Pomeroy V M, King L, Pollock A, Baily-Hallam A, Langhorne P
St George's Hospital Medical School, Department of Geriatric Medicine, Cranmer Terrace, London, UK, SW17 0RE.
Cochrane Database Syst Rev. 2006 Apr 19;2006(2):CD003241. doi: 10.1002/14651858.CD003241.pub2.
Electrostimulation might improve motor recovery after stroke by providing neuromuscular re-training.
To find if electrostimulation improved functional motor ability, and the ability to undertake activities of daily living.
We searched the Cochrane Stroke Group Trials Register (last searched August 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2004), MEDLINE (1966 to January 2004), EMBASE (1980 to January 2004), CINAHL (1982 to January 2004), AMED - Allied and Complementary Medicine Database (1985 to January 2004), Physiotherapy Evidence Database (PEDro), REHABDATA and the ISI Science Citation Index (1981 to 2003). We placed a request on the PHYSIO e-mail discussion list and contacted authors of relevant studies to elicit any unpublished or ongoing studies, searched the reference lists of included trials and contacted trialists.
Randomised controlled trials of electrostimulation delivered to the peripheral neuromuscular system which was designed to improve voluntary movement control, functional motor ability and activities of daily living.
Two review authors independently selected trials for inclusion, assessed trial quality and extracted the data.
Of the 2077 references identified, 24 trials were included in this review. For electrostimulation compared with no treatment this review found that electrostimulation improved some aspects of functional motor ability and some aspects of motor impairment and normality of movement. In addition, there was a significant difference in favour of no treatment compared with electrostimulation for an aspect of functional motor ability. For electrostimulation compared with placebo this review found that electrostimulation improved an aspect of functional motor ability. For electrostimulation compared with conventional physical therapy this review found that electrostimulation improved an aspect of motor impairment. There were no statistically significant differences between electrostimulation and control treatment for all other outcomes. However, these results need to be interpreted with reference to the following: (1) the majority of analyses only contained one trial; (2) variation was found between included trials in time after stroke, level of functional deficit, and dose of electrostimulation; and (3) the possibility of selection and detection bias in the majority of included trials.
AUTHORS' CONCLUSIONS: At present, there are insufficient robust data to inform clinical use of electrostimulation for neuromuscular re-training. Research is needed to address specific questions about the type of electrostimulation that might be most effective, in what dose and at what time after stroke.
电刺激可能通过提供神经肌肉再训练来改善中风后的运动恢复。
探讨电刺激是否能改善功能性运动能力以及进行日常生活活动的能力。
我们检索了Cochrane中风组试验注册库（最后检索时间为2005年8月）、Cochrane对照试验中心注册库（CENTRAL）（《Cochrane图书馆》2004年第1期）、MEDLINE（1966年至2004年1月）、EMBASE（1980年至2004年1月）、CINAHL（1982年至2004年1月）、AMED - 联合与补充医学数据库（1985年至2004年1月）、物理治疗证据数据库（PEDro）、康复数据库以及ISI科学引文索引（1981年至2003年）。我们在物理治疗电子邮件讨论列表上发布了请求，并联系了相关研究的作者以获取任何未发表或正在进行的研究，检索了纳入试验的参考文献列表并联系了试验者。
对外周神经肌肉系统进行电刺激的随机对照试验，旨在改善自主运动控制、功能性运动能力和日常生活活动能力。
两位综述作者独立选择纳入试验，评估试验质量并提取数据。
在识别出的2077篇参考文献中，本综述纳入了24项试验。对于电刺激与不治疗的比较，本综述发现电刺激改善了功能性运动能力的某些方面以及运动障碍和运动正常性的某些方面。此外，在功能性运动能力的一个方面，不治疗与电刺激相比存在显著差异，支持不治疗。对于电刺激与安慰剂的比较，本综述发现电刺激改善了功能性运动能力的一个方面。对于电刺激与传统物理治疗的比较，本综述发现电刺激改善了运动障碍的一个方面。对于所有其他结局，电刺激与对照治疗之间无统计学显著差异。然而，这些结果需要参考以下内容进行解释：（1）大多数分析仅包含一项试验；（2）纳入试验在中风后时间、功能缺陷水平和电刺激剂量方面存在差异；（3）大多数纳入试验存在选择和检测偏倚的可能性。
目前，没有足够有力的数据为电刺激用于神经肌肉再训练的临床应用提供依据。需要开展研究以解决关于哪种电刺激类型可能最有效、剂量以及中风后何时进行电刺激的具体问题。
