School of Physiotherapy, Hanze University of Applied Sciences, Groningen; Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen.
J Physiother. 2013 Dec;59(4):245-54. doi: 10.1016/S1836-9553(13)70201-7.
Does static stretch positioning combined with simultaneous neuromuscular electrical stimulation (NMES) in the subacute phase after stroke have beneficial effects on basic arm body functions and activities?
Multicentre randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis.
Forty-six people in the subacute phase after stroke with severe arm motor deficits (initial Fugl-Meyer Assessment arm score ≤ 18).
In addition to conventional stroke rehabilitation, participants in the experimental group received arm stretch positioning combined with motor amplitude NMES for two 45-minute sessions a day, five days a week, for eight weeks. Control participants received sham arm positioning (ie, no stretch) and sham NMES (ie, transcutaneous electrical nerve stimulation with no motor effect) to the forearm only, at a similar frequency and duration.
The primary outcome measures were passive range of arm motion and the presence of pain in the hemiplegic shoulder. Secondary outcome measures were severity of shoulder pain, restrictions in performance of activities of daily living, hypertonia, spasticity, motor control and shoulder subluxation. Outcomes were assessed at baseline, mid-treatment, at the end of the treatment period (8 weeks) and at follow-up (20 weeks).
Multilevel regression analysis showed no significant group effects nor significant time × group interactions on any of the passive range of arm motions. The relative risk of shoulder pain in the experimental group was non-significant at 1.44 (95% CI 0.80 to 2.62).
In people with poor arm motor control in the subacute phase after stroke, static stretch positioning combined with simultaneous NMES has no statistically significant effects on range of motion, shoulder pain, basic arm function, or activities of daily living.
NTR1748.
在脑卒中后亚急性期，静态伸展定位结合同时的神经肌肉电刺激（NMES）是否对基本的上肢身体功能和活动有有益影响？
多中心随机试验，采用隐藏分组、评估者设盲和意向治疗分析。
46 名脑卒中后亚急性期且上肢运动功能严重受损的患者（初始 Fugl-Meyer 上肢评估得分≤18）。
除了常规的脑卒中康复治疗外，实验组患者还接受臂部伸展定位，结合运动幅度 NMES，每天两次，每次 45 分钟，每周 5 天，共 8 周。对照组患者仅在前臂接受假臂定位（即无伸展）和假 NMES（即无运动效应的经皮神经电刺激），频率和时长与实验组相同。
主要结局测量是被动上肢运动范围和偏瘫肩部疼痛的存在。次要结局测量是肩痛严重程度、日常生活活动受限、上肢痉挛、上肢肌肉张力、运动控制和肩半脱位。在基线、治疗中期、治疗结束时（8 周）和随访时（20 周）评估结局。
多层次回归分析显示，在任何一种被动上肢运动范围上，组间均无显著差异，也无显著的时间×组间交互作用。实验组肩部疼痛的相对风险比为 1.44（95%CI 0.80 至 2.62），无统计学意义。
在脑卒中后亚急性期上肢运动控制较差的患者中，静态伸展定位结合同时的 NMES 对运动范围、肩部疼痛、基本上肢功能或日常生活活动没有统计学上的显著影响。
NTR1748。
