Discipline of Occupational Therapy, School of Allied Health, College of Science, Health and Engineering, La Trobe University; Occupational Therapy Department, Alfred Health, Melbourne.
Discipline of Occupational Therapy, School of Allied Health, College of Science, Health and Engineering, La Trobe University; Occupational Therapy Department, Alfred Health, Melbourne; John Walsh Centre for Rehabilitation Research, Sydney Medical School (Northern), The University of Sydney.
J Physiother. 2016 Oct;62(4):182-7. doi: 10.1016/j.jphys.2016.08.006. Epub 2016 Aug 24.
In people receiving rehabilitation aimed at reducing activity limitations of the lower and/or upper limb after stroke, does adding extra rehabilitation (of the same content as the usual rehabilitation) improve activity? What is the amount of extra rehabilitation that needs to be provided to achieve a beneficial effect?
Systematic review with meta-analysis of randomised trials.
Adults aged 18 years or older that had a diagnosis of stroke.
Extra rehabilitation with the same content as usual rehabilitation aimed at reducing activity limitations of the lower and/or upper limb.
Activity measured as lower or upper limb ability.
A total of 14 studies, comprising 15 comparisons, met the inclusion criteria. Pooling data from all the included studies showed that extra rehabilitation improved activity immediately after the intervention period (SMD=0.39, 95% CI 0.07 to 0.71, I(2)=66%). When only studies with a large increase in rehabilitation (> 100%) were included, the effect was greater (SMD 0.59, 95% CI 0.23 to 0.94, I(2)=44%). There was a trend towards a positive relationship (r=0.53, p=0.09) between extra rehabilitation and improved activity. The turning point on the ROC curve of false versus true benefit (AUC=0.88, p=0.04) indicated that at least an extra 240% of rehabilitation was needed for significant likelihood that extra rehabilitation would improve activity.
Increasing the amount of usual rehabilitation aimed at reducing activity limitations improves activity in people after stroke. The amount of extra rehabilitation that needs to be provided to achieve a beneficial effect is large.
PROSPERO CRD42012003221. [Schneider EJ, Lannin NA, Ada L, Schmidt J (2016) Increasing the amount of usual rehabilitation improves activity after stroke: a systematic review.Journal of Physiotherapy62: 182-187].
在接受康复治疗以减少中风后下肢和/或上肢活动受限的人群中，增加额外的康复治疗（与常规康复治疗内容相同）是否能提高活动能力？需要提供多少额外的康复治疗才能达到有益的效果？
系统评价与随机试验的荟萃分析。
年龄在 18 岁或以上，被诊断为中风的成年人。
与常规康复治疗内容相同的额外康复治疗，旨在减少下肢和/或上肢的活动受限。
活动能力，以下肢或上肢能力来衡量。
共有 14 项研究，包含 15 项比较，符合纳入标准。对所有纳入研究的数据进行汇总分析显示，额外的康复治疗可在干预期后立即提高活动能力（SMD=0.39，95%CI 0.07 至 0.71，I(2)=66%）。当仅纳入康复治疗增加幅度较大（>100%）的研究时，效果更为显著（SMD 0.59，95%CI 0.23 至 0.94，I(2)=44%）。有一个趋势表明，额外康复治疗与活动能力改善之间存在正相关关系（r=0.53，p=0.09）。ROC 曲线的虚假与真实获益转折点（AUC=0.88，p=0.04）表明，需要额外提供至少 240%的康复治疗，才有可能显著提高活动能力。
增加旨在减少活动受限的常规康复治疗量可以提高中风后患者的活动能力。需要提供大量的额外康复治疗才能达到有益的效果。
PROSPERO CRD42012003221。[Schneider EJ、Lannin NA、Ada L、Schmidt J（2016 年）增加常规康复治疗量可改善中风后患者的活动能力：系统评价。《物理治疗杂志》62：182-187]。
