机器人辅助训练对脑卒中患者上肢运动功能效果的Meta分析

doi:10.3969/j.issn.1006-9771.2023.02.004

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (2): 156-166.doi: 10.3969/j.issn.1006-9771.2023.02.004

机器人辅助训练对脑卒中患者上肢运动功能效果的Meta分析

张丽英¹^,², 王杰宁¹^,²(), 于小明²

1.上海中医药大学市七临床医学院，上海市 201210
2.上海市第七人民医院康复医学中心，上海市 200137

收稿日期:2022-07-15 修回日期:2022-11-08 出版日期:2023-02-25 发布日期:2023-03-16
通讯作者: 王杰宁 E-mail:sevenhos_yb@163.com
作者简介:张丽英(1997-)，女，汉族，福建邵武市人，硕士研究生，主要研究方向：中西医结合康复治疗。
基金资助:
上海市进一步加快中医药传承创新发展三年行动计划项目(2021年-2023年)No(ZY(2021-2023)-0104-01);浦东新区"国家中医药发展综合改革试验区"建设项目(PDZY-2019-0501)

Effect of robot-assisted training on upper limb motor in patients with stroke: a meta-analysis

ZHANG Liying¹^,², WANG Jiening¹^,²(), YU Xiaoming²

1. The Seventh Clinical School of Medicine, Shanghai University of Traditional Medicine, Shanghai 201210, China
2. Rehabilitation Medical Center, Shanghai Seventh People's Hospital, Shanghai 200137, China

Received:2022-07-15 Revised:2022-11-08 Published:2023-02-25 Online:2023-03-16
Contact: WANG Jiening E-mail:sevenhos_yb@163.com
Supported by:
Supported by Shanghai Further Accelerates the Three-Year Action Plan for the Inheritance, Innovation and Development of Traditional Chinese Medicine (2021-2023) No.(ZY(2021-2023)-0104-01);the Construction Project of "National Comprehensive Reform Pilot Zone for the Development of Traditional Chinese Medicine" in Pudong New Area No(PDZY-2019-0501)

摘要/Abstract

摘要：

目的系统评价机器人辅助训练对脑卒中患者上肢运动功能障碍的治疗效果。方法检索PubMed、Medline、Embase、Cochrane Library、Web of Science、中国知网、万方数据、中国生物医学文献数据库和维普数据库中关于机器人辅助训练对脑卒中患者上肢运动功能效果的文献，时限均为2019年7月1日至2022年7月1日。两名研究人员独立筛选文献并提取数据，评估方法学质量。使用Rev Man 5.4进行Meta分析。结果纳入19项随机对照试验，共1 258例受试者。试验组Fugl-Meyer评定量表上肢部分(SMD = 0.55, 95%CI 0.40~0.71, P < 0.001)、改良Bathel指数(MD = 7.55, 95%CI = 6.55~8.54, P < 0.001)、运动活动日志(SMD = -0.84, 95%CI -1.38~-0.31, P = 0.002)评分均明显优于对照组；两组间Brunnstrom分期上肢部分(SMD = 0.61, 95%CI -0.08~1.30, P = 0.08)和改良Ashworth量表(MD = -0.51, 95%CI -1.18~0.17, P = 0.14)评分均无显著性差异。结论机器人辅助训练对脑卒中患者的上肢运动功能有效。

关键词: 脑卒中, 机器人辅助训练, 上肢, 运动功能, Meta分析

Abstract: Objective To systematically review the efficacy of robot-assisted training on upper limb motor dysfunction in stroke patients. Methods Related literatures were searched in PubMed, Medline, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, SinoMed, VIP data from July 1, 2019 to July 1, 2022. Two researchers screened the studies and extracted the data independently, and evaluated the methodological quality. Rev Man 5.4 was used for meta-analysis. Results A total of 19 randomised controlled trials with 1 258 subjects were finally included. The scores of Fugl-Meyer Assessment-Upper Extremity (SMD = 0.55, 95%CI 0.40 to 0.71, P < 0.001), modified Bathel Index (MD = 7.55, 95%CI 6.55 to 8.54, P < 0.001) and Motor Activity Log (SMD = -0.84, 95%CI -1.38 to -0.31, P = 0.002) were better in the experimental group than in the control group. However, no significant difference was found in the scores of Brunnstrom stages (upper extremity) (SMD = 0.61, 95%CI -0.08 to 1.30, P = 0.08) and modified Ashworth Scale (MD = -0.51, 95%CI -1.18 to 0.17, P = 0.14) between two groups. Conclusion Robot-assisted training could significantly improve the motor function of upper limbs in stroke patients.

Key words: stroke, robot-assisted training, upper exteremity, motor function, meta-analysis

中图分类号:

R743.3

张丽英, 王杰宁, 于小明. 机器人辅助训练对脑卒中患者上肢运动功能效果的Meta分析[J]. 《中国康复理论与实践》, 2023, 29(2): 156-166.

ZHANG Liying, WANG Jiening, YU Xiaoming. Effect of robot-assisted training on upper limb motor in patients with stroke: a meta-analysis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(2): 156-166.

图/表 11

图1

表1

纳入文献的基本特征"

纳入研究	n(T/C)	年龄(T/C)/岁	病程(T/C)	干预频率	干预方式及病程	结局指标
Taravati等^[26](2022)	37(17/20)	(50.94±17.20)/(55.75±11.61)	(10.94±8.02)个月/ (12.65±8.42)个月	每天30~45 min，每周5 d，共4周	T：常规+机器人辅助训练 C：常规康复训练	①②④
Frisoli等^[27](2022)	22(11/11)	(62±12)/(70±11)	(30±20) d/(37±24) d	每次45 min，每周3次，共6周	T：机器人辅助训练 C：常规物理治疗	①
苏丽丽等^[28](2022)	60(30/30)	(64.97±4.88)/(65.53±5.46)	(27.13±3.88) d/ (26.73±4.08) d	每次40 min，每天1次，每周5 d，共4周	T：作业治疗+机器人辅助训练 C：作业治疗+认知训练	①③
何艳等^[29](2021)	60(30/30)	(57.53±14.61)/(57.67±12.98)	(2.93±2.43)个月/ (2.33±1.69)个月	每次30 min，每天2次，每周5 d，共4周	T：常规+机器人辅助训练 C：常规康复训练	①③
Kim等^[30](2021)	47(23/24)	(57.17±15.12)/(62.08±12.42)		每次40 min,每天1次，每周5 d，共4周	T：作业治疗+机器人辅助训练 C：作业治疗	①③④
Chinembiri等^[31](2021)	45(20/25)	(57.25±9.23)/(57.72±7.37)		每次70 min，每天1次，每周5 d，共6周	T：常规+机器人辅助训练 C：常规康复治疗	①③
Franceschini等^[32](2020)	48(25/23)	70.0(60.3,72.0)/74.0(68.3,80.3)	31.0 (28.0, 33.0) d/ 31.0 (29.0, 33.0) d	每次45 min，每天1次，每周5 d，共6周	T：机器人辅助治疗 C：物理治疗	①
Carpinella等^[33](2020)	38(19/19)	67.0(58.0~70.0)/59.0(46.0~69.0)	7.0 (1.7~11.9)个月/ 5.3 (1.9~89.6)个月	每次45 min，每周5次，共20次	T：机器人辅助治疗 C：物理治疗	①④
梅英春^[34](2020)	32(16/16)	(55.94±1.82)/(54.75±1.43)		每天3 h，每周5 d，共8周	T：运动康复+机器人辅助训练 C：运动康复	①②④
李宇淇^[35](2020)	40(20/20)	(49.9±14.2)/(49.45±11.69)	1(1,2)个月/ 1.5(1,3)个月	每次60 min，每天1次，每周7 d，共2周	T：常规+机器人辅助训练 C：常规康复训练	①②③④
姜荣荣等^[36](2020)	40(20/20)	(63.15±11.79)/(65.10±9.14)	(73.75±52.32) d/ (79.70±52.25) d	每次30 min，每天1次，每周6 d，共2周	T：机器人辅助训练 C：作业治疗+认知训练	①③⑤
顾琦等^[37](2020)	46(23/23)	(62.09±10.75)/(59.57±11.08)	(24.35±6.34) d/ (24.96±5.47) d	每次30 min/次，每天1次，每周5 d，共9周	T：常规+机器人辅助训练 C：常规康复训练	①③④
Rodgers等^[38](2019)	469(233/236)	(59.9±13.5)/(59.4±14.3)	233(102~549) d/ 258(115~546) d	每次45 min，每周3次，共12周	T：机器人辅助训练 C：上肢强化训练	①③
Ramos等^[39](2019)	28(16/12)	(49.3±12.5)/(50.3±12.2)		每次1 h，每天1次，每周5 d，共4周	T：机器人辅助训练 C：常规康复训练	①⑤
Hsu等^[40](2019)	43(22/21)	(53.1±13.9)/(52.6±12.5)	(13.7±8.6)周/ (14.7±13.2)周	每次50 min，每周3次，共4周	T：机器人辅助训练 C：常规康复护理	①⑤
Dehem等^[41](2019)	45(23/22)	(67.3±11.1)/(68.6±19.1)	(194.7±17.0) d/ (191.3±12.3) d	每次45 min，每天1次，每周4 d，共9周	T：机器人辅助训练 C：常规康复训练	①③
张杨^[42](2019)	28(14/14)	(55.07±12.56)/(56.00±11.11)		每次30 min，每天1次，每个疗程5 d，共3个疗程	T：常规+机器人辅助训练 C：常规康复训练	①②③
张海燕等^[43](2019)	40(20/20)	(54.00±12.45)/(56.50±11.62)	(31.20±18.14) d/(30.55±17.63) d	每天1次，每周6 d，共4周	T：常规+机器人辅助训练 C：常规康复训练	①
翁静等^[44](2019)	90(45/45)	(55.48±12.18)/(54.56±11.74)	(2.48±1.11)个月/(2.36±1.23)个月	每次30 min，每天1次，共6周	T：常规+机器人辅助训练 C：常规康复训练	①③

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纳入研究	①	②	③	④	⑥	⑦	⑧	⑨	⑩	⑪	总分
Taravati等^[26](2022)	√	√	√	√		√	√	√	√	√	8
Frisoli等^[27](2022)	√	√	√	√		√	√	√	√	√	8
苏丽丽等^[28](2022)	√	√	√	√			√	√	√	√	7
何艳等^[29](2021)	√	√	√	√			√	√	√	√	7
Kim等^[30](2021)	√	√	√	√		√	√	√	√	√	8
Chinembiri等^[31](2021)	√	√	√	√		√	√	√	√	√	8
Franceschini等^[32](2020)	√	√	√	√		√	√	√	√	√	8
Carpinella等^[33](2020)	√	√	√	√		√	√	√	√	√	8
梅英春^[34](2020)	√	√	√	√			√	√	√	√	7
李宇淇^[35](2020)	√	√	√	√			√	√	√	√	7
姜荣荣等^[36](2020)	√	√	√	√			√	√	√	√	7
顾琦等^[37](2020)	√	√	√	√			√	√	√	√	7
Rodgers等^[38](2019)	√	√	√	√		√	√	√	√	√	8
Ramos等^[39](2019)	√	√	√	√	√	√	√	√	√	√	9
Hsu等^[40](2019)	√	√	√	√		√	√	√	√	√	8
Dehem等^[41](2019)	√	√	√	√		√	√	√	√	√	8
张杨^[42](2019)	√	√	√	√			√	√	√	√	7
张海燕等^[43](2019)	√	√	√	√			√	√	√	√	7
翁静等^[44](2019)	√	√	√	√			√	√	√	√	7

机器人辅助训练对脑卒中患者上肢运动功能效果的Meta分析

Effect of robot-assisted training on upper limb motor in patients with stroke: a meta-analysis

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