电刺激治疗脑卒中后肩手综合征有效性的系统评价与Meta分析

doi:10.3969/j.issn.1006-9771.2023.09.008

Abstract

Abstract:

Objective To systematically evaluate the efficacy of electrical stimulation on shoulder-hand syndrome after stroke, and compare the curative effect of different electrical stimulation therapies.

Methods The randomized controlled trials (RCT) about the effect of electrical stimulation on shoulder-hand syndrome after stroke were retrieved from eight databases, including PubMed, Web of Science, Embase, Cochrane Library, CNKI, CBM, VIP and Wanfang data, from the establishment to February 14th, 2023. Two researchers selected and screened the literature, and evaluated the quality of methodology independently. RevMan 5.4 software and Stata 14.0 software were used for meta-analysis and network meta-analysis, respectively.

Results A total of 18 RCT were selected, including 1 310 cases. Compared to conventional rehabilitation therapy alone, electrical stimulation combined with conventional rehabilitation therapy could improve the scores of Fugl-Meyer Assessment-Upper Extremities (MD = 8.17, 95%CI 6.90 to 9.45, P< 0.001) and modified Barthel Index (MD = 11.80, 95%CI 10.18 to 13.42, P < 0.001), and reduce the Visual Analogue Score (MD = -1.68, 95%CI -2.03 to -1.32, P < 0.001) and edema score (MD = -0.98, 95%CI -1.18 to -0.79, P< 0.001). The best effect of improving upper limb function followed as intermediate frequency electrotherapy, electroacupuncture, low frequency electrotherapy and routine rehabilitation therapy. The best effect of improving pain followed as electroacupuncture, intermediate frequency electrotherapy, low frequency electrotherapy and routine rehabilitation therapy.

Conclusion Electrical stimulation therapy can relieve pain and edema of patients with shoulder-hand syndrome after stroke, and improve upper limb activity and activities of daily living. Intermediate frequency electrotherapy is the best in improving upper limb function, and electroacupuncture is the best in relieving pain.

Key words: stroke, shoulder-hand syndrome, electric stimulation therapy, systematic review, network meta-analysis

CLC Number:

R743.3

WANG He, HAN Liang, KAN Mengfan, YU Shaohong. Efficacy of electrical stimulation on shoulder-hand syndrome after stroke: a systematic review and meta-analysis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1048-1056.

Figures/Tables 8

纳入文献	n (C/T)	平均年龄(C/T)/岁	平均病程(C/T)	干预时间	干预周期	结局指标
单婷婷^[22](2021)	32/33	(59.03±10.21)/(59.25±10.24)	(33.09±6.56)/(33.11±6.72) d	每次30 min，每天1次	20 d	①②③
雷波等^[23](2017)	31/31	(49.2±7.5)/(48.3±8.1)	(33.4±5.5)/(32.3±6.1) d	每次30 min，每天1次	20 d	①②④
梁楠等^[24](2016)	42/42	(55.8±3.6)/(56.5±3.2)	(15 d~3个月)/(10 d~3个月)	每次30 min，每天1次	30 d	①②
石翠霞等^[25](2014)	40/40	(52.65±10.03)/(52.73±11.17)	(25.68±4.71)/(25.53±3.8) d	每次20 min，每天1次	4周	①②③④
章晓峰等^[26](2022)	32/33	(64.84±6.95)/(63.03±8.80)	(32.60±4.83)/(31.94±4.61) d	每次30 min，每天1次	8周	①②
张晓玲等^[27](2012)	33/35	(60.8±11.3)/(61.4±10.9)	(3.6±4.3)/(3.7±4.2) d	每次20 min，每天1次	3周	②④
崔高亮等^[28](2011)	24/23	(63.5±7.9)/(65.4±8.4)	50/47 d	每次10 min，每天1次	1个月	①②
费立凤等^[29](2009)	28/28	61/63	60/62 d	每次40 min，每天1次	1个月	①②
黄心熳等^[30](2022)	60/60	(61.24±11.15)/(60.08±10.97)	(20.42±6.47)/(18.92±5.17) d	每次30 min，每天1次，每周5 d	3周	①②④
李素丹等^[31](2022)	35/35	(55.3±13.2)/(55.5±13.0)	(47.2±11.9)/(47.5±11.6) d	每次30 min，每天1次	21 d	①②
刘学春等^[32](2021)	40/39	(64.21±9.35)/(63.38±9.22)	未提及	每次15~20 min，每天2次	2周	①②③
邵丽丽等^[33](2019)	39/39	(60.47±13.42)/(59.42±11.56)	(3.13±1.72)/(2.83±1.47)个月	每次20 min，每天1次	30 d	①③
吴延深等^[34](2022)	25/25	(55.39±2.54)/(55.23±2.52)	(3.22±0.43)/(3.53±0.51)个月	每次30 min，每天1次	1个月	①②
谢晶军等^[35](2016)	40/40	(51±10)/(55±11)	(15 d~2个月)/(14 d~2个月)	每次30 min，每周3次	4周	①②
徐力康^[36](2021)	60/60	(63.74±5.83)/(64.22±6.05)	(2.31±0.56)/(2.81±0.91)个月	每次30 min，每天1次	4周	①②
李水琴等^[37](2010)	50/48	(55.64±5.89)/(57.58±6.02)	(32.75±4.85)/(33.68±3.26) d	每次20 min，每天1次	1个月	①②
李新华^[38](2008)	24/24	(59±10)/(59±13)	未提及	每次40~60 min，每天1次	4周	①
周科望等^[39](2017)	20/20	(63.12±6.89)/(63.71±6.45)	(39.65±33.12)/(39.83±32.18) d	每次45 min，每天2次，每周6 d	6周	①

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结局指标		纳入研究数/n	异质性检验		效应模型	Meta分析结果
结局指标		纳入研究数/n	I²值(%)	P值	效应模型	MD (95%CI)	P值
FMA-UE		17^{[22,26,28⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓-39]}	86	< 0.001	随机效应模型	8.17 (6.90, 9.45)	< 0.001
	病程< 1个月	5^{[22-23,25-26,30]}	91	< 0.001	随机效应模型	9.02 (5.39, 12.64)	< 0.001
	病程1~2个月	5^{[28-29,31,37,39]}	74	0.004	随机效应模型	9.62 (6.78, 12.46)	< 0.001
	病程> 2个月	3^[33,34,36]	51	0.130	随机效应模型	6.53 (5.64, 7.43)	< 0.001
VAS		15^{[22⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓⇓-37]}	94	< 0.001	随机效应模型	-1.68 (-2.03, -1.32)	< 0.001
	病程< 1个月	6^{[22-23,25⇓-27,30]}	94	< 0.001	随机效应模型	-1.39 (-1.95, -0.83)	< 0.001
	病程1~2个月	4^{[28-29,31,37]}	49	0.120	固定效应模型	-1.81 (-1.94, -1.68)	< 0.001
	病程> 2个月	2^[34,36]	99	< 0.001	随机效应模型	-2.39 (-4.72, -0.06)	< 0.001
水肿评分		4^{[22-23,25,27]}	44	0.150	固定效应模型	-0.98 (-1.18, -0.79)	< 0.001
MBI		4^{[22,25,32-33]}	46	0.130	固定效应模型	11.80 (10.18, 13.42)	< 0.001

结局指标	干预措施	MD (95%CI)
FMA-UE	常规康复疗法vs.电针	-8.34 (-11.36, -5.32)
	常规康复疗法vs.低频电疗	-7.62 (-11.06, -4.19)
	常规康复疗法vs.中频电疗	-11.43 (-16.36, -6.51)
	低频电疗vs.电针	-0.72 (-5.29, 3.86)
	中频电疗vs.电针	3.09 (-2.68, 8.87)
	中频电疗vs.低频电疗	3.81 (-2.19, 9.81)
VAS	常规康复疗法vs.电针	1.92 (1.48, 2.36)
	常规康复疗法vs.低频电疗	1.49 (0.93, 2.04)
	常规康复疗法vs.中频电疗	1.88 (1.01, 2.76)
	低频电疗vs.电针	0.44 (-0.27, 1.15)
	中频电疗vs.电针	0.04 (-0.94, 1.02)
	中频电疗vs.低频电疗	-0.40 (-1.43, 0.64)

结局指标	干预措施	累积排序概率/%
FMA-UE	电针	58.9
	低频电疗	49.4
	中频电疗	91.7
	常规康复疗法	0
VAS	电针	80.9
	低频电疗	45.1
	中频电疗	74.1
	常规康复疗法	0

Efficacy of electrical stimulation on shoulder-hand syndrome after stroke: a systematic review and meta-analysis

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