《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (10): 1143-1153.doi: 10.3969/j.issn.1006-9771.2026.00.004
收稿日期:2026-07-01
修回日期:2026-08-03
接受日期:2026-08-05
出版日期:2026-10-25
发布日期:2026-08-21
通讯作者:
温晓妮(1973-),女,汉族,陕西渭南市人,博士,教授,主要研究方向:慢性病与老年病康复。E-mail: weniweni@163.com作者简介:车芙蓉(1999-),女,汉族,陕西渭南市人,硕士研究生,主要研究方向:慢性病与老年病康复。
基金资助:
Che Furong1, Pan Yi1, Qi Senjie1, Wen Xiaoni2(
)
Received:2026-07-01
Revised:2026-08-03
Accepted:2026-08-05
Published:2026-10-25
Online:2026-08-21
Supported by:摘要:
目的 评价不同振动频率的全身振动训练(WBV)对脑卒中患者平衡和步行功能的疗效。
方法 计算机检索中国知网、维普、万方数据库、中国生物医学数据库、PubMed、Embase和Cochrane Library数据库,收集建库至2026年4月关于WBV改善脑卒中后平衡和步行功能的随机对照试验(RCT)。以Berg平衡量表(BBS)、功能性步行量表(FAC)和计时起立-行走测试(TUGT)为结局指标,采用Cochrane 5.1.0手册推荐的RCT偏倚风险评估工具和PEDro量表对所纳入文献进行质量评价,采用Stata 18.0进行Meta分析。
结果 共纳入22篇RCT,涉及1 335例患者,PEDro量表评分为5~9分。Meta分析显示,WBV训练后脑卒中患者的BBS评分(WMD = 4.761, 95%CI 3.220~6.302, P < 0.001)、FAC分级(WMD = 0.537, 95%CI 0.239~0.835, P < 0.001)均显著优于对照组,TUGT时间明显缩短(WMD = -2.329, 95%CI -3.889~-0.769, P = 0.003)。亚组分析显示,低频(≤ 20 Hz) WBV在BBS、FAC和TUGT方面优于对照组(P < 0.05),而高频(> 20 Hz)未达显著性水平(P > 0.05);低频WBV的FAC分级明显优于高频(Q = 8.070, P= 0.005),高低频亚组间BBS和TUGT比较无显著性差异(P> 0.05);Meta回归提示频率并非异质性的主要来源,总干预次数和病程可能是潜在影响因素;不良反应轻微且均见于高频组。
结论 WBV能有效改善脑卒中后平衡和步行功能,基于当前有限证据,低频(≤ 20 Hz) WBV在疗效和安全性方面均优于高频;同时应重视训练总量的累积效应,结合患者病程选择最佳干预时机。
中图分类号:
车芙蓉, 潘义, 祁森洁, 温晓妮. 不同振动频率的全身振动训练对脑卒中患者平衡和步行功能影响的Meta分析[J]. 《中国康复理论与实践》, 2026, 32(10): 1143-1153.
Che Furong, Pan Yi, Qi Senjie, Wen Xiaoni. Effects of whole body vibration training at different vibration frequencies on balance and gait in stroke patients: a meta-analysis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(10): 1143-1153.
表2
纳入文献PEDro量表评分"
| 纳入文献 | 纳入与排除标准 | 随机分配 | 分配隐藏 | 基线相似 | 被试施盲 | 治疗师施盲 | 评估者施盲 | 退出率≤15% | 意向治疗分析 | 组间统计比较 | 点测量和差异值 | 总分 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 马飞翔等[ | √ | √ | √ | √ | √ | √ | √ | √ | 7 | |||
| 涂美等[ | √ | √ | √ | √ | √ | √ | √ | √ | 7 | |||
| 王盛等[ | √ | √ | √ | √ | √ | √ | 5 | |||||
| 宋云锋等[ | √ | √ | √ | √ | √ | √ | √ | 6 | ||||
| 金振华等[ | √ | √ | √ | √ | √ | √ | √ | √ | 7 | |||
| 魏巍等[ | √ | √ | √ | √ | √ | √ | √ | 6 | ||||
| 肖悦等[ | √ | √ | √ | √ | √ | √ | √ | 6 | ||||
| 胡川等[ | √ | √ | √ | √ | √ | √ | √ | 6 | ||||
| 张国兴等[ | √ | √ | √ | √ | √ | √ | √ | 6 | ||||
| 金振华等[ | √ | √ | √ | √ | √ | √ | √ | 6 | ||||
| 李岩等[ | √ | √ | √ | √ | √ | √ | √ | 6 | ||||
| 王伟国等[ | √ | √ | √ | √ | √ | √ | √ | 6 | ||||
| 毛璐熙等[ | √ | √ | √ | √ | √ | √ | √ | 6 | ||||
| 冯兵等[ | √ | √ | √ | √ | √ | √ | √ | 6 | ||||
| Irshad等[ | √ | √ | √ | √ | √ | √ | √ | √ | 7 | |||
| Lee等[ | √ | √ | √ | √ | √ | √ | 5 | |||||
| Lee等[ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 8 | ||
| Burq等[ | √ | √ | √ | √ | √ | √ | √ | √ | 7 | |||
| Marín等[ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 8 | ||
| van Nes等[ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 9 | |
| Brogårdh等[ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 9 | |
| Lau等[ | √ | √ | √ | √ | √ | √ | √ | √ | √ | 8 |
表3
纳入文献基本特征"
| 纳入文献 | n(男/女) | 年龄/岁 | 病程 | 干预措施 | 疗程 | 评价指标 | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| C | T | C | T | C | T | C | T | |||
| 马飞翔等[ | 13/7 | 13/9 | 50.90±7.14 | 51.14±6.80 | (107.90±35.52) d | (103.09±33.48) d | Ⅱ、Ⅲ | Ⅱ+7 Hz、3 mm的WBV | 每周10次,4周 | ①③ |
| 14/6 | 49.35±8.10 | (101.30±26.88) d | Ⅱ+15 Hz、3 mm的WBV | |||||||
| 涂美等[ | 17 | 16 | 55.4±4.5 | 53.9±3.8 | (10.0±2.3)个月 | (11.4±4.4)个月 | Ⅱ | Ⅱ+5 Hz、2 mm的WBV | 每周5次,6周 | ③ |
| 17 | 55.6±4.3 | (11.7±3.1)个月 | Ⅱ+5 Hz、2 mm的WBV | |||||||
| 16 | 57.2±4.0 | (11.1±2.1)个月 | Ⅱ+5 Hz、2 mm的WBV | |||||||
| 王盛等[ | 8/6 | 9/6 | 62.50±7.78 | 57.67±11.55 | (19.00±4.47) d | (21.50±5.71) d | Ⅱ、Ⅲ | Ⅱ+起始2 Hz、4 mm的WBV | 每周5次,3周 | ① |
| 宋云锋等[ | 36/32 | 35/23 | 49.76±7.55 | 49.43±7.12 | — | — | Ⅰ、Ⅱ | Ⅰ+Ⅱ+20~35 Hz、2 mm的WBV | 每周5次,12周 | ① |
| 金振华等[ | 17/17 | 18/15 | 61.09±4.34 | 60.55±4.59 | (67.79±4.03) d | (67.18±5.45) d | Ⅱ | Ⅱ+20 Hz、4 mm的WBV | 6周 | ② |
| 魏巍等[ | 19/11 | 18/12 | 50.28±6.17 | 49.62±8.48 | (79.58±37.26) d | (82.72±30.81) d | Ⅰ、Ⅱ | Ⅰ、Ⅱ+30 Hz、2 mm的WBV | 每周6次,4周 | ① |
| 肖悦等[ | 9/6 | 8/7 | 59.13±10.88 | 60.93±9.98 | (2.26±1.57)个月 | (2.63±1.53)个月 | Ⅱ、Ⅲ | Ⅱ+5/10/5 Hz、4 mm的WBV | 每周6次,2周 | ③ |
| 胡川等[ | 13/10 | 14/9 | 62.42±9.34 | 60.35±11.63 | (3.23±1.76)个月 | (3.41±1.48)个月 | Ⅱ | Ⅱ+5~8 Hz、2 mm的WBV | 每周5次,4周 | ③ |
| 张国兴等[ | 6/4 | 7/3 | 59.5±11.9 | 60.7±10.3 | (40.1±9.2) d | (38.54±10.3) d | Ⅱ、Ⅳ | Ⅱ+Ⅳ+20 Hz、5 mm的WBV | 6周 | ①② |
| 金振华等[ | 16/19 | 18/17 | 55.0±4.7 | 55.0±4.8 | (63.5±5.0) d | (63.7±6.0) d | Ⅱ、Ⅴ | Ⅱ+Ⅴ+20 Hz、3 mm的WBV | 每周5次,6周 | ①② |
| 李岩等[ | 12/13 | 18/7 | 61.92±5.64 | 62.64±7.02 | (53.28±11.72) d | (53.68±8.88) d | Ⅱ、Ⅲ | Ⅱ+12 Hz、2 mm的WBV | 每周5次,8周 | ① |
| 王伟国等[ | 26/17 | 27/16 | 59.83±6.52 | 60.15±7.8 | — | — | Ⅱ | Ⅱ+5~8 Hz、2.5 mm的WBV | 每周6次,12周 | ① |
| 毛璐熙等[ | 52/18 | 55/15 | 48.64±8.25 | 50.51±9.86 | (38.15±6.68) d | (40.53±6.17) d | Ⅱ | Ⅱ+8/20/20 Hz的WBV(间歇/连续) | 每周5次,4周 | ①② |
| 冯兵等[ | 26/22 | 27/21 | 62.22±6.18 | 62.22±5.23 | (45.50±6.80) d | (44.50±7.60) d | Ⅱ | Ⅱ+15 Hz、5 mm的WBV | 每周5次,4周 | ① |
| Irshad等[ | 25/18 | 23/20 | — | — | — | — | Ⅱ、Ⅵ | Ⅱ+30/40/50 Hz、2.5/3.5/8 mm的WBV | 每周5次,6周 | ①③ |
| Lee等[ | 6/3 | 8/4 | 56.0±9.1 | 59.3±13.2 | (18.0±10.9)个月 | (19.0±9.1)个月 | Ⅱ | Ⅱ+1~3 Hz、30 mm的WBV | 每周3次,6周 | ①③ |
| Lee等[ | 7/8 | 8/7 | 64.4±14.8 | 59.1±16.9 | (25.3±12.2) d | (18.4±6.9) d | Ⅱ | Ⅱ(单次)+40 Hz的WBV | 每周5次,2周 | ①② |
| Burq等[ | 19/13 | 21/11 | 55.06±11.48 | 54.56±8.85 | (10.82±5.15)个月 | (14.46±12.14)个月 | Ⅱ | Ⅱ+20 Hz、3 mm的WBV | 每周6次,2周 | ③ |
| Marín等[ | 5/4 | 6/5 | 64.4±7.6 | 62.4±10.7 | (4.3±3.0)年 | (4.3±2.0)年 | Ⅱ、Ⅲ | Ⅱ+5~21 Hz、4~6 mm的WBV | 12周,17次 | ① |
| van Nes等[ | 14/12 | 16/11 | 62.6±7.6 | 59.7±12.3 | (34.2±11.1) d | (38.9±9.2) d | Ⅱ、Ⅶ | Ⅱ+30 Hz、3 mm的WBV | 每周5次,6周 | ①② |
| Brogardh等[ | 12/3 | 13/3 | 63.9±5.8 | 61.3±8.5 | (33.1±29.2)个月 | (37.4±31.8)个月 | Ⅲ | 25 Hz、3.75 mm的WBV | 每周2次,6周 | ①③ |
| Lau等[ | 32/9 | 26/15 | 57.4±11.1 | 57.3±11.3 | (5.3±4.2)年 | (4.6±3.5)年 | Ⅷ | Ⅷ+20~30 Hz、0.44~0.60 mm的WBV | 每周3次,8周 | ① |
表4
Meta分析结果"
| 结局指标 | 纳入研究数/n | 样本量/n | 异质性检验 | Meta分析结果 | 效应模型 | ||
|---|---|---|---|---|---|---|---|
| I2值 | P值 | WMD(95%CI) | P值 | ||||
| BBS | 17[ | 1062 | 89.3% | < 0.001 | 4.761(3.220~6.302) | < 0.001 | 随机 |
| FAC | 5[ | 327 | 77.2% | 0.002 | 0.537(0.239~0.835) | < 0.001 | 随机 |
| TUGT | 8[ | 406 | 70.3% | 0.001 | -2.329(-3.889~-0.769) | 0.003 | 随机 |
表5
亚组分析结果"
| 结局指标 | 亚组 | 纳入研究数/n | 样本量/n | 异质性检验 | Meta分析结果 | 亚组间比较 | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| I2值 | P值 | Z值 | WMD(95%CI) | P值 | Q值 | P值 | ||||
| BBS | 低频 | 10[ | 594 | 79.2% | < 0.001 | 7.645 | 5.603 (4.166~7.039) | < 0.001 | 1.420 | 0.233 |
| 高频 | 7[ | 468 | 93.9% | < 0.001 | 1.962 | 3.374 (0.003~6.745) | 0.050 | |||
| 低剂量 | 9[ | 509 | 89.5% | < 0.001 | 2.946 | 3.814 (1.277~6.352) | 0.003 | 1.810 | 0.178 | |
| 高剂量 | 7[ | 533 | 85.4% | < 0.001 | 7.069 | 5.887 (4.255~7.519) | < 0.001 | |||
| FAC | 低频 | 4[ | 297 | 62.3% | 0.047 | 5.408 | 0.660 (0.421~0.899) | < 0.001 | 8.070 | 0.005 |
| 高频 | 1[ | 30 | - | - | -0.420 | -0.100 (-0.567~0.367) | 0.674 | |||
| TUGT | 低频 | 6[ | 289 | 0.0% | 0.525 | -6.121 | -2.737 (-3.614~-1.861) | < 0.001 | 0.450 | 0.505 |
| 高频 | 2[ | 117 | 94.8% | < 0.001 | -0.043 | -0.166 (-7.667~7.336) | 0.965 | |||
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