强制性运动疗法对脑卒中患者上肢运动功能影响的系统评价再评价  

Efficacy of constraint-induced movement therapy on upper limb motor dysfunctionin stroke patients:an overview of systematic reviews

作　　者：冯露叶 沈悦 周珊珊 杨媛媛 王德花 汤继芹[1,3] Feng Luye;Shen Yue;Zhou Shanshan;Yang Yuanyuan;Wang Dehua;Tang Jiqin(School of Rehabilitation Medicine,Shandong University of Traditional Chinese Medicine,Jinan 250355,China)

机构地区：[1]山东中医药大学康复医学院,山东济南250355 [2]山东第二医科大学康复医学院 [3]山东中医药大学第一临床医学院

出　　处：《护理学杂志》2025年第4期81-85,共5页Journal of Nursing Science

基　　金：山东省老年医学学会科技发展计划项目(LKJGG2021Z018);山东省中医药科技发展计划项目(2017-011);教育部产学合作协同育人项目(202002137071)。

摘　　要：目的再评价强制性运动疗法运用于脑卒中患者上肢运动功能障碍的康复训练系统评价,以期为脑卒中患者的临床康复提供更科学、可靠的证据支持。方法计算机检索国内外数据库中关于强制性运动疗法运用于脑卒中后上肢运动功能障碍的系统评价,检索时限为建库至2024年4月。通过ROBIS工具、AMSTAR 2工具、PRISMA 2020报告规范和GRADE软件对纳入研究分别进行偏倚风险、方法学质量、报告质量和证据质量评价。结果纳入18篇文献,其中1篇质量为高等级,1篇质量为中等级,10篇质量为低等级,6篇质量为极低等级。72个结局指标中有10个中等质量证据,32个低质量证据和30个极低质量证据。结果显示强制性运动疗法对改善卒中后患者上肢运动功能、患侧上肢使用频率、动作完成质量和日常生活能力方面有积极影响,但在改善残疾情况和生活质量方面有待进一步研究。结论强制性运动疗法在一定程度上可以有效促进脑卒中患者上肢运动功能和日常生活能力的恢复。但目前纳入的系统评价文献质量较低,未来仍需更多高质量的研究进一步证实强制性运动疗法对改善脑卒中后上肢运动功能障碍的康复效果,为临床决策提供有力证据。Objective To evaluate the systematic reviews of efficacy ofconstraint-induced movement therapy(CIMT)in rehabilitation training for upper limb motor dysfunction in stroke patients,in order to provide more scientific and reliable evidence for the clinical rehabilitation of stroke.Methods Systematic reviews of the application of CIMT in patients with upper limb motor dysfunction after stroke was searched in domestic and foreign databases from the establishment to April 2024.The Risk of Biasin Systematic Review(ROBIS)scale,A measurement Tool to Assess Systematic Reviews 2(AMSTAR 2),Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020(PRISMA 2020)and Grading of Recommendations Assessment,Development and Evaluation System(GRADE)were respectively used to evaluate the risk of bias,methodological quality,reporting quality and evidence quality of the included studies.Results A total of 18 articles were included,and the methodological quality of 1 article was high,1 article was medium,10 articles were low,and the other 6 articles were very low.GRADE evidence quality evaluation involved 72 outcome indicators,in which 10 were of moderate quality,32 were of low quality and 30 were of very low quality.CIMT has a positive impact on the rehabilitation of upper limb motor function,amount of use and quality of movement of the hemiplegic upper limb,and basic daily life of post-stroke patients,but in terms of disability and quality of life needs further research.Conclusion CIMT can effectively promote the recovery of upper limb motor function and daily living ability of stroke patients to a certain extent.However,the quality of the included systematic reviews is low,more high-quality studies are needed to further confirm the efficacy of CIMT in the rehabilitation of patients with upper limb motor dysfunction after stroke and provide strong evidence for clinical decision-making.

关 键 词：脑卒中 强制性运动疗法 上肢运动 功能障碍 康复护理 生活质量 日常生活能力 系统评价 

分 类 号：R473.3[医药卫生—护理学] R743.3[医药卫生—临床医学]