García-Rudolph Alejandro, Sánchez-Pinsach David, Salleras Eloy Opisso, Tormos Josep María
Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona.
Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès).
Medicine (Baltimore). 2019 Feb;98(8):e14501. doi: 10.1097/MD.0000000000014501.
Stroke is a leading cause of disabilities worldwide. One of the key disciplines in stroke rehabilitation is physical therapy which is primarily aimed at restoring and maintaining activities of daily living (ADL). Several meta-analyses have found different interventions improving functional capacity and reducing disability.
To systematically evaluate existing evidence, from published systematic reviews of meta-analyses, of subacute physical rehabilitation interventions in (ADLs) for stroke patients.
Umbrella review on meta-analyses of RCTs ADLs in MEDLINE, Web of Science, Scopus, Cochrane, and Google Scholar up to April 2018. Two reviewers independently applied inclusion criteria to select potential systematic reviews of meta-analyses of randomized controlled trials (RCTs) of physical rehabilitation interventions (during subacute phase) reporting results in ADLs. Two reviewers independently extracted name of the 1st author, year of publication, physical intervention, outcome(s), total number of participants, and number of studies from each eligible meta-analysis. The number of subjects (intervention and control), ADL outcome, and effect sizes were extracted from each study.
Fifty-five meta-analyses on 21 subacute rehabilitation interventions presented in 30 different publications involving a total of 314 RCTs for 13,787 subjects were identified. Standardized mean differences (SMDs), 95% confidence intervals (fixed and random effects models), 95% prediction intervals, and statistical heterogeneity (I and Q test) were calculated. Virtual reality, constraint-induced movement, augmented exercises therapy, and transcranial direct current stimulation interventions resulted statistically significant (P < .05) with moderate improvements (0.5 ≤ SMD ≤ 0.8) and no heterogeneity (I = 0%). Moxibustion, Tai Chi, and acupuncture presented best improvements (SMD > 0.8) but with considerable heterogeneity (I2 > 75%). Only acupuncture reached "suggestive" level of evidence.
Despite the range of interventions available for stroke rehabilitation in subacute phase, there is lack of high-quality evidence in meta-analyses, highlighting the need of further research reporting ADL outcomes.
中风是全球致残的主要原因之一。中风康复的关键学科之一是物理治疗，其主要目的是恢复和维持日常生活活动（ADL）。多项荟萃分析发现不同的干预措施可改善功能能力并减少残疾。
系统评价已发表的荟萃分析系统评价中关于中风患者亚急性物理康复干预对日常生活活动（ADL）影响的现有证据。
截至2018年4月，在MEDLINE、科学网、Scopus、Cochrane和谷歌学术中对随机对照试验（RCT）中ADL的荟萃分析进行伞状综述。两名评审员独立应用纳入标准，选择关于物理康复干预（亚急性期）随机对照试验（RCT）荟萃分析的潜在系统评价，这些分析报告了ADL方面的结果。两名评审员独立从每项合格的荟萃分析中提取第一作者姓名、发表年份、物理干预、结果、参与者总数和研究数量。从每项研究中提取受试者数量（干预组和对照组）、ADL结果和效应量。
共识别出30篇不同出版物中关于21种亚急性康复干预的55项荟萃分析，涉及13787名受试者的314项RCT。计算标准化平均差（SMD）、95%置信区间（固定效应模型和随机效应模型）、95%预测区间和统计异质性（I²和Q检验）。虚拟现实、强制性运动疗法、强化运动疗法和经颅直流电刺激干预在统计学上具有显著意义（P < 0.05）且有中度改善（0.5≤SMD≤0.8）且无异质性（I² = 0%）。艾灸、太极拳和针灸呈现出最佳改善效果（SMD > 0.8）但存在相当大的异质性（I² > 75%）。只有针灸达到了“提示性”证据水平。
尽管亚急性期中风康复有多种可用干预措施，但荟萃分析中缺乏高质量证据，凸显了进一步报告ADL结果研究的必要性。
