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

doi:10.3969/j.issn.1006-9771.2016.12.005

摘要/Abstract

摘要： 目的　系统回顾镜像疗法对脑卒中患者患侧上肢运动功能和日常生活能力的疗效。方法　在Medline、PubMed、CINAHL、OT seeker、PEDro、万方数据库和中国知网数据库中系统检索2006年1月~2016年5月研究镜像疗法对脑卒中患者上肢功能疗效的研究，纳入随机对照研究，排除不以患侧上肢运动功能和日常生活活动能力为主要结局指标的研究。进行数据提取，采用RevMan 5.3进行分析。结果　共纳入14篇随机对照研究。相比对照治疗，镜像疗法可提高患侧上肢Fugl-Meyer评分(SMD=0.81, 95%CI=0.43~1.20, P<0.001, I2=64%)，在剔除仅纳入严重偏瘫的2篇文献后，效应提高(SMD=0.96, 95%CI=0.59~1.34, P<0.001, I2=51%)，且不同镜像疗法亚组间有非常显著性差异(P=0.004)。镜像疗法也可提高脑卒中患者患侧上肢动作研究量表评分(SMD=0.33, 95%CI=0.01~0.64, P=0.040, I2=0)、组块测试评分(SMD=0.70, 95%CI=0.03~1.37, P=0.040, I2=62%)，还可提高患侧上肢Brunstrom分级(SMD=1.56, 95%CI=1.07~2.06, P<0.001, I2=41%)；可提高脑卒中患者日常生活活动能力(SMD=0.93, 95%CI=0.62~1.24, P<0.001, I2=0)。尚无证据表明镜像疗法可改善患侧上肢肌张力(SMD=-0.22, 95%CI=-0.73~0.28, P=0.890, I2=0)。结论　镜像疗法可在一定程度上改善脑卒中患者患侧上肢运动功能，提高日常生活能力。

关键词: 脑卒中, 镜像疗法, 上肢, 运动功能, 日常生活活动, Meta分析

Abstract: Objective To systematically summarize the effects of mirror therapy on upper extremity motor function and activities of daily living after stroke.Methods The literatures about mirror therapy published between January, 2006 and May, 2016 were recalled from Medline, PubMed, CINAHL, OT seeker, PEDro, Wanfang and CNKI databases. The randomized control trials were included, and those didn't concern upper extremity motor function and activities of daily living were excluded. The data were extracted and analysed with RevMan 5.3.Results Fourteen trials were included. Mirror therapy could significantly improve Fugl-Meyer Assessment score (SMD=0.81, 95%CI=0.43-1.20, P<0.001, I2=64%). Subgroups analysis indicated movement based mirror therapy was more effective on mild to moderate hemiplegia (SMD=0.96, 95%CI=0.59~1.34, P<0.001, I2=51%) and the subgroup differences were also significant (P=0.004). Mirror therapy could improve score of Action Research Arm Test (SMD=0.33, 95%CI=0.01-0.64, P=0.040, I2=0), Box and Block Test (SMD=0.70, 95%CI=0.03-1.37, P=0.040, I2=62%) and Brunstrom stages (SMD=1.56, 95%CI=1.07-2.06, P<0.001, I2=41%) of affected upper extremities. It could also improve activities of daily living (SMD=0.93, 95%CI=0.62-1.24, P<0.001, I2=0). No evidence revealed mirror therapy could change muscle tone of flexors of affected upper limbs (SMD=-0.22, 95%CI=-0.73-0.28, P=0.890, I2=0).Conclusion Mirror therapy can significantly improve upper extremity motor function and activity of daily living.

Key words: stroke, mirror therapy, upper extremity, motor function, activity of daily living, Meta-analysis

中图分类号:

R743.3

白钟飞，张子未，王惠芳，陆佳妮. 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): 1384-1383.

BAI Zhong-fei, ZHANG Zi-wei, WANG Hui-fang, LU Jia-ni. Effect of Mirror Therapy on Upper Extremity Motor Function and Activities of Daily Living after Stroke: A Meta-analysis　[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2016, 22(12): 1384-1383.

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