Division of Physical Therapy (R.A.S., Y.S., E.P.) Long Island University, Brooklyn Campus, New York, USA.
J Neurol Phys Ther. 2009 Dec;33(4):179-86. doi: 10.1097/NPT.0b013e3181c29a8c.
BACKGROUND AND PURPOSE: : Overground gait training-observation and cueing of patient's walking pattern along with related exercises-forms a major part of rehabilitation services for individuals with chronic stroke in almost every setting. This report of a Cochrane systematic review assessed the effects of overground gait training on walking ability for individuals with mobility deficits subsequent to chronic stroke. DATA SOURCES: : We searched the Cochrane Stroke Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, Science Citation Index Expanded, http://www.clinicaltrials.gov, among other databases through spring 2008. We also searched reference lists and contacted authors and trial investigators. REVIEW METHODS: : Only randomized controlled trials comparing overground physical therapy gait training with a placebo or no treatment condition were included. RESULTS: : Nine studies involving 499 participants were included. We found no evidence of a benefit on walking function, the primary variable, based on three studies (n = 269). Some performance variables did show significant effects. Walking speed increased by 0.07 m/sec [95% confidence interval (CI), 0.05-0.10] based on seven studies (n = 396), Timed Up and Go test improved by 1.81 seconds (95% CI, -2.29 to -1.33) based on three studies (n = 118), and six-minute walk test increased by 26.06 m (95% CI, 7.14-44.97) based on four studies (n = 181). CONCLUSIONS: : We found insufficient evidence to determine whether overground physical therapy gait training benefits walking function in individuals with chronic stroke, although limited evidence suggests potential benefits for some performance variables. High-quality randomized controlled trials are needed to replicate and extend these findings.
背景与目的:在几乎所有环境中,对于慢性脑卒中患者,地上行走训练——观察和提示患者的行走模式,并结合相关练习——构成康复服务的主要部分。本项 Cochrane 系统评价报告评估了地上行走训练对慢性脑卒中后行动能力受损患者的行走能力的影响。
资料来源:我们检索了 Cochrane 卒中组试验注册库、 Cochrane 对照试验中心注册库(CENTRAL)、MEDLINE、EMBASE、CINAHL、科学引文索引扩展版、www.clinicaltrials.gov 以及其他数据库,检索时间截至 2008 年春季。我们还检索了参考文献列表,并联系了作者和试验研究者。
评价方法:仅纳入比较地上物理治疗步态训练与安慰剂或无治疗条件的随机对照试验。
结果:9 项研究共纳入 499 名参与者。我们发现,基于 3 项研究(n = 269),主要变量——行走功能方面,没有证据显示治疗有益。一些运动功能变量确实显示出显著的影响。基于 7 项研究(n = 396),行走速度提高了 0.07 m/sec[95%可信区间(CI),0.05-0.10];基于 3 项研究(n = 118),计时起立行走测试(Timed Up and Go test)改善了 1.81 秒(95% CI,-2.29 至-1.33);基于 4 项研究(n = 181),6 分钟步行测试增加了 26.06 m(95% CI,7.14-44.97)。
结论:我们发现没有足够的证据来确定地上物理治疗步态训练是否有益于慢性脑卒中患者的行走功能,尽管有限的证据表明,这种训练对一些运动功能变量可能有益。需要高质量的随机对照试验来复制和扩展这些发现。
J Neurol Phys Ther. 2009-12
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