核心稳定性训练对脑卒中偏瘫患者康复效果的系统评价及试验序贯分析
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摘要
目的:系统评价核心稳定性训练(corestabilityexercise,CST)对脑卒中偏瘫患者的康复效果。方法:计算机检索Cochrane Library,Web of Science,PubMed,Embase,知网,万方,维普,CBM等中英文数据库中相关文献,检索时间截至2018年9月,然后由2人独立对检索文献进行筛选、数据提取和质量评价,采用RevMan 5.3进行数据分析,TSA 0.9进行试验序贯分析(trial sequentialanalysi s, TSA)。结果:共纳入11篇随机对照试验,包括736名患者。Meta分析结果显示,CST联合常规康复治疗对脑卒中偏瘫患者躯干控制能力、平衡能力、日常生活活动能力及10m最大步行速度的效果均优于单纯常规康复治疗,且不同干预时间的各亚组间差异不显著。TSA结果显示:以上4项结局指标的合并结果均稳定且可靠。结论:CST联合常规康复治疗可有效提高脑卒中偏瘫患者的躯干控制能力、平衡能力、日常生活活动能力及步速,建议临床推广使用。
Objective: To systematically evaluate the clinical effects of core stability exercise for rehabilitation of stroke patients with hemiplegia. Methods: Cochrane Library, Web of Science, PubMed, Embase, CNKI, Wanfang, VIP, CBM were searched for relevant articles from the inception to September 2018. All randomized controlled trials assessing core stability exercises for stroke patients were included. Studies screening, data extraction, and quality evaluation were conducted independently by two researchers. Data was analyzed using RevMan 5.3, and trial sequential analysis(TSA) was conducted by TSA 0.9. Results: Totally 11 studies and 736 patients were included. Results showed that combination of core stability exercise and conventional rehabilitation had significantly better effects on trunk control ability, balance ability, activities of daily living, and maximum walking speed in 10 metersthan single conventional rehabilitation, and differences of all subgroups in four outcomes were not significant. TSA confirmed that the pooled results of outcomes above were stable and reliable. Conclusion: Core stability exercise combined with conventional rehabilitation can significantly improve the trunk control, balance, activities of daily living and walking speed of stroke patients, and thus it should be applied in clinical practice.
Objective: To systematically evaluate the clinical effects of core stability exercise for rehabilitation of stroke patients with hemiplegia. Methods: Cochrane Library, Web of Science, PubMed, Embase, CNKI, Wanfang, VIP, CBM were searched for relevant articles from the inception to September 2018. All randomized controlled trials assessing core stability exercises for stroke patients were included. Studies screening, data extraction, and quality evaluation were conducted independently by two researchers. Data was analyzed using RevMan 5.3, and trial sequential analysis(TSA) was conducted by TSA 0.9. Results: Totally 11 studies and 736 patients were included. Results showed that combination of core stability exercise and conventional rehabilitation had significantly better effects on trunk control ability, balance ability, activities of daily living, and maximum walking speed in 10 metersthan single conventional rehabilitation, and differences of all subgroups in four outcomes were not significant. TSA confirmed that the pooled results of outcomes above were stable and reliable. Conclusion: Core stability exercise combined with conventional rehabilitation can significantly improve the trunk control, balance, activities of daily living and walking speed of stroke patients, and thus it should be applied in clinical practice.
引文
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10.付常喜,张秋阳.核心稳定性训练对脑卒中偏瘫患者平衡功能和步行能力的影响[J].中国老年学杂志,2016,36(21):5397-5398.FU Changxi,ZHANG Qiuyang.Effects of core stability training on balance function and walking ability of stroke patients with hemiplegia[J].Chinese Journal of Gerontology,2016,36(21):5397-5398.
11.林君,宋成宪,李舜,等.核心稳定性训练对脑卒中患者平衡功能及腹肌厚度的影响[J].中国临床研究,2017,30(4):498-501.LIN Jun,SONG Chengxian,LI Shun,et al.Effect of core stability training on balance function and abdominal muscle thickness in stroke patients[J].Chinese Journal of Clinical Research,2017,30(4):498-501.
12.李秋菊.核心稳定性训练对脑卒中患者平衡及ADL能力的影响[J].医药前沿,2015,5(11):46-47.LI Qiuju.The effect of core stability training on stroke patients'balance and ADL ability.Frontiers of Medicine,2015,5(11):46-47.
13.王文威,潘翠环,陈艳.核心稳定性训练对脑卒中偏瘫患者站立平衡和步行能力的影响[C].广州:第四届粤港澳台物理医学与康复学学术会议暨2013年广东省医学会物理医学与康复学学术会议,2013:421-426.WANG Wenwei,PAN Cuihuan,CHEN Yan.Effects of core stability training on standing balance and walking ability in stroke patients with hemiplegia[C].Guangzhou:the 4th Guangdong,Hong Kong,Macao and Taiwan Conference on Physical Medicine and Rehabilitation and the 2013 Guangdong Medical Association Conference on Physical Medicine and Rehabilitation,2013:421-426.
14.廖亮华,周冰峰,滕新,等.核心稳定性训练对脑卒中偏瘫患者运动功能的影响[C].广州:第五届粤港澳台物理医学与康复学学术会议暨2014年广东省医学会物理医学与康复学学术会议,2014:381-384.LIAO Lianghua,ZHOU Bingfeng,TENG Xin,et al.Effects of core stability training on motor function in stroke patients with hemiplegia[C].Guangzhou:Proceedings of the 5th Guangdong,Hong Kong,Macao and Taiwan Conference on Physical Medicine and Rehabilitation and the 2014 Guangdong Medical Association Conference on Physical Medicine and Rehabilitation,2014:381-384.
15.王伟,王杨,胡西,等.核心肌群训练对脑卒中偏瘫患者步行能力的影响[J].中国疗养医学,2014,23(2):152-154.WANG Wei,WANG Yang,HU Xi,et al.Effects of core muscle training on walking ability of stroke patients with hemiplegia[J].Chinese Journal of Convalescent Medicine,2014,23(2):152-154.
16.宋磊.核心稳定性训练对脑卒中后患者下肢运动功能的影响[J].中国保健营养,2018(2):129.SONG Lei.Effect of core stability training on lower limb motor function in patients after stroke[J].China Health Care and Nutrition,2018(2):129.
17.Kibler WB,Press J,Sciascia A.The role of core stability in athletic function[J].Sports Med,2006,36(3):189-198.
18.Verheyden G,Vereeck L,Truijen S,et al.Trunk performance after stroke and the relationship with balance,gait and functional ability[J].Clin Rehabil,2006,20(5):451-458.
19.高春华,黄晓琳,张威,等.核心稳定性训练对社区脑卒中患者下肢运动功能的作用[J].卒中与神经疾病,2014,21(4):207-211.GAO Chunhua,HUANG Xiaolin,ZHANG Wei,et al.Effects of core stability training on lower extremity motor function in patients with stroke in the community[J].Stroke Nervous Disease,2014,21(4):207-211.
20.Karthikbabu S,Solomon JM,Manikandan N,et al.Role of trunk rehabilitation on trunk control,balance and gait in patients with chronic stroke:a pre-post design[J].Neurosci Med,2011,2(2):61-67.
21.彭静,王小伟,孙冬梅,等.核心稳定性训练的研究进展[J].中国康复理论与实践,2014,20(7):629-633.PENG Jing,WANG Xiaowei,SUN Dongmei,et al.Research progress on core stability training[J].Chinese Journal Rehabilitation Theory and Practice,2014,20(7):629-633.
22.Cabanas-Valdés R,Bagur-Calafat C,Girabent-Farrés M,et al.Long-term follow-up of a randomized controlled trial on additional core stability exercises training for improving dynamic sitting balance and trunk control in stroke patients[J].Clin Rehabil,2017,31(11):1492-1499.
23.Cabanas-Valdés R,Bagur-Calafat C,Girabent-Farrés M,et al.The effect of additional core stability exercises on improving dynamic sitting balance and trunk control for subacute stroke patients:a randomized controlled trial[J].Clin Rehabil,2016,30(10):1024-1033.
24.Bower KJ,Louie J,Landesrocha Y,et al.Clinical feasibility of interactive motion-controlled games for stroke rehabilitation[J].J Neuroeng Rehabil,2015,12:63.
25.Sun X,Gao Q,Dou H,et al.Which is better in the rehabilitation of stroke patients,core stability exercises or conventional exercises?[J].JPhys Ther Sci,2016,28(4):1131-1133.
26.Ferrarello F,Bianchi VAM,Baccini M,et al.Tools for observational gait analysis in patients with stroke:a systematic review[J].Phys Ther,2013,93(12):1673-1685.
27.李威,曾祥斌,章荣,等.核心稳定性训练对脑卒中偏瘫患者步态时空参数和对称性参数的影响[J].中国康复医学杂志,2014,29(9):816-822.LI Wei,ZENG Xiangbin,ZHANG Rong,et al.Effect of core stability training on gait spatiotemporal parameters and symmetry parameters in patients with stroke hemiplegia[J].Chinese Journal of Rehabilitation Medicine,2014,29(9):816-822.
28.Chung EJ,Kim JH,Lee BH.The effects of core stabilization exercise on dynamic balance and gait function in stroke patients[J].J Phy Ther Sci,2013,25(7):803-806.
29.Haruyama K,Kawakami M,Otsuka T.Effect of core stability training on trunk function,standing balance,and mobility in stroke patients:a randomized controlled trial[J].Neurorehabil Neural Repair,2017,31(3):240-249.
2.Ellis RH,Wilson NZ,Foster FM.Statewide treatment outcome assessment in Colorado:the Colorado Client Assessment Record(CCAR)[J].Community Ment Health J,1984,20(1):72-89.
3.Yu SH,Park SD.The effects of core stability strength exercise on muscle activity and trunk impairment scale in stroke patients[J].J Exerc Rehabil,2013,9(3):362-367.
4.Review Manager(RevMan)[computer program].Version 5.3.Copenhagen:The Nordic Cochrane Centre,The Cochrane Collaboration,2014.https://community.cochrane.org/help/toolsand-software/revman-5/support-revman-5.
5.Higgins JPT,Green S,editors.Cochrane handbook for systematic reviews of interventions[M].The Cochrane Collaboration,2011.
6.梁天佳,吴小平,龙耀斌,等.核心稳定性训练对脑卒中偏瘫患者运动功能的影响[J].中华物理医学与康复杂志,2012,34(5):353-356.LIANG Tianjia,WU Xiaoping,LONG Yaobin,et al.Effects of core stability training on motor function in stroke patients with hemiplegia[J].Chinese Journal of Physical Medicine and Rehabilitation,2012,34(5):353-356.
7.沈怡,王文威,陈艳,等.核心稳定性训练对脑卒中偏瘫患者站立平衡和步行能力的影响[J].中国康复医学杂志,2013,28(9):830-833.SHEN Yi,WANG Wenwei,CHEN Yan,et al.Effects of core stability training on standing balance and walking ability in stroke patients with hemiplegia[J].Chinese Journal of Rehabilitation Medicine,2013,28(9):830-833.
8.朱志中,尹苗苗,崔立玲,等.核心稳定性训练对脑梗死患者平衡功能和步行能力的影响[J].中华物理医学与康复杂志,2017,39(4):289-291.ZHU Zhizhong,YIN Miaomiao,CUI Liling,et al.Effect of core stability training on balance function and walking ability in patients with cerebral infarction[J].Chinese Journal of Physical Medicine and Rehabilitation,2017,39(4):289-291.
9.张微峰,姜冬蕾,马跃文.核心稳定性训练对脑卒中偏瘫患者上肢联合反应的效果[J].中国康复理论与实践,2016,22(12):1375-1379.ZHANG Weifeng,JIANG Donglei,MA Yuewen.Effect of core stability training on upper limb joint response in patients with stroke hemiplegia[J].Chinese Journal of Rehabilitation Theory and Practice,2016,22(12):1375-1379.
10.付常喜,张秋阳.核心稳定性训练对脑卒中偏瘫患者平衡功能和步行能力的影响[J].中国老年学杂志,2016,36(21):5397-5398.FU Changxi,ZHANG Qiuyang.Effects of core stability training on balance function and walking ability of stroke patients with hemiplegia[J].Chinese Journal of Gerontology,2016,36(21):5397-5398.
11.林君,宋成宪,李舜,等.核心稳定性训练对脑卒中患者平衡功能及腹肌厚度的影响[J].中国临床研究,2017,30(4):498-501.LIN Jun,SONG Chengxian,LI Shun,et al.Effect of core stability training on balance function and abdominal muscle thickness in stroke patients[J].Chinese Journal of Clinical Research,2017,30(4):498-501.
12.李秋菊.核心稳定性训练对脑卒中患者平衡及ADL能力的影响[J].医药前沿,2015,5(11):46-47.LI Qiuju.The effect of core stability training on stroke patients'balance and ADL ability.Frontiers of Medicine,2015,5(11):46-47.
13.王文威,潘翠环,陈艳.核心稳定性训练对脑卒中偏瘫患者站立平衡和步行能力的影响[C].广州:第四届粤港澳台物理医学与康复学学术会议暨2013年广东省医学会物理医学与康复学学术会议,2013:421-426.WANG Wenwei,PAN Cuihuan,CHEN Yan.Effects of core stability training on standing balance and walking ability in stroke patients with hemiplegia[C].Guangzhou:the 4th Guangdong,Hong Kong,Macao and Taiwan Conference on Physical Medicine and Rehabilitation and the 2013 Guangdong Medical Association Conference on Physical Medicine and Rehabilitation,2013:421-426.
14.廖亮华,周冰峰,滕新,等.核心稳定性训练对脑卒中偏瘫患者运动功能的影响[C].广州:第五届粤港澳台物理医学与康复学学术会议暨2014年广东省医学会物理医学与康复学学术会议,2014:381-384.LIAO Lianghua,ZHOU Bingfeng,TENG Xin,et al.Effects of core stability training on motor function in stroke patients with hemiplegia[C].Guangzhou:Proceedings of the 5th Guangdong,Hong Kong,Macao and Taiwan Conference on Physical Medicine and Rehabilitation and the 2014 Guangdong Medical Association Conference on Physical Medicine and Rehabilitation,2014:381-384.
15.王伟,王杨,胡西,等.核心肌群训练对脑卒中偏瘫患者步行能力的影响[J].中国疗养医学,2014,23(2):152-154.WANG Wei,WANG Yang,HU Xi,et al.Effects of core muscle training on walking ability of stroke patients with hemiplegia[J].Chinese Journal of Convalescent Medicine,2014,23(2):152-154.
16.宋磊.核心稳定性训练对脑卒中后患者下肢运动功能的影响[J].中国保健营养,2018(2):129.SONG Lei.Effect of core stability training on lower limb motor function in patients after stroke[J].China Health Care and Nutrition,2018(2):129.
17.Kibler WB,Press J,Sciascia A.The role of core stability in athletic function[J].Sports Med,2006,36(3):189-198.
18.Verheyden G,Vereeck L,Truijen S,et al.Trunk performance after stroke and the relationship with balance,gait and functional ability[J].Clin Rehabil,2006,20(5):451-458.
19.高春华,黄晓琳,张威,等.核心稳定性训练对社区脑卒中患者下肢运动功能的作用[J].卒中与神经疾病,2014,21(4):207-211.GAO Chunhua,HUANG Xiaolin,ZHANG Wei,et al.Effects of core stability training on lower extremity motor function in patients with stroke in the community[J].Stroke Nervous Disease,2014,21(4):207-211.
20.Karthikbabu S,Solomon JM,Manikandan N,et al.Role of trunk rehabilitation on trunk control,balance and gait in patients with chronic stroke:a pre-post design[J].Neurosci Med,2011,2(2):61-67.
21.彭静,王小伟,孙冬梅,等.核心稳定性训练的研究进展[J].中国康复理论与实践,2014,20(7):629-633.PENG Jing,WANG Xiaowei,SUN Dongmei,et al.Research progress on core stability training[J].Chinese Journal Rehabilitation Theory and Practice,2014,20(7):629-633.
22.Cabanas-Valdés R,Bagur-Calafat C,Girabent-Farrés M,et al.Long-term follow-up of a randomized controlled trial on additional core stability exercises training for improving dynamic sitting balance and trunk control in stroke patients[J].Clin Rehabil,2017,31(11):1492-1499.
23.Cabanas-Valdés R,Bagur-Calafat C,Girabent-Farrés M,et al.The effect of additional core stability exercises on improving dynamic sitting balance and trunk control for subacute stroke patients:a randomized controlled trial[J].Clin Rehabil,2016,30(10):1024-1033.
24.Bower KJ,Louie J,Landesrocha Y,et al.Clinical feasibility of interactive motion-controlled games for stroke rehabilitation[J].J Neuroeng Rehabil,2015,12:63.
25.Sun X,Gao Q,Dou H,et al.Which is better in the rehabilitation of stroke patients,core stability exercises or conventional exercises?[J].JPhys Ther Sci,2016,28(4):1131-1133.
26.Ferrarello F,Bianchi VAM,Baccini M,et al.Tools for observational gait analysis in patients with stroke:a systematic review[J].Phys Ther,2013,93(12):1673-1685.
27.李威,曾祥斌,章荣,等.核心稳定性训练对脑卒中偏瘫患者步态时空参数和对称性参数的影响[J].中国康复医学杂志,2014,29(9):816-822.LI Wei,ZENG Xiangbin,ZHANG Rong,et al.Effect of core stability training on gait spatiotemporal parameters and symmetry parameters in patients with stroke hemiplegia[J].Chinese Journal of Rehabilitation Medicine,2014,29(9):816-822.
28.Chung EJ,Kim JH,Lee BH.The effects of core stabilization exercise on dynamic balance and gait function in stroke patients[J].J Phy Ther Sci,2013,25(7):803-806.
29.Haruyama K,Kawakami M,Otsuka T.Effect of core stability training on trunk function,standing balance,and mobility in stroke patients:a randomized controlled trial[J].Neurorehabil Neural Repair,2017,31(3):240-249.