Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center, 1007 MB Amsterdam, The Netherlands.
Stroke. 2011 Nov;42(11):3311-5. doi: 10.1161/STROKEAHA.111.623819. Epub 2011 Oct 13.
The purpose of this study was to determine the effects of augmented exercise therapy on gait, gait-related activities, and (basic and extended) activities of daily living within the first 6 months poststroke.
A systematic literature search in electronic databases from 1990 until October 2010 was performed. Randomized controlled trials were included in which the experimental group spent augmented time in lower-limb exercise therapy compared with the control group. Outcomes were gait, gait-related activities, and (extended) activities of daily living. Results from individual studies were pooled by calculating the summary effect sizes. Subgroup analyses were applied for a treatment contrast of ≥16 hours, timing poststroke, type of control intervention, and methodological quality.
Fourteen (N=725) of 4966 identified studies were included. Pooling resulted in small to moderate significant summary effect sizes in favor of augmented exercise therapy for walking ability, comfortable and maximum walking speed, and extended activities of daily living. No significant effects were found for basic activities of daily living. Subgroup analysis did not show a significant effect modification.
Dose-response trials in stroke rehabilitation are heterogeneous. The present meta-analysis suggests that increased time spent on exercise of gait and gait-related activities in the first 6 months poststroke results in significant small to moderate effects in terms of walking ability, walking speed, and extended activities of daily living. High-quality dose-response exercise therapy trials are needed with identical treatment goals but incremental levels of intensity.
本研究旨在确定增强型运动疗法在脑卒中后 6 个月内对步态、与步态相关的活动以及（基本和扩展）日常生活活动的影响。
对从 1990 年到 2010 年 10 月的电子数据库进行了系统的文献检索。纳入的随机对照试验中，实验组下肢运动疗法的治疗时间比对照组延长。结局指标为步态、与步态相关的活动以及（扩展）日常生活活动。通过计算汇总效应大小来合并单个研究的结果。进行了治疗对比≥16 小时、脑卒中后时间、对照干预类型和方法学质量的亚组分析。
从 4966 项已识别的研究中，有 14 项（N=725）符合纳入标准。汇总结果表明，增强型运动疗法在步行能力、舒适和最大步行速度以及扩展日常生活活动方面具有较小到中等显著的汇总效应。基本日常生活活动没有显著影响。亚组分析未显示出显著的效应修饰。
脑卒中康复中的剂量反应试验具有异质性。本荟萃分析表明，在脑卒中后 6 个月内增加步态和与步态相关活动的运动疗法时间可显著改善步行能力、步行速度和扩展日常生活活动，效果为小到中等。需要开展具有相同治疗目标但递增强度的高质量剂量反应运动疗法试验。
