视觉反馈平衡训练仪训练对脑卒中后平衡及步行能力影响的Meta分析
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摘要
目的系统评价视觉反馈平衡训练仪训练对脑卒中患者平衡能力、步行能力以及日常生活能力的康复疗效。方法计算机检索PubMed、Web of Science、EMBASE、Cochrane图书馆、中国知网、万方、维普中文科技期刊全文等国内外数据库从建库到2018年4月的有关文献,收集视觉反馈平衡训练仪训练对脑卒中患者平衡及步行能力影响的临床随机对照试验,并运用RevMan 5.3软件对符合纳入标准的所有结果进行Meta分析。结果最后选入12篇文献共565例患者。Meta分析结果显示:视觉反馈平衡仪训练组与常规平衡训练组平衡量表评分12篇文献合并效应量均数差=6.49,95%可信区间5.63～7.35,Z=14.77,P<0.000 01,两组差异有统计学意义;视觉反馈平衡仪训练组与常规平衡训练组"起立-行走"计时6篇文献合并效应量均数差=-3.91,95%可信区间-4.68～-3.14,Z=9.97,P<0.000 01,两组差异有统计学意义;视觉反馈平衡仪训练组与常规平衡训练组日常生活能力量表评分2篇文献合并效应量均数差=5.58,95%可信区间2.31～8.84,Z=3.35,P=0.000 8,两组差异有统计学意义。结论视觉反馈平衡训练仪训练能有效增强脑卒中患者的站位平衡功能并改善他们的步行能力与日常生活活动能力,且较传统平衡训练改善更明显。但是目前与平衡仪训练相关的高水平的临床研究较少,故需要进行大样本量的临床随机对照试验来证实其有效性。
Objective To systematically review the effect of visual-feedback balanced training on balance,walking and daily living after stroke. Methods Randomized controlled trials(RCTs) about balance training instrument for balance and walking ability of stroke were electronically searched in PubMed,Web of Science,EMBASE,the Cochrane library,China National Knowledge Infrastructure,Wanfang Data,VIP Database for Chinese Technical Periodicals from the date of establishment to April 2018. Using RevMan 5.3 software to analyze all the results that conform to the standard by meta. Results A total of 565 patients of 12 RCTs were included. The results of meta analysis showed that after treatment,the Berg balance scale scores of 12 articles of balancing instrument training group and conventional balance training group with effect of the amount of MD=6.49,95%CI 5.63～7.35,Z=14.77,P<0.000 01,the two groups have significant difference. The"Up & Go test"of 6 articles of balancing instrument training group and conventional balance training group with effect of the amount of MD=-3.91,95%CI-4.68～-3.14,Z=9.97,P<0.000 01,the two groups have significant differerce. The modify Barthel scores of balancing instrument training group and conventional balance training group with effect of the amount of MD=5.58,95%CI 2.31～8.84,Z=3.35,P=0.000 8,the two groups have significant difference. Conclusion Balanced training instrument exercises effectively enhance the balance function of stroke patients,improve their walking function and their daily living ability,and it is more obvious than traditional balance training. However,there are few high level clinical studies related to the training of balance instrument,so a large sample of clinical randomized controlled trials is needed to verify its effectiveness.
Objective To systematically review the effect of visual-feedback balanced training on balance,walking and daily living after stroke. Methods Randomized controlled trials(RCTs) about balance training instrument for balance and walking ability of stroke were electronically searched in PubMed,Web of Science,EMBASE,the Cochrane library,China National Knowledge Infrastructure,Wanfang Data,VIP Database for Chinese Technical Periodicals from the date of establishment to April 2018. Using RevMan 5.3 software to analyze all the results that conform to the standard by meta. Results A total of 565 patients of 12 RCTs were included. The results of meta analysis showed that after treatment,the Berg balance scale scores of 12 articles of balancing instrument training group and conventional balance training group with effect of the amount of MD=6.49,95%CI 5.63～7.35,Z=14.77,P<0.000 01,the two groups have significant difference. The"Up & Go test"of 6 articles of balancing instrument training group and conventional balance training group with effect of the amount of MD=-3.91,95%CI-4.68～-3.14,Z=9.97,P<0.000 01,the two groups have significant differerce. The modify Barthel scores of balancing instrument training group and conventional balance training group with effect of the amount of MD=5.58,95%CI 2.31～8.84,Z=3.35,P=0.000 8,the two groups have significant difference. Conclusion Balanced training instrument exercises effectively enhance the balance function of stroke patients,improve their walking function and their daily living ability,and it is more obvious than traditional balance training. However,there are few high level clinical studies related to the training of balance instrument,so a large sample of clinical randomized controlled trials is needed to verify its effectiveness.
引文
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[13]徐华平,全莉娟,冯珍.PRO-KIN平衡仪训练对脑卒中患者平衡功能康复的疗效[J].南昌大学学报(医学版),2011,51(2):66-67.
[14]黄小静,窦祖林,丘卫红,等.动态姿态平衡仪训练对脑卒中偏瘫患者平衡功能的影响[J].中国康复医学杂志,2011,26(11):1029-1034.
[15]王建文,赵力生,李侠,等.电脑平衡仪视觉反馈训练对偏瘫患者平衡功能和步行能力的影响[J].中国康复理论与实践,2010,16(7):657-658.
[16]杨婷,高政,尹玉文,等.视觉反馈平衡训练仪对于脑卒中偏瘫患者平衡功能影响的临床研究[J].中华临床医师杂志(电子版),2012,6(19):6046-6048.
[17]姜慧强,范振林,李琳.PC708A型平衡训练仪对脑卒中患者平衡功能及社区日常生活能力的影响[J].中国社区医师,2016,32(35):179-180.
[18]翟浩瀚.平衡仪训练对偏瘫患者平衡和行走能力的影响[D].合肥:安徽医科大学,2005.
[19]PARK J,CHUNG Y.The effects of robot-assisted gait training using virtual reality and auditory stimulation on balance and gait abilities in persons with stroke[J].Neuro Rehabilitation,2018,43(2):227-235.
[20]FERREIRA V,CARVAS N,ARTILHEIRO M C,et al.Interactive video gaming improves functional balance in poststroke individuals:Meta-analysisof randomized controlled trials[J].Eval Health Prof,2018,Jan 1:163278718784998.[Epub ahead of print].
[21]BYUN S D,JUNG T D,KIM C H,et al.Effects of the sliding rehabilitation machine on balance and gait in chronic stroke patients-a controlledclinical trial[J].Clin Rehabil,2011,25(5):408-415.
[22]MACKINTOSH S F,HILL K D,DODD K J,et al.Balance score and a history of falls in hospital predict recurrent falls in the 6 months following stroke rehabilitation[J].Arch Phys Med Rehabil,2018,2006,87(12):1583-1589.
[23]梁丹.基于STDP的神经系统突触可塑性研究[D].桂林:广西师范大学,2014.
[24]ASIMINA L,LOUKAS A,DIONYSSIOS M,et al.fMRI as a molecular imaging procedure for the functional reorganizationof motor systems in chronic stroke[J].Mol Med Rep,2013,8(3):775.
[25]HAGMANN P,CAMMOUN L,GIGANDET X,et al.Mapping the structural core of human cerebral cortex[J].PLoS Biol,2008,6(7):e159.
[26]PELLEGRINO L,GIANNONI P,MARINELLI L,et al.Effects of continuous visual feedback during sitting balance training in chronic stroke survivors[J].J Neuroeng Rehabil,2017,14(1):107.
[2]李媛媛.2010年全球脑卒中发病情况分析[D].郑州:郑州大学,2017.
[3]陈冲,高晓平,冯小军.MOTOmed智能运动训练系统训练对脑卒中偏瘫患者平衡功能及日常生活活动能力的影响[J].中华物理医学与康复杂志,2010,32(7):510-512.
[4]HUNG J W,CHOU C X,HSIEH Y W,et al.Randomized comparison trial of balance training by using exergaming and conventiona weight-shift therapy in patients with chronic stroke[J].Arch Phys Med Rehabil,2014,95(9):1629-1637.
[5]MACTASZEK J,BORAWSKA S,WOJCIKIEWICZ J.Influence of posturographic platform biofeedback training on the dynamic balance of adult strokepatients[J].J Stroke Cerebrovasc Dis,2014,23(6):1269-1274.
[6]GEIGER R A,ALLEN J B,O’KEEFE J,et al.Balance and mobility following stroke:Effects of physical therapy interventions with and without biofeedback/force plate training[J].Phys Ther,2001,81(4):995-1005.
[7]JADAD A R,MOORE R A,CARROLL D,et al.Assessing the quality of reports of randomized clinical trials:Is blinding necessary?[J].Control Clin Trials,1996,17(1):1-12.
[8]LEE S H,BYUN S D,KIM C H,et al.Feasibility and effects of newly developed balance control trainer for mobility and balance in chronic stroke patients:A randomized controlled trial[J].Ann Rehabil Med,2012,36(4):521-529.
[9]迪晓霞,李鑫铭,翟月萍.平衡仪训练对脑卒中患者平衡功能及跌倒风险的影响[J].中国康复,2017,32(3):196-198.
[10]丁珊珊.平衡仪平衡训练对改善偏瘫患者日常生活能力的疗效观察[J].中国伤残医学,2013,21(9):310-311.
[11]王小清,高崇,滕安琪,等.静态平衡仪对脑卒中偏瘫患者平衡功能的影响[J].临床医学,2012,32(11):30-32.
[12]李中元,王雅青,马启寿,等.静动态站立平衡仪治疗脑卒中偏瘫22例疗效观察[J].福建中医药大学学报,2013,23(1):62-63.
[13]徐华平,全莉娟,冯珍.PRO-KIN平衡仪训练对脑卒中患者平衡功能康复的疗效[J].南昌大学学报(医学版),2011,51(2):66-67.
[14]黄小静,窦祖林,丘卫红,等.动态姿态平衡仪训练对脑卒中偏瘫患者平衡功能的影响[J].中国康复医学杂志,2011,26(11):1029-1034.
[15]王建文,赵力生,李侠,等.电脑平衡仪视觉反馈训练对偏瘫患者平衡功能和步行能力的影响[J].中国康复理论与实践,2010,16(7):657-658.
[16]杨婷,高政,尹玉文,等.视觉反馈平衡训练仪对于脑卒中偏瘫患者平衡功能影响的临床研究[J].中华临床医师杂志(电子版),2012,6(19):6046-6048.
[17]姜慧强,范振林,李琳.PC708A型平衡训练仪对脑卒中患者平衡功能及社区日常生活能力的影响[J].中国社区医师,2016,32(35):179-180.
[18]翟浩瀚.平衡仪训练对偏瘫患者平衡和行走能力的影响[D].合肥:安徽医科大学,2005.
[19]PARK J,CHUNG Y.The effects of robot-assisted gait training using virtual reality and auditory stimulation on balance and gait abilities in persons with stroke[J].Neuro Rehabilitation,2018,43(2):227-235.
[20]FERREIRA V,CARVAS N,ARTILHEIRO M C,et al.Interactive video gaming improves functional balance in poststroke individuals:Meta-analysisof randomized controlled trials[J].Eval Health Prof,2018,Jan 1:163278718784998.[Epub ahead of print].
[21]BYUN S D,JUNG T D,KIM C H,et al.Effects of the sliding rehabilitation machine on balance and gait in chronic stroke patients-a controlledclinical trial[J].Clin Rehabil,2011,25(5):408-415.
[22]MACKINTOSH S F,HILL K D,DODD K J,et al.Balance score and a history of falls in hospital predict recurrent falls in the 6 months following stroke rehabilitation[J].Arch Phys Med Rehabil,2018,2006,87(12):1583-1589.
[23]梁丹.基于STDP的神经系统突触可塑性研究[D].桂林:广西师范大学,2014.
[24]ASIMINA L,LOUKAS A,DIONYSSIOS M,et al.fMRI as a molecular imaging procedure for the functional reorganizationof motor systems in chronic stroke[J].Mol Med Rep,2013,8(3):775.
[25]HAGMANN P,CAMMOUN L,GIGANDET X,et al.Mapping the structural core of human cerebral cortex[J].PLoS Biol,2008,6(7):e159.
[26]PELLEGRINO L,GIANNONI P,MARINELLI L,et al.Effects of continuous visual feedback during sitting balance training in chronic stroke survivors[J].J Neuroeng Rehabil,2017,14(1):107.