Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China.
Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China.
Complement Ther Clin Pract. 2017 Nov;29:35-47. doi: 10.1016/j.ctcp.2017.08.005. Epub 2017 Aug 26.
OBJECTIVE: To systematically review literature about the rehabilitative effects of traditional Chinese exercises (TCEs) on limb function among patients with stroke. METHODS: Systematic review and meta-analysis of randomized controlled trials (RCTs). Twelve electronic databases were searched from their inceptions to February 2017, including PudMed, The Cochrane Library, Web of Science, EMBase, Science Direct, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine, Chinese Scientific Journal Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and WanFang Data. RCTs were located to examine the rehabilitative effects of TCEs on limb function among stroke patients. Two authors independently screened the literature, extracted data and assessed the risk bias of the included studies. Methodological quality evaluation and meta-analysis of included studies was performed by using Cochrane Collaboration's tool (RevMan 5.3). RESULTS: A total of 31 RCTs with 2349 participants were included. Results of meta-analysis showed that TCEs produced positive effects on limb motor function (random effects model, standardized mean difference [SMD] = 1.21, 95% confidence interval [CI] = 0.66 to 1.77, P < 0.01), balance function{Berg balance scale: (random effects model, SMD = 2.07, 95%CI = 1.52 to 2.62, P < 0.01), timed-up-and-go test: (fixed effects model, mean difference [MD] = -1.77, 95%CI = -2.87 to -0.67, P < 0.01)}, activities of daily living (ADL) ability {Barthel Index scale: (random effects model, MD = 15.60, 95%CI = 7.57 to 23.63, P < 0.01), Modified Barthel Index scale: (random effects model, MD = 12.30, 95%CI = 7.48 to 17.12, P < 0.01)}, and neurological impairment (fixed effects model, MD = -2.57, 95%CI = -3.14 to -2.00, P < 0.01). After subgroup analysis and sensitivity analysis, the positive effects did not be affected by different types of TCEs and different lengths of intervention time. However, TCEs were no benefit to physical function on Short Physical Performance Battery and 2-min Step Test among stroke patients. CONCLUSION: Current evidence showed that TCEs produced positive effects on limb motor function, balance function, ADL ability and neurological impairment among stroke patients. More large-scale, high-quality, multiple center RCTs are required to further verify above conclusions in the future.
目的：系统评价传统中医运动疗法（TCEs）对脑卒中患者肢体功能康复的疗效。
方法：系统评价和随机对照试验（RCTs）的荟萃分析。从各数据库建立起至 2017 年 2 月检索了 12 个电子数据库，包括PubMed、The Cochrane Library、Web of Science、EMBase、Science Direct、PsycINFO、护理学及相关健康领域累积索引、联合补充医学、中国科学期刊数据库、中国国家知识基础设施、中国生物医学文献数据库和万方数据。检索 RCTs 以评估 TCEs 对脑卒中患者肢体功能的康复效果。两名作者独立筛选文献、提取数据并评估纳入研究的偏倚风险。使用 Cochrane 协作工具（RevMan 5.3）对纳入研究进行方法学质量评价和荟萃分析。
结果：共纳入 31 项 RCTs，涉及 2349 名参与者。荟萃分析结果显示，TCEs 对肢体运动功能（随机效应模型，标准化均数差 [SMD] = 1.21，95%置信区间 [CI] = 0.66 至 1.77，P < 0.01）、平衡功能（Berg 平衡量表：[随机效应模型，SMD = 2.07，95%CI = 1.52 至 2.62，P < 0.01]；计时起立行走测试：[固定效应模型，差值 [MD] = -1.77，95%CI = -2.87 至 -0.67，P < 0.01]）、日常生活活动能力（Barthel 指数量表：[随机效应模型，MD = 15.60，95%CI = 7.57 至 23.63，P < 0.01]；改良 Barthel 指数量表：[随机效应模型，MD = 12.30，95%CI = 7.48 至 17.12，P < 0.01]）和神经功能缺损（固定效应模型，MD = -2.57，95%CI = -3.14 至 -2.00，P < 0.01）均有积极作用。经过亚组分析和敏感性分析，不同类型的 TCEs 和不同的干预时间对阳性结果没有影响。然而，TCEs 对脑卒中患者的短距离体力活动测试和 2 分钟踏步测试的身体功能没有益处。
结论：现有证据表明，TCEs 对脑卒中患者的肢体运动功能、平衡功能、日常生活活动能力和神经功能缺损有积极作用。未来需要更多大规模、高质量、多中心 RCT 来进一步验证上述结论。
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