下肢镜像疗法对改善中风后平衡、步态和运动功能的疗效：一项系统评价和荟萃分析
The Efficacy of Lower Extremity Mirror Therapy for Improving Balance, Gait, and Motor Function Poststroke: A Systematic Review and Meta-Analysis.
作者信息
Louie Dennis R, Lim Shannon B, Eng Janice J
机构信息
Graduate Program in Rehabilitation Sciences, University of British Columbia, Canada; Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Canada.
Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Canada; Department of Physical Therapy, University of British Columbia, Canada.
出版信息
J Stroke Cerebrovasc Dis. 2019 Jan;28(1):107-120. doi: 10.1016/j.jstrokecerebrovasdis.2018.09.017. Epub 2018 Oct 9.
BACKGROUND
Mirror therapy is less commonly used to target the lower extremity after stroke to improve outcomes but is simple to perform. This review and meta-analysis aimed to evaluate the efficacy of lower extremity mirror therapy in improving balance, gait, and motor function for individuals with stroke.
METHODS
PubMed, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, and PsychINFO were searched from inception to May 2018 for randomized controlled trials (RCTs) comparing lower extremity mirror therapy to a control intervention for people with stroke. Pooled effects were determined by separate meta-analyses of gait speed, mobility, balance, and motor recovery.
RESULTS
Seventeen RCTs involving 633 participants were included. Thirteen studies reported a significant between-group difference favoring mirror therapy in at least one lower extremity outcome. In a meta-analysis of 6 trials that reported change in gait speed, a large beneficial effect was observed following mirror therapy training (standardized mean differences [SMD] = 1.04 [95% confidence interval [CI] = .43, 1.66], I = 73%, and P < .001). Lower extremity mirror therapy also had a positive effect on mobility (5 studies, SMD = .46 [95% CI = .01, .90], I = 43%, and P = .05) and motor recovery (7 studies, SMD = .47 [95% CI = .21, .74], I = 0%, and P < .001). A significant pooled effect was not found for balance capacity.
CONCLUSIONS
Mirror therapy for the lower extremity has a large effect for gait speed improvement. This review also found a small positive effect of mirror therapy for mobility and lower extremity motor recovery after stroke.
背景
镜像疗法较少用于中风后针对下肢以改善预后，但操作简单。本综述和荟萃分析旨在评估下肢镜像疗法对中风患者改善平衡、步态和运动功能的疗效。
方法
检索了PubMed、Cochrane对照试验中央注册库、MEDLINE、Embase、护理及相关健康文献累积索引、物理治疗证据数据库和PsychINFO，从数据库建立至2018年5月，查找比较下肢镜像疗法与对照干预措施对中风患者疗效的随机对照试验（RCT）。通过对步态速度、活动能力、平衡和运动恢复进行单独的荟萃分析来确定合并效应。
结果
纳入了17项涉及633名参与者的RCT。13项研究报告了至少一项下肢结局在组间存在显著差异，支持镜像疗法。在对6项报告步态速度变化的试验进行的荟萃分析中，镜像疗法训练后观察到有很大的有益效果（标准化均数差[SMD] = 1.04[95%置信区间[CI] = 0.43, 1.66]，I² = 73%，P < 0.001）。下肢镜像疗法对活动能力（5项研究，SMD = 0.46[95% CI = 0.01, 0.90]，I² = 43%，P = 0.05）和运动恢复（7项研究，SMD = 0.47[95% CI = 0.21, 0.74]，I² = 0%，P < 0.001）也有积极影响。未发现平衡能力有显著的合并效应。
结论
下肢镜像疗法对改善步态速度有很大作用。本综述还发现镜像疗法对中风后的活动能力和下肢运动恢复有较小的积极影响。
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