Department of Healthcare, PHL University College Hasselt, Hasselt, Belgium.
BMC Neurol. 2012 Jul 2;12:49. doi: 10.1186/1471-2377-12-49.
The upper extremity plays an important role in daily functioning of patients with Multiple Sclerosis (MS) and strongly influences their quality of life. However, an explicit overview of arm-hand training programs is lacking. The present review aims to investigate the training components and the outcome of motor training programs for arm and hand in MS.
A computerized systematic literature search in 5 databases (PubMed, CINAHL, EMBASE, PEDro and Cochrane) was performed using the following Mesh terms: Multiple Sclerosis, Rehabilitation, Physical Education and Training, Exercise, Patient-Centered Care, Upper Extremity, Activities of Daily Living, Motor Skills, Motor Activity, Intervention Studies and Clinical Trial. The methodological quality of the selected articles was scored with the Van Tulder Checklist. A descriptive analyses was performed using the PICO principle, including scoring of training components with the calculation of Hedges'g effect sizes.
Eleven studies were eligible (mean Van Tulder-score = 10.82(SD2.96)). Most studies reported a specific improvement in arm hand performance at the ICF level that was trained at. The mean number of training components was 5.5(SD2.8) and a significant correlation (r = 0.67; p < 0.05) between the number of training components and effect sizes was found. The components 'client-centered' and 'functional movement' were most frequently used, whereas 'distribution based practice', 'feedback' and 'random practice' were never used. The component 'exercise progression' was only used in studies with single ICF body function training, with the exception of 1 study with activity level training. Studies including the component 'client-centred' demonstrated moderate to high effect sizes.
Motor training programs (both at the ICF body function and activity level) have shown to improve arm and hand performance in MS in which the value of the training specificity was emphasized. To optimize upper extremity training in MS the component 'client-centred' and 'exercise progression' may be important. Furthermore, given the importance attributed to the components 'distribution based practice', 'feedback' and 'random practice' in previous research in stroke patients, the use of these components in arm hand training should be explored in future research.
上肢在多发性硬化症（MS）患者的日常功能中起着重要作用，强烈影响他们的生活质量。然而，目前缺乏对手臂手部训练计划的明确概述。本综述旨在调查 MS 患者手臂手部运动训练计划的训练组成部分和结果。
在 5 个数据库（PubMed、CINAHL、EMBASE、PEDro 和 Cochrane）中进行计算机系统文献检索，使用以下 MeSH 术语：多发性硬化症、康复、体育教育和训练、运动、以患者为中心的护理、上肢、日常生活活动、运动技能、运动活动、干预研究和临床试验。使用 Van Tulder 清单对所选文章的方法学质量进行评分。使用 PICO 原则进行描述性分析，包括使用计算 Hedges'g 效应大小对训练组成部分进行评分。
11 项研究符合入选标准（平均 Van Tulder 评分=10.82（SD2.96））。大多数研究报告称，在 ICF 水平上训练的手臂手部性能有特定的改善。训练组成部分的平均数量为 5.5（SD2.8），并且发现数量和效应大小之间存在显著相关性（r=0.67；p<0.05）。最常使用的组件是“以患者为中心”和“功能性运动”，而“基于分布的练习”、“反馈”和“随机练习”从未使用过。仅在单一 ICF 身体功能训练的研究中使用“运动进展”组件，除了 1 项活动水平训练研究外。包含“以患者为中心”组件的研究显示出中等到高的效应大小。
运动训练计划（ICF 身体功能和活动水平）已被证明可以改善 MS 患者的手臂和手部功能，其中强调了训练特异性的价值。为了优化 MS 患者的上肢训练，“以患者为中心”和“运动进展”组件可能很重要。此外，鉴于先前在中风患者的研究中对“基于分布的练习”、“反馈”和“随机练习”组件的重视，未来的研究应探讨在手臂手部训练中使用这些组件。
