不同强化训练对脑性瘫痪儿童上肢运动功能效果的网状Meta分析

doi:10.3969/j.issn.1006-9771.2024.04.009

Abstract

Abstract:

Objective To systematically review the effect of upper extremity intensive training on upper limb motor function in children with cerebral palsy.

Methods The PICO framework was constructed. PubMed, Embase, Cochrane Library, Scopus, Web of Science, CNKI, CBM, VIP and Wanfang data were retrieved for randomized controlled trials on the improvement of upper limb motor function in children with cerebral palsy by upper extremity intensive training from January, 2010 to March, 2024. The quality of the included researches was evaluated using the Cochrane System Evaluation Manual and Physiotherapy Evidence Database scale. Two reviewers independently screened literature, extracted data and assessed the risk of bias. Network meta-analysis was conducted using RevMan 5.4 and Stata 17.0.

Results A total of 27 randomized controlled trials were selected, including 1 173 cases, involving three kinds of upper extremity intensive training. Constraint-induced movement therapy, modified constraint-induced movement therapy and hand-arm bimanual intensive therapy improved Assistive Hand Assessment score and Peabody Developmental Motor Scale-Fine Motor score; constraint-induced movement therapy and modified constraint-induced movement therapy improved the Quality of Upper Extremity Skills Test score; hand-arm bimanual intensive therapy improved Pediatric Evaluation of Disability Inventory score. Constraint-induced movement therapy was the best in improving the Assistive Hand Assessment score, Quality of Upper Extremity Skills Test score and Peabody Developmental Motor Scale-Fine Motor score, while hand-arm bimanual intensive therapy was the best in improving the Pediatric Evaluation of Disability Inventory score.

Conclusion Upper extremity intensive training can significantly improve upper limb motor function, fine motor function and activities of daily living in children with cerebral palsy. Constraint-induced movement therapy is the best in improving upper limb function and fine motor function, and hand-arm bimanual intensive therapy is the best in improving the activities of daily living.

Key words: cerebral palsy, upper extremity, intensive training, constraint-induced movement therapy, motor function, network meta-analysis

CLC Number:

R742.3

CUI Tiantian, YANG Yulin, CUI Tengteng, MA Lihong. Effect of different intensive training on upper limb motor function in children with cerebral palsy: a network meta-analysis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 437-448.

Figures/Tables 18

Table1

Figure 1

Figure 2

Table 2

PEDro scale scores of included studies"

纳入文献	资格标准	随机分配	分配隐藏	基线均衡	被试施盲	治疗师施盲	评估者施盲	被试流失率≤15%	意向性分析	组间统计比较	点估计和变异性测量	总分
Abd El Wahab等^[15](2015)	√	√		√				√	√	√	√	6
Fedrizzi等^[16](2013)	√	√		√	√		√	√	√	√	√	8
Figueiredo等^[17](2020)	√	√		√				√	√	√	√	6
李巧秀^[18](2017)	√	√		√				√	√	√	√	6
孙瑞雪等^[19](2016)	√	√		√				√	√	√	√	6
王臣等^[20](2021)	√	√		√				√	√	√	√	6
Araneda等^[21](2022)	√	√		√				√	√	√	√	6
Araneda等^[22](2024)	√	√	√	√	√		√	√	√	√	√	9
Bleyenheuft等^[23](2015)	√	√	√	√	√	√		√	√	√	√	9
Saussez等^[24](2023)	√	√		√			√	√	√	√	√	7
De Brito Brandão等^[25](2010)	√	√	√	√			√	√	√	√	√	8
Eliasson等^[26](2018)	√	√		√	√		√	√	√	√	√	8
Ramey等^[27](2021)	√	√	√	√			√	√	√	√	√	8
Chen等^[28](2013)	√	√	√	√	√	√	√	√	√	√	√	10
Gordon等^[29](2011)	√	√		√	√	√		√	√	√	√	8
Sakzewski等^[30](2011)	√	√	√	√	√			√	√	√	√	8
Zafer等^[31](2016)	√	√		√				√	√	√	√	6
Choudhary等^[32](2013)	√	√	√	√	√		√	√	√	√	√	9
Hoare等^[33](2013)	√	√	√	√	√	√	√	√	√	√	√	10
Hwang等^[34](2020)	√	√		√			√	√	√	√	√	7
Mohamed等^[35](2021)	√	√	√	√	√		√	√	√	√	√	9
刘鹏等^[36](2022)	√	√		√			√	√	√	√	√	7
Bingöl等^[37](2022)	√	√	√	√	√	√	√	√	√	√	√	10
Bingöl等^[38](2023)	√	√	√	√	√		√	√	√	√	√	9
Chamudot等^[39](2018)	√	√		√	√		√	√	√	√	√	8
Deppe等^[40](2013)	√	√	√	√	√		√	√	√	√	√	9
Sakzewski等^[41](2015)	√	√	√	√	√		√	√	√	√	√	9

Table 2

Table 3

Basic characteristics of included literatures"

纳入文献	国家	场所	n		年龄/岁 (试验组/对照组)	干预措施		干预周期	结局指标
纳入文献	国家	场所	试验组	对照组	年龄/岁 (试验组/对照组)	试验组	对照组	干预周期	结局指标
Abd El Wahab等^[15](2015)	埃及	医院	15	15	3.64±0.48/4.11±0.93	HABIT	CRT	12周	①
Fedrizzi等^[16](2013)	意大利	机构	39(T1)	33	2~8	mCIMT(T1)	CRT	10周	②
Fedrizzi等^[16](2013)	意大利	机构	33(T2)	33	2~8	HABIT(T2)	CRT	10周	②
Figueiredo等^[17](2020)	巴西	机构	19	20	9.42±3.58/9.67±4.16	HABIT	CRT	3周	③
李巧秀^[18](2017)	中国	医院	43	43	4.3±0.8	HABIT	CRT	8周	①②③
孙瑞雪等^[19](2016)	中国	医院	20	20	2.5~6	HABIT	CRT	12周	①②③
王臣等^[20](2021)	中国	医院	45	50	4.64±2.15/4.68±2.26	HABIT	CRT	8周	①
Araneda等^[21](2022)	比利时	实验室	16	15	9.3±4.25/9.3±5.3	HABIT	CRT	2周	④
Araneda等^[22](2024)	比利时	医院	25	24	3±3.46/2.76±3.51	HABIT	CRT	2周	③④
Bleyenheuft等^[23](2015)	比利时	医院	12	12	8.9 ± 1.7/8.5 ± 1.7	HABIT	CRT	2周	③④
Saussez等^[24](2023)	比利时	实验室	20	20	9.1±2.9/9.0±3.1	HABIT	CRT	2周	③④
De Brito Brandão等^[25](2010)	巴西	机构	8	7	5.5±1.92/6.58±1.11	CIMT	CRT	2周	③
Eliasson等^[26](2018)	瑞典	医院	18	13	0.5±0.49/0.42±0.46	CIMT	CRT	6周	④
Ramey等^[27](2021)	美国	医院	25	23	3.4±1.2/4.5±2.1	CIMT	CRT	4周	①②③④
Chen等^[28](2013)	中国	医院	24	23	8.7±1.9/8.8±2.0	CIMT	CRT	4周	①
Gordon等^[29](2011)	美国	实验室	21	21	6.3±2.2/6.4±1.11	CIMT	HABIT	3周	②④
Sakzewski等^[30](2011)	澳大利亚	实验室	32	32	10.2±2.7	CIMT	HABIT	3周	④
Zafer等^[31](2016)	巴基斯坦	研究所	9	9	8.75±3.06	CIMT	HABIT	2周	②
Choudhary等^[32](2013)	印度	医院	16	15	4.88±5.11/5.22±5.2	mCIMT	CRT	4周	②
Hoare等^[33](2013)	澳大利亚	诊所	17	17	3±4.5/2.97±4.73	mCIMT	CRT	8周	②③④
Hwang等^[34](2020)	韩国	医院	12	12	1.33±2.42/1.44±1.79	mCIMT	CRT	3周	①③
Mohamed等^[35](2021)	埃及	医院	20	20	7.7±0.86/7.75±0.91	mCIMT	CRT	12周	②
刘鹏等^[36](2022)	中国	医院	20	20	2.94±0.88/3.04±0.86	mCIMT	CRT	12周	①②
Bingol等^[37](2022)	土耳其	学校	16	16	10.75±2.95/10.12±2.96	mCIMT	HABIT	10周	②
Bingol等^[38](2023)	土耳其	学校	15	15	8.73±1.66/8.33±1.44	mCIMT	HABIT	16周	②
Chamudot等^[39](2018)	以色列	机构	17	16	0.93±0.64	mCIMT	HABIT	8周	④
Deppe等^[40](2013)	德国	机构	24	18	5.83±1.83/6.83±2.08	mCIMT	HABIT	4周	③④
Sakzewski等^[41](2015)	澳大利亚	医院	32	31	10.1±2.6/10.2±2.6	mCIMT	HABIT	2周	④

Table 3

Figure 3

Table 4

Figure 4

Figure 5

Table 5

Figure 6

Figure 7

Table 6

Figure 8

Figure 9

Table 7

Figure 10

Table 8

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人群 (Population)		干预 (Intervention)	比较 (Comparison)	结局 (Outcome)
脑瘫儿童	8D2Z脑瘫	干预措施	干预前后比较	上肢运动功能(QUEST)
< 18岁		常规康复治疗	干预方式比较	b710关节活动功能
		常规康复治疗＋上肢强化训练	干预组和对照组比较	b760随意运动控制功能
		干预时间		精细运动功能(AHA与PDMS-FM)
		干预场所		d440精细手的使用
				d445手和手臂的使用
				日常生活活动能力(PEDI)
				d599自我照顾能力

方法	CIMT	mCIMT	HABIT
mCIMT	1.11 (0.58, 2.11)
HABIT	1.44 (0.81, 2.56)	1.30 (0.86, 1.96)
CRT	1.91 (1.06, 3.43)^a	1.72 (1.21, 2.45)^a	1.33 (0.90, 1.95)

方法	CIMT	mCIMT	HABIT
mCIMT	1.69 (0.99, 2.86)
HABIT	1.32 (0.89, 1.97)	0.78 (0.54, 1.14)
CRT	2.74 (1.80, 4.17)^a	1.63 (1.04, 2.55)^a	2.07 (1.49, 2.88)^a

方法	CIMT	mCIMT	HABIT
mCIMT	1.95 (0.98,3.87)
HABIT	1.72 (1.02,2.89)^a	0.88 (0.48,1.62)
CRT	3.38 (2.20,5.19)^a	1.74 (1.02,2.96)^a	1.97 (1.47,2.63)^a

方法	CIMT	mCIMT	HABIT
mCIMT	1.60 (0.29,8.81)
HABIT	0.98 (0.22,4.33)	0.61 (0.20,1.91)
CRT	2.30 (0.61,8.70)	1.44 (0.49,4.21)	2.35 (1.21,4.59)^a

Effect of different intensive training on upper limb motor function in children with cerebral palsy: a network meta-analysis

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结局指标	n	样本量	偏倚风险	不一致性	证据质量
AHA评分	12	501	1^①	1^②	低
QUEST评分	12	513	1^①	0	中
PDMS-FM评分	8	439	1^①	0	中
PEDI评分	12	472	1^①	1^②	低

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