3^[27-29]	0%	0.312	随机	1.58(-0.20, 3.35)	0.081
运动-运动	3^[30,32-33]	66%	0.055	随机	3.98(2.19~5.77)	< 0.001

干预类型	纳入研究数/n	异质性		效应模型	Meta分析结果
干预类型	纳入研究数/n	I²	P值	效应模型	MD(95%CI)	P值
运动-认知	4^{[24-25,29,31]}	0%	0.864	随机	0.05(0.02~0.09)	0.002
运动-运动	3^[23,30,32]	60%	0.082	随机	0.11(0.03~0.18)	0.004

双任务训练对脑卒中患者移动和平衡功能康复疗效的Meta分析

Effect of dual task training on mobility and balance in stroke patients: a meta-analysis

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