UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland.
Disabil Rehabil. 2020 Feb;42(4):473-501. doi: 10.1080/09638288.2018.1501617. Epub 2018 Dec 3.
Approximately 70% of strokes occur in low and middle income countries, yet the effectiveness of physical rehabilitation in these contexts remains undetermined. This systematic review identifies and summarises the current evidence supporting physical rehabilitation interventions post-stroke in low and lower-middle income countries. Five databases were comprehensively searched (April 2017) for randomised controlled trials, clinical controlled trials, and cohort studies testing rehabilitation interventions post-stroke in these countries. The Effective Public Health Practice Project Tool assessed quality of included studies. Sixty-two studies (2115 participants) were included. Interventions addressed upper limb ( = 26), lower limb ( = 22), and other ( = 14) outcomes. Seven studies were rated as strong in quality, 16 moderate and 39 rated as weak. Overall, in addition to usual care, physical rehabilitation interventions improved outcomes for stroke survivors. Best evidence synthesis provides level I (b) evidence supporting constraint induced movement therapy and mirror therapy to improve upper limb functional outcomes. Level I (b) evidence supports multimodal interventions that include lower limb motor imagery to improve gait parameters. Level II (b) evidence supports sit-to-stand training to improve balance outcomes. Exercise-based and brain training interventions improved functional outcomes post-stroke in low and lower-middle income countries. Further high-quality studies including participation outcomes are required.Implications for RehabilitationLow-cost physical rehabilitation interventions requiring minimal resources can improve functional outcomes after stroke in low and lower-middle income countries.Exercise-based interventions can improve upper limb, lower limb, gait, and balance outcomes after stroke.Brain training paradigms such as mirror therapy and motor imagery, when included in therapy packages, can improve upper limb and gait outcomes.The proven efficacy for rehabilitation interventions in improving stroke outcomes in low and lower-middle income countries supports the need to strengthen the rehabilitation workforce in this context.
大约 70%的中风发生在中低收入国家，但这些环境下的物理康复的有效性仍未确定。本系统评价确定并总结了支持中低收入国家中风后康复干预的现有证据。全面检索了五个数据库（2017 年 4 月），以获取这些国家中风后康复干预的随机对照试验、临床对照试验和队列研究。有效公共卫生实践项目工具评估了纳入研究的质量。纳入了 62 项研究（2115 名参与者）。干预措施涉及上肢（ = 26）、下肢（ = 22）和其他（ = 14）结果。7 项研究质量评为强，16 项为中等，39 项为弱。总体而言，除常规护理外，物理康复干预措施改善了中风幸存者的结局。最佳证据综合提供了 I 级（b）证据，支持约束诱导运动疗法和镜像疗法改善上肢功能结局。I 级（b）证据支持包括下肢运动想象的多模式干预措施，以改善步态参数。II 级（b）证据支持坐立训练改善平衡结局。基于运动的干预措施和脑训练干预措施改善了中低收入国家中风后的功能结局。需要进一步开展高质量研究，包括参与结局。康复的意义在中低收入国家，低费用的物理康复干预措施，所需资源最少，可以改善中风后的功能结局。基于运动的干预措施可以改善上肢、下肢、步态和平衡结局。当镜像疗法和运动想象等脑训练模式纳入治疗方案时，可以改善上肢和步态结局。康复干预措施在改善中风结局方面的疗效已得到证实，这支持了在这一背景下加强康复人员队伍的必要性。
