镜像疗法对卒中偏瘫患者下肢运动疗效的Meta分析

doi:10.3969/j.issn.1673-5765.2020.11.006

摘要/Abstract

摘要：

目的评价镜像疗法对卒中偏瘫患者下肢运动疗效。方法在APTA、PEDro、Embase、PubMed、CINAHL、Cochrane图书馆、中国生物医学文献、万方、维普及中国知网系统检索2004年5月-2019年5月关于镜像疗法对改善卒中后下肢运动功能效果的随机对照试验（randomized controlled trial，RCT）。根据纳入、排除标准进行筛选，提取资料，采用RevMan 5.3软件对符合标准RCT研究中患者的下肢功能、平衡功能及步态指标进行Meta分析。结果共纳入14项RCT研究。Meta分析结果显示：相比对照治疗，镜像疗法可提高Fugl-Meyer下肢评分[标准化均数差（standardized mean difference，SMD）3.20，95%CI 1.52～4.88，P＜0.001]，提高患者踝关节活动度（SMD 1.20，95%CI 0.71～1.69，P <0.001），提高下肢Brunstrom分期[均数差（mean difference， MD）0.55，95%CI 0.28～0.82，P <0.001]。尚无证据表明镜像疗法可改善下肢肌张力。镜像疗法可提高 10 m步行测试分数（SMD 0.08，95%CI 0.03～0.13，P＜0.001），但在提高功能性步行量表未显示明显优势。镜像疗法可提高Berg平衡量表评分（SMD 0.98，95%CI 0.42～1.53，P＜0.001），但无法改善下肢平衡的总体稳定指数。结论镜像疗法可在一定程度上改善卒中后患者下肢运动功能、步态，但平衡能力的改善仍需临床研究证实。

文章导读： 本研究发现，镜像疗法可促进卒中后偏瘫患者下肢运动的恢复，增强下肢活动功能，但不能改善患者患侧下肢肌张力，可改善步态，也能有效改善下肢的平衡能力。

关键词: 卒中; 镜像疗法; 下肢; 运动功能

Abstract:

Objective To systematically evaluate the effects of mirror therapy on hemiplegic lower extremity motor function, gait and balance in stroke patients. Methods Randomized controlled trials (RCT) of mirror therapy on the improvement of lower extremity motor function after stroke were searched in APTA, PEDro, Embase, PubMed, CINAHL, Cochrane Library, China Biomedical Literature (CBM), Wanfang Data, VIP and China National Knowledge Infrastructure (CNKI) System from 2004 May to 2019 May. The data were screened strictly according to the inclusion and exclusion criteria, and the meta-analysis of standard RCTs was performed using RevMan 5.3 software. Results A total of 14 RCTs were included. Meta analysis showed that mirror therapy improved lower extremity Fugl-Meyer assessment score [standardized mean difference (SMD) 3.20, 95%CI 1.52- 4.88, P <0.001], improved the ankle joint motion range (SMD 1.20, 95%CI 0.71-1.69, P <0.001), and improved the lower extremity Brunstrom stage [mean difference (MD) 0.55, 95%CI 0.28-0.82, P <0.001], compared with control treatment. There is no evidence that mirror therapy can improve muscle tension of the lower extremities; mirror therapy can improve 10 meter walk test score (SMD 0.08, 95%CI 0.03-0.13, P <0.001), but showed no obvious advantage in improving the functional ambulation category scale (P >0.05); mirror therapy can improve the Berg balance scale score (SMD 0.98, 95%CI 0.42-1.53, P <0.001), but not improve the overall stability of the lower extremity balance. Conclusions Compared with the control treatment, mirror therapy can enhance the lower limbs recovery, improve the lower limb motor function and gait in stroke patients, but the improvement of balance ability still needs further verification.

Key words: Stroke; Mirror therapy; Lower extremity; Motor function

刘高，周鹭，王蕾，和意娴，蔡恩丽. 镜像疗法对卒中偏瘫患者下肢运动疗效的Meta分析[J]. 中国卒中杂志, 2020, 15(11): 1183-1191.

LIU Gao, ZHOU Lu, WANG Lei, HE Yi-Xian, CAI En-Li. The Efficacy of Mirror Therapy for Improving Hemiplegic Lower Extremity Motor Poststroke: A Meta Analysis[J]. Chinese Journal of Stroke, 2020, 15(11): 1183-1191.

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