基于WHO-FICs作业治疗改善脑卒中上肢功能效果的系统综述  

Effects of occupational therapy on upper extremity for patients with stroke:a systematic review using WHO-FICs

作　　者：徐悦莹[1,2] 郑洁皎 高文[1] 丁建伟 陈茜[2] XU Yueying;ZHENG Jiejiao;GAO Wen;DING Jianwei;CHEN Xi(Huadong Hospital Affiliated to Fudan University,Shanghai 200040,China;Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]复旦大学附属华东医院,上海市200040 [2]上海中医药大学,上海市201203

出　　处：《中国康复理论与实践》2023年第2期140-150,共11页Chinese Journal of Rehabilitation Theory and Practice

基　　金：国家重点研发计划项目(No.2020YFC2008700,No.2020YFC2008702);上海康复医学临床研究中心计划项目(No.21MC1930200);上海市科委科技创新行动计划项目(No.22Y31900201)。

摘　　要：目的基于世界卫生组织国际分类家族(WHO-FICs)构建作业治疗改善脑卒中上肢功能的PICO架构,并分析主要作业疗法改善脑卒中患者上肢功能的效果。方法运用WHO-FICs框架,检索Web of Science、PubMed、CNKI、SinoMed等数据库,收集建库至2022年10月关于作业治疗干预脑卒中上肢功能的相关文献,并进行系统综述。结果最终纳入10项随机对照试验,382例参与者(≥18岁),来自6个国家,主要来源于康复医学、物理和康复医学、神经科学、生物工程医学、作业治疗等研究领域,发表年限集中于2013年以后。纳入文献物理治疗证据数据库(PEDro)量表评分平均7.5分。基于WHO-FICs框架,纳入文献中涉及的疾病类型涵盖脑出血(8B00)、缺血性脑卒中(8B11)、蛛网膜下腔出血(8B01)、肌张力和异常反射(MB47)、偏瘫(MB53)。主要功能障碍包括关节活动功能(b710)、关节稳定性功能(b715)、肌肉力量功能(b730)、肌张力功能(b735)、运动反射功能(b750)、随意运动控制功能(b760)、不随意运动功能(b765)。主要活动受限和参与局限包括上肢的活动和参与,如举起和搬运物体(d430),手和手臂的使用(d445),精巧手的使用(d440);以及日常生活活动和社会参与能力,如自理(d510-d570),家庭生活(d610-d660),主要生活领域(d810-d879),社区、社会和公民生活(d910-d950)。涉及身体功能的治疗类干预措施有肌肉功能电刺激(MU2.SC.BP)、协助和指导运动功能训练(MV2.PG.ZZ);涉及活动和参与的治疗类干预措施有举起和搬运物体训练(SIA.PH.ZZ)、使用精巧手的训练(SIG.PH.ZZ)、使用上肢和手的训练(SIJ.PH.ZZ)、自理的干预措施(SM1-SMH)、主要生活领域的干预措施(SO2-SOD)、游戏训练(SXD.PH.ZZ)。每次干预15~60 min,每周3~10次,持续3~8周。干预场所一般为医院或居家。干预效果分为3个层面:身体功能层面,涉及神经运动传导功能、反射功能、随意运动控制能力、协调性与速�Objective To construct a framework of PICO for occupational therapy to improve upper extremity function in stroke patients based on World Health Organization Family of International Classifications(WHO-FICs),and to analyze the functional outcome of major occupational therapies to improve upper extremity in stroke.Methods Using the WHO-FICs framework,the databases such as Web of Science,PubMed,CNKI and SinoMed were searched for literature related to occupational therapy interventions for upper extremity function in stroke patients from the date of establishment to October,2022,and the contents of the literature were extracted for a systematic review.Results Ten randomized controlled trials from six countries were finally included,involving 382 participants(≥18 years old).The literatures were mainly from the fields of rehabilitation medicine,physics and rehabilitation medicine,neuroscience,bioengineering medicine,occupational therapy and other research fields,and were published mainly after 2013.The quality of the included literatures was evaluated using Physiotherapy Evidence Database(PEDro)scale with a mean score of 7.5.Based on the WHO-FICs framework,the types of diseases included intracerebral haemorrhage(8B00),cerebral ischemic stroke(8B11),subarachnoid hemorrhage(8B01),abnormality of tonus and reflex(MB47),and hemiplegia(MB53).The main dysfunctions of the upper extremity after stroke included mobility of joint functions(b710),stability of joint functions(b715),muscle power functions(b730),muscle tone functions(b735),motor reflex functions(b750),control of voluntary movement functions(b760),involuntary movement functions(b765).Activity and participation included activity of upper limb,such as lifting and carrying objects(d430),hand and arm use(d445),and fine hand use(d440);and the daily life activities and social participation,such as self-care(d510-d570),domestic life(d610-d660),major life areas(d810-d879),community,social and civic life(d910-d950).Therapeutic interventions on body functions included electr

关 键 词：脑卒中 作业治疗 上肢 活动和参与 世界卫生组织国际分类家族 系统综述 

分 类 号：R743.3[医药卫生—神经病学与精神病学]