强制性运动疗法改善偏瘫脑瘫患者上肢活动和参与能力：系统评价。
Constraint-induced movement therapy improves upper limb activity and participation in hemiplegic cerebral palsy: a systematic review.
机构信息
Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan (ROC).
Discipline of Physiotherapy,The University of Sydney, Sydney, Australia.
出版信息
J Physiother. 2016 Jul;62(3):130-7. doi: 10.1016/j.jphys.2016.05.013. Epub 2016 Jun 17.
QUESTIONS
Does constraint-induced movement therapy improve activity and participation in children with hemiplegic cerebral palsy? Does it improve activity and participation more than the same dose of upper limb therapy without restraint? Is the effect of constraint-induced movement therapy related to the duration of intervention or the age of the children?
DESIGN
Systematic review of randomised trials with meta-analysis.
PARTICIPANTS
Children with hemiplegic cerebral palsy with any level of motor disability.
INTERVENTION
The experimental group received constraint-induced movement therapy (defined as restraint of the less affected upper limb during supervised activity practice of the more affected upper limb). The control group received no intervention, sham intervention, or the same dose of upper limb therapy.
OUTCOME MEASURES
Measures of upper limb activity and participation were used in the analysis.
RESULTS
Constraint-induced movement therapy was more effective than no/sham intervention in terms of upper limb activity (SMD 0.63, 95% CI 0.20 to 1.06) and participation (SMD 1.21, 95% CI 0.41 to 2.02). However, constraint-induced movement therapy was no better than the same dose of upper limb therapy without restraint either in terms of upper limb activity (SMD 0.05, 95% CI -0.21 to 0.32) or participation (SMD -0.02, 95% CI -0.34 to 0.31). The effect of constraint-induced movement therapy was not related to the duration of intervention or the age of the children.
CONCLUSIONS
This review suggests that constraint-induced movement therapy is more effective than no intervention, but no more effective than the same dose of upper limb practice without restraint.
REGISTRATION
PROSPERO CRD42015024665. [Chiu H-C, Ada L (2016) Constraint-induced movement therapy improves upper limb activity and participation in hemiplegic cerebral palsy: a systematic review.Journal of Physiotherapy62: 130-137].
问题
强制性运动疗法是否能提高偏瘫脑瘫患儿的活动能力和参与度？与无约束的同等剂量上肢治疗相比，它是否能更有效地提高活动能力和参与度？强制性运动疗法的效果是否与干预持续时间或儿童年龄有关？
设计
随机试验的系统评价和荟萃分析。
参与者
任何运动能力障碍程度的偏瘫脑瘫患儿。
干预措施
实验组接受强制性运动疗法（定义为在受监督的患侧上肢活动练习期间，对非患侧上肢进行约束）。对照组未接受任何干预、假干预或接受相同剂量的上肢治疗。
结局测量
分析中使用了上肢活动和参与的测量方法。
结果
与无干预/假干预相比，强制性运动疗法在提高上肢活动能力方面更为有效（SMD 0.63，95%CI 0.20 至 1.06）和参与度（SMD 1.21，95%CI 0.41 至 2.02）。然而，与无约束的同等剂量上肢治疗相比，强制性运动疗法在提高上肢活动能力（SMD 0.05，95%CI -0.21 至 0.32）或参与度（SMD -0.02，95%CI -0.34 至 0.31）方面并无优势。强制性运动疗法的效果与干预持续时间或儿童年龄无关。
结论
本综述表明，强制性运动疗法比无干预更为有效，但与无约束的同等剂量上肢练习相比，并无优势。
注册
PROSPERO CRD42015024665。[Chiu H-C，Ada L（2016）强制性运动疗法可提高偏瘫脑瘫患儿的上肢活动能力和参与度：系统评价。《物理治疗杂志》62：130-137]。
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