Wee Seng Kwee, Hughes Ann-Marie, Warner Martin, Burridge Jane H
University of Southampton, Southampton, UK Tan Tock Seng Hospital, Singapore, Singapore
University of Southampton, Southampton, UK.
Neurorehabil Neural Repair. 2014 Sep;28(7):660-77. doi: 10.1177/1545968314521011. Epub 2014 Feb 10.
Many stroke patients exhibit excessive compensatory trunk movements during reaching. Compensatory movement behaviors may improve upper extremity function in the short-term but be detrimental to long-term recovery.
To evaluate the evidence that trunk restraint limits compensatory trunk movement and/or promotes better upper extremity recovery in stroke patients.
A search was conducted through electronic databases from January 1980 to June 2013. Only randomized controlled trials (RCTs) comparing upper extremity training with and without trunk restraint were selected for review. Three review authors independently assessed the methodological quality and extracted data from the studies. Meta-analysis was conducted when there was sufficient homogenous data.
Six RCTs involving 187 chronic stroke patients were identified. Meta-analysis of key outcome measures showed that trunk restraint has a moderate statistically significant effect on improving Fugl-Meyer Upper Extremity (FMA-UE) score, active shoulder flexion, and reduction in trunk displacement during reaching. There was a small, nonsignificant effect of trunk restraint on upper extremity function.
Trunk restraint has a moderate effect on reduction of upper extremity impairment in chronic stroke patients, in terms of FMA-UE score, increased shoulder flexion, and reduction in excessive trunk movement during reaching. There is insufficient evidence to demonstrate that trunk restraint improves upper extremity function and reaching trajectory smoothness and straightness in chronic stroke patients. Future research on stroke patients at different phases of recovery and with different levels of upper extremity impairment is recommended.
许多中风患者在伸手够物时表现出过度的躯干代偿运动。代偿运动行为可能在短期内改善上肢功能，但对长期恢复不利。
评估躯干约束限制中风患者代偿性躯干运动和/或促进更好的上肢恢复的证据。
检索了1980年1月至2013年6月的电子数据库。仅选择比较有和没有躯干约束的上肢训练的随机对照试验（RCT）进行综述。三位综述作者独立评估方法学质量并从研究中提取数据。当有足够的同质数据时进行荟萃分析。
确定了6项涉及187例慢性中风患者的RCT。关键结局指标的荟萃分析表明，躯干约束对改善Fugl-Meyer上肢（FMA-UE）评分、主动肩屈曲以及伸手过程中躯干位移的减少有中度统计学显著效果。躯干约束对上肢功能有微小的、不显著的影响。
就FMA-UE评分、增加肩屈曲以及减少伸手过程中过度的躯干运动而言，躯干约束对慢性中风患者上肢损伤的减轻有中度效果。没有足够的证据表明躯干约束能改善慢性中风患者的上肢功能以及伸手轨迹的平滑度和直线度。建议对处于不同恢复阶段和具有不同上肢损伤程度的中风患者进行未来研究。
