School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China.
School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China.
Complement Ther Clin Pract. 2017 Aug;28:75-84. doi: 10.1016/j.ctcp.2017.05.009. Epub 2017 May 26.
This study aimed to evaluate the effects of motor imagery (MI) on walking function and balance in patients after stroke.
Related randomized controlled trials (RCTs) were searched in 12 electronic databases (Cochrane Central Register of Controlled Trials, PubMed, Science Direct, Web of Science, Allied and Complementary Medicine, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, WanFang, and VIP) from inception to November 30, 2016, and Review Manager 5.3 was used for meta-analysis. References listed in included papers and other related systematic reviews on MI were also screened for further consideration.
A total of 17 studies were included. When compared with "routine methods of treatment or training", meta-analyses showed that MI was more effective in improving walking abilities (standardized mean difference [SMD] = 0.69, random effect model, 95% confidence interval [CI] = 0.38 to 1.00, P < 0.0001) and motor function in stroke patients (SMD = 0.84, random effect model, 95% CI = 0.45 to 1.22, P < 0.0001), but no statistical difference was noted in balance (SMD = 0.81, random effect model, 95% CI = -0.03 to 1.65, P = 0.06). Statistically significant improvement in walking abilities was noted at short-term (0 to < six weeks) (SMD = 0.83, fixed effect model, 95% CI = 0.24 to 1.42, P = 0.006) and long-term (≥six weeks) assessments (SMD = 0.45, fixed effect model, 95% CI = 0.25 to 0.64, P < 0.00001). Subgroup analyses suggested that MI had a positive effect on balance with short-term duration (0 to < six weeks) (SMD = 4.67, fixed effect model, 95% CI = 2.89 to 6.46, P < 0.00001), but failed to improve balance (SMD = 0.82, random effect model, 95% CI = -0.27 to 1.90, P = 0.14) with long-term (≥six weeks) duration.
MI appears to be a beneficial intervention for stroke rehabilitation. Nonetheless, existing evidence regarding the effects of MI in patients after stroke remains inconclusive because of significantly statistical heterogeneity and methodological flaws identified in the included studies. More large-scale and rigorously designed RCTs in future research with sufficient follow-up periods are needed to provide more reliable evidence on the effects of MI in post-stroke patients.
本研究旨在评估运动想象（MI）对脑卒中后患者步行功能和平衡的影响。
检索了 12 个电子数据库（Cochrane 对照试验中心注册库、PubMed、Science Direct、Web of Science、补充和综合医学、Embase、护理和联合健康文献累积索引、PsycINFO、中国国家知识基础设施、中国生物医学文献数据库、万方、维普）中从成立到 2016 年 11 月 30 日的相关随机对照试验（RCT），并使用 Review Manager 5.3 进行荟萃分析。还对纳入文献中的参考文献和其他相关系统综述中的 MI 进行了筛选，以供进一步考虑。
共纳入 17 项研究。与“常规治疗或训练方法”相比，荟萃分析显示 MI 在改善脑卒中患者的步行能力（标准化均数差 [SMD] = 0.69，随机效应模型，95%置信区间 [CI] = 0.38 至 1.00，P < 0.0001）和运动功能方面更为有效（SMD = 0.84，随机效应模型，95%CI = 0.45 至 1.22，P < 0.0001），但在平衡方面无统计学差异（SMD = 0.81，随机效应模型，95%CI = -0.03 至 1.65，P = 0.06）。在短期（0 至 <6 周）（SMD = 0.83，固定效应模型，95%CI = 0.24 至 1.42，P = 0.006）和长期（≥6 周）评估中，步行能力的改善均具有统计学意义（SMD = 0.45，固定效应模型，95%CI = 0.25 至 0.64，P < 0.00001）。亚组分析表明，MI 对短期（0 至 <6 周）的平衡有积极影响（SMD = 4.67，固定效应模型，95%CI = 2.89 至 6.46，P < 0.00001），但对长期（≥6 周）的平衡无影响（SMD = 0.82，随机效应模型，95%CI = -0.27 至 1.90，P = 0.14）。
MI 似乎是一种有益于脑卒中康复的干预措施。然而，由于纳入研究中存在显著的统计学异质性和方法学缺陷，目前关于 MI 对脑卒中患者影响的证据仍然不确定。未来的研究需要进行更大规模和更严格设计的 RCT，并进行足够的随访，以提供更可靠的证据，证明 MI 对脑卒中后患者的影响。
