《中国康复理论与实践》

《中国康复理论与实践》 ›› 2013, Vol. 19 ›› Issue (08): 710-721.

• 论文 • 上一篇    下一篇

虚拟现实技术对脑卒中患者上下肢运动功能康复效果的系统评价

杨雨洁，岳雨珊，郭佳宝，张文毅，谢斌，潘桦飞，朱毅   

  1. 1.南京中医药大学第二临床医学院，江苏南京市210023；2.江苏省人民医院钟山康复分院，江苏南京市210014。
  • 收稿日期:2013-01-29 修回日期:2013-06-12 出版日期:2013-08-25 发布日期:2013-08-25
  • 通讯作者: 朱毅

Effect of Virtual Reality on Motor Function in Patients with Stroke: A Systematic Review of Randomaized Controlled Trials

YANG Yu-jie, YUE Yu-shan, GUO Jia-bao, et al.   

  1. The Second Clinical Medical School, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu,China
  • Received:2013-01-29 Revised:2013-06-12 Published:2013-08-25 Online:2013-08-25

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摘要： 目的系统评价虚拟现实技术对脑卒中患者上下肢运动功能康复的效果。方法计算机检索PubMed、Cochrane Central Register of Controlled Trials、中国知网、维普、万方数据库中关于虚拟现实技术改善脑卒中患者运动功能障碍的随机对照试验。搜索时限从建库至2013 年1 月。按照Cochrane 系统评价员手册推荐方法逐一评价纳入研究的质量，提取有效数据，对符合质量要求的文献数据采用RevMan 5.0 软件对最终纳入文献数据进行统计学分析。结果最终纳入20 篇文献，其中上肢运动功能相关13 篇，下肢运动功能相关7 篇。Meta 分析结果显示，虚拟现实技术疗法对Fugl-Meyer 评定法(FMA)上肢部分(WMD=4.27, 95%CI:2.47~6.06, Z=4.67, P<0.00001)及盒子和阻碍物测试(BBT)(WMD=9.29, 95%CI: 5.24~13.34, Z=4.50, P<0.00001)与常规康复治疗比较，其差异均有统计学意义。而Berg 平衡量表(BBS)(WMD=1.63, 95%CI: -0.83~4.09, Z=1.30, P=0.20)和步行速度(WMD=0.01, 95% CI: -0.14~0.17, Z=0.18, P=0.86)与常规康复治疗比较，其差异无统计学意义。纳入文献质量的Jadad 评分，低质量16 篇，高质量4篇。结论虚拟现实技术能明显改善脑卒中后患者上肢运动功能，但对于脑卒中患者下肢运动功能的恢复无明显疗效。

关键词: 脑卒中, 虚拟现实, 运动功能, 随机对照试验, 系统评价, Meta分析

Abstract: Objective To evaluate the effect of virtual reality on motor function in patients with stroke. Methods PubMed, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI), VIP Database for Chinese Technical Periodicals and Wanfang Data were searched for the randomized controlled trials (RCTs) of virtual reality on motor function in patients with stroke from the date of establishment to January 2013. The included studies were evaluated according to the method recommended by the Cochrane Collaboration. RevMan 5.0 software was used to analyze the extracted data. Results 20 trials were included (13 trials about the upper extremity function and 7 trials about the lower extremity function). Compared with conventional training, the virtual reality training significantly increased the score of Fugl-Meyer assessment (FMA) (WMD=4.27, 95%CI: 2.47~6.06, Z=4.67, P<0.00001) and Box and Block Test (BBT) (WMD=9.29, 95% CI: 5.24~13.34, Z=4.50, P<0.00001). However, the results of Berg balance scale (BBS) (WMD=1.63, 95% CI: -0.83~4.09, Z=1.30, P=0.20) and walking speed (WMD=0.01, 95%CI: -0.14~0.17, Z=0.18, P=0.86) were not statistically significance for the lower extremity function. According to the Jadad Score of included studies, 16 of them were of low quality and only 4 of them were of high quality. Conclusion The virtual reality training could improve the upper extremity function in patients with stroke, but not for the lower extremity function.

Key words: stroke, virtual reality, motor function, randomized controlled trials, systematic review, Meta-analysis