水中运动治疗对脑卒中患者下肢运动功能及日常生活活动能力效果的Meta分析  

Effects of Aquatic Exercise on Lower-limb Motor Function and Activities of Daily Living for Patients with Stroke:AMeta-analysis

作　　者：崔尧[1,2] 贾威[1,2] 曾明 丛芳[1,2] 金龙[1,2] 司凤山[1,2] 姚斌[1,2] 萧敦武 张凯 CUI Yao;JIA Wei;ZENG Ming;CONG Fang;JIN Long;SI Feng-shan;YAO Bin;XIAO Dun-wu;ZHANG Kai(Capital Medical University School of Rehabilitation Medicine,Beijing 100068,China;Beijing Bo'ai Hospital,China Rehabilitation Research Center,Beijing 100068,China;The Second Hospital of Jiaxing City,Jiaxing,Zhejiang 314000,China)

机构地区：[1]首都医科大学康复医学院,北京市100068 [2]中国康复研究中心北京博爱医院,北京市100068 [3]嘉兴市第二医院,浙江嘉兴市314000

出　　处：《中国康复理论与实践》2020年第3期263-277,共15页Chinese Journal of Rehabilitation Theory and Practice

基　　金：中国康复研究中心青年基金项目(No.2014-Q3);首都医科大学教学课题(No.2018JYJX083)。

摘　　要：目的系统评价水中运动治疗对脑卒中患者下肢运动功能及日常生活活动能力的干预效果。方法检索Cochrane Library、PEDro、PubMed、EMBASE、Web of Knowledge、Web of Science、OVID、EBSCO、CMCI、CNKI、Wanfang和VIP数据库,筛选脑卒中患者水中运动治疗的随机对照试验(RCTs),进行方法学质量评价,提取相关数据,采用RevMan5.3软件进行Meta分析。结果最终纳入23项RCTs,共861例患者。与对照组相比,水中运动治疗可改善患者Berg平衡量表评分(WMD=4.61,95%CI 3.79~5.43,P<0.001)、计时起立-行走测试成绩(WMD=-1.56,95%CI-3.07^-0.05,P<0.05)、功能性前伸测试成绩(WMD=2.69,95%CI 1.21~4.16,P<0.001)、压力中心移动速度(左右)(WMD=-1.38,95%CI-2.72^-0.05,P<0.05)、压力中心移动速度(前后)(WMD=-1.64,95%CI-3.10^-0.18,P<0.05)、步速(SMD=0.33,95%CI 0.07~0.58,P<0.05)、2分钟步行测试成绩(WMD=12.75,95%CI 4.17~21.34,P<0.01)、功能性步行量表分级(WMD=0.94,95%CI 0.67~1.20,P<0.001)、膝关节伸肌肌力(WMD=4.30,95%CI 1.53~7.07,P<0.01)、膝关节屈肌肌力(WMD=4.80,95%CI 0.29~9.32,P<0.05)和功能独立性测试评分(WMD=6.12,95%CI3.98~8.27,P<0.001),但对改良Barthel指数评分无明显改善作用(WMD=2.92,95%CI-6.74~12.58,P=0.55)。结论水中运动治疗能够改善脑卒中患者的平衡功能、步行能力和下肢肌力,但对日常生活活动能力的效果不明显。Objective To evaluate the effects of aquatic exercise on lower-limb motor function and activities of daily living for pa‐tients with stroke.Methods The randomized controlled trials(RCTs)about effects of aquatic therapeutic exercise on stroke patients were recalled from the databases of Cochrane Library,PEDro,PubMed,EMBASE,Web of Knowledge,Web of Science,OVID,EBSCO,CMCI,CNKI,Wanfang and VIP.The methodological quality of the included RCTs was evaluated.The data were extracted,and analysed with RevMan 5.3.Results A total of 23 RCTs that represented 861 participants were evaluated.Compared with the control group,aquatic exercise significantly improved the performance of Berg Balance Scale(WMD=2.69,95%CI 1.21 to 4.16,P<0.001),Timed Up and Go Test(WMD=-1.56,95%CI-3.07 to-0.05,P<0.05),Functional Reach Test(WMD=2.69,95%CI 1.21 to 4.16,P<0.001),sway velocity of center of pressure(SVCOP)(left/right)(WMD=-1.38,95%CI-2.72 to-0.05,P<0.05),SVCOP(anteroposterior)(WMD=-1.64,95%CI-3.10 to-0.18,P<0.05),walking speed(SMD=0.33,95%CI 0.07 to 0.58,P<0.05),Two Minute Walk Test(WMD=12.75,95%CI 4.17 to 21.34,P<0.01),Functional Ambulation Category(WMD=0.94,95%CI 0.67 to 1.20,P<0.001),muscle strength of knee extensor(WMD=4.30,95%CI 1.53 to 7.07,P<0.01),muscle strength of knee flexor(WMD=4.80,95%CI 0.29 to 9.32,P<0.05),and Functional Independence Measurement(WMD=6.12,95%CI 3.98 to 8.27,P<0.001),but not significantly in the score of modified Barthel Index(WMD=2.92,95%CI-6.74 to 12.58,P=0.55).Conclusion Aquatic exercise can improve balance,walking and muscle strength of lower extremities of stroke patients,but do not for activities of daily living.

关 键 词：脑卒中 水中运动治疗 平衡 步行 肌力 日常生活活动 META分析 

分 类 号：R743.3[医药卫生—神经病学与精神病学]