镜像疗法改善脑卒中患者上肢功能障碍的系统评价  

Mirror therapy for treating the upper limbs after stroke： A systematic review

作　　者：岳雨珊[1] 黄杰[3] 谢斌[1] 李忠汗[1] 张文毅[1] 王旭东[2] 朱毅[1] 

机构地区：[1]南京中医药大学第二临床医学院,南京210046 [2]南京中医药大学第二临床文献研究所,南京210046 [3]华中科技大学同济医学院附属同济医院康复医学科

出　　处：《中华物理医学与康复杂志》2013年第2期97-106,共10页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：2012年度江苏省高校“青蓝工程”培养对象项目

摘　　要：目的系统评价镜像疗法对脑卒中患者上肢功能障碍的康复效果。方法计算机检索PUBMED、MEDLINE、EMbase、Cochrane Central Register of Controlled Trials（CENTRAL）、ISIWebofKnowledge、OVID、中国知网、万方数据库和维普数据库中关于镜像疗法改善脑卒中后上肢功能障碍的随机对照试验，同时检索已纳入文献的参考文献。检索时间从建库至2012年4月。由2名独立的研究人员依据Cochrane协作网推荐的偏倚风险评估方法，对纳入文献的质量进行严格评估及资料提取，对符合标准的随机对照试验进行Meta合并分析。统计分析采用RevMan5．1软件和GRADEprofiler3．6软件。结果共纳入9个随机对照研究。Meta分析的结果显示，镜像疗法训练4周后，脑卒中患者的Fugl-Meyer运动评分量表（FMA）上肢部分评分与无视觉反馈组比较，差异无统计学意义[WMD=－0．46，95％CI（－11．61，10．69）]；镜像疗法训练6周后，脑卒中患者的上肢动作研究量表（ARAT）评分与无视觉反馈组比较，差异无统计学意义[WMD=0．73，95％CI（－5．02，6．47）]；镜像疗法训练4周后及随访6个月时，脑卒中患者的Brunnstrom手功能评分与无视觉反馈组比较，差异有统计学意义[WMD（95％cI）的值分别为0．61（0．15，1．07），0．92（0．09，1．74）]；镜像疗法训练4周后，脑卒中患者的改良痉挛评价量表（MAS）评分与无视觉反馈组比较，差异无统计学意义[WMD=－0．26，95％CI（－0．55，0．22）]，但随访6个月时，脑卒中患者的MAS评分与无视觉反馈组比较，差异有统计学意义[WMD：－0．30，95％CI（－0．56，－0．04）]；镜像疗法训练4周后及随访6月时，脑卒中患者的功能独立评定（FIM）自我照顾部分评分与无视觉反馈组比较，差异有统计学意义[WMD（95％cI）的值分别为4．81（2．74，6．87），8．67（3．50，13．83）]；镜像疗法训练4周后�Objective To evaluate the effectiveness of mirror therapy in treating the upper limbs of pa- tients with stroke. Methods The PUBMED, MEDLINE, EMbase, Cochrane Central Register of Controlled Trials （CENTRAL） , ISI Web of Knowledge, OVID, CNKI, VIP and Wanfang Data databases were searched for reports of randomized controlled trials （RCTs） of mirror therapy in the treatment of the upper limbs of patients with stroke from the date of establishment of each database to April 2012. The bibliographies of the studies retrieved were also searched. Two independent researchers evaluated the included studies using the risk of bias provided by Cochrane Library. The extracted data were analyzed using RevMan 5. 1 software and version 3.6 of the GRAED profiler.Results Reports of 9 trials were discovered. Meta-analysis showed that compared to the group that didn＇t have vis- ual feedback, mirror therapy did not significantly increase Fugl-Meyer assessment （FMA） （ Upper Limb） scores after 4 weeks of treatment compared with groups that did not have visual feedback. Mirror therapy also did not sig- nificantly increase average scores on the action research arm test （ARAT） after 6 weeks of treatment. Mirror thera- py did, however, increase average Brunnstrom stage scores for the hand after 4 weeks of treatment and at a 6-month follow-up. Mirror therapy did not increase average scores on the modified Ashworth scale （MAS） after 4 weeks of treatment, but increased MAS scores were observed at a 6-month follow-up compared with a group which had no visual feedback. Mirror therapy increased functional independence measure （ FIM ） self-care scores after 4 weeks of treatment and at a 6-month follow-up, and it also increased modified Barthel index （MBI） scores after 4 weeks of treatment. In the GRADE system, the scores of Brunnstrom stages for the hand after 4 weeks of treatment were of moderate quality, but those scores and the MAS scores at the 6-month follow-up were of low quality. The FIM self- care scores af

关 键 词：镜像疗法 脑卒中 手功能 荟萃分析 

分 类 号：R743.3[医药卫生—神经病学与精神病学]