静态拉伸定位对脑卒中后上肢痉挛和运动功能的影响：系统评价与荟萃分析。
Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: Systematic review with meta-analysis.
机构信息
Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil; Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
Department of Physiotherapy, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
出版信息
Ann Phys Rehabil Med. 2019 Jul;62(4):274-282. doi: 10.1016/j.rehab.2018.11.004. Epub 2018 Dec 22.
OBJECTIVE
To systematically review the effects of static stretching with positioning orthoses or simple positioning combined or not with other therapies on upper-limb spasticity and mobility in adults after stroke.
METHODS
This meta-analysis was conducted according to PRISMA guidelines and registered at PROSPERO. MEDLINE (Pubmed), Embase, Cochrane CENTRAL, Scopus and PEDro databases were searched from inception to January 2018 for articles. Two independent researchers extracted data, assessed the methodological quality and rated the quality of evidence of studies.
RESULTS
Three studies (57 participants) were included in the spasticity meta-analysis and 7 (210 participants) in the mobility meta-analysis. Static stretching with positioning orthoses reduced wrist-flexor spasticity as compared with no therapy (mean difference [MD]=-1.89, 95% confidence interval [CI] -2.44 to -1.34; I 79%, P<0.001). No data were available concerning the spasticity of other muscles. Static stretching with simple positioning, combined or not with other therapies, was not better than conventional physiotherapy in preventing loss of mobility of shoulder external rotation (MD=3.50, 95% CI -3.45 to 10.45; I 54.7%, P=0.32), shoulder flexion (MD=-1.20, 95% CI -8.95 to 6.55; I 0%, P=0.76) or wrist extension (MD=-0.32, 95% CI -6.98 to 5.75; I 38.5%, P=0.92). No data were available concerning the mobility of other joints.
CONCLUSION
This meta-analysis revealed very low-quality evidence that static stretching with positioning orthoses reduces wrist flexion spasticity after stroke as compared with no therapy. Furthermore, we found low-quality evidence that static stretching by simple positioning is not better than conventional physiotherapy for preventing loss of mobility in the shoulder and wrist. Considering the limited number of studies devoted to this issue in post-stroke survivors, further randomized clinical trials are still needed.
CLINICAL TRIAL REGISTRATION
PROSPERO (CRD42017078784).
目的
系统评价静态拉伸联合定位矫形器或单纯定位治疗对脑卒中后上肢痉挛和活动度的影响。
方法
本 meta 分析按照 PRISMA 指南进行，并在 PROSPERO 注册。从建库至 2018 年 1 月，检索 MEDLINE（Pubmed）、Embase、Cochrane 中心数据库、Scopus 和 PEDro 数据库，纳入静态拉伸联合定位矫形器或单纯定位治疗脑卒中后患者上肢痉挛和活动度的研究。由 2 名研究者独立提取数据、评价方法学质量和评估研究证据质量。
结果
痉挛 meta 分析纳入 3 项研究（57 例患者），活动度 meta 分析纳入 7 项研究（210 例患者）。与不治疗相比，静态拉伸联合定位矫形器可降低腕屈肌痉挛（均数差值〔MD〕=-1.89，95%置信区间〔CI〕-2.44 至-1.34；I 2 =79%，P<0.001），但无其他肌肉痉挛的数据。联合或不联合其他疗法的静态拉伸单纯定位治疗与常规物理治疗相比，对预防肩外旋（MD=3.50，95%CI -3.45 至 10.45；I 2 =54.7%，P=0.32）、肩前屈（MD=-1.20，95%CI -8.95 至 6.55；I 2 =0%，P=0.76）或腕伸肌（MD=-0.32，95%CI -6.98 至 5.75；I 2 =38.5%，P=0.92）活动度丧失的效果均无差异。无其他关节活动度的数据。
结论
本 meta 分析结果为低质量证据，表明与不治疗相比，静态拉伸联合定位矫形器可降低脑卒中后腕屈肌痉挛，但静态拉伸单纯定位治疗对预防肩和腕活动度丧失的效果并不优于常规物理治疗。鉴于目前仅有少数研究关注脑卒中幸存者的这一问题，仍需要开展更多的随机临床试验。
临床试验注册
PROSPERO（CRD42017078784）。
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