Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil.
Divisão de Neurologia e Epidemiologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.
NeuroRehabilitation. 2019;44(3):369-377. doi: 10.3233/NRE-182585.
Although the role of trunk exercises in the chronic phase of stroke is acknowledged, the addition of specific inpatient training in the subacute stage is a matter of debate and varies among centers. Recent new evidence suggests the question should be revisited.
To assess the impact of the addition of specific trunk training to inpatient rehabilitation protocols after a recent stroke.
A systematic review was performed assessing the impact of inpatient trunk training. The search was performed in LILACS, SciELO, PEDro, Cochrane, and NCBI PubMed databases for clinical trials published up to December 31st, 2017. The initial bibliographic research identified 3202 articles. After analyzing the titles, 19 abstracts were selected for detailed analysis. After application of the eligibility criteria, the final selection included nine studies. Outcome measurements from the same evaluation instruments were submitted to a meta-analysis to improve homogeneity (7 studies).
All patients in the included studies were recruited less than three months after a stroke. Seven studies assessed trunk control using the Trunk Impairment Scale (TIS). There was a significant improvement in trunk control with a pooled increase in TIS score of 3.3 points from the baseline (CI95:2.54-4.06, p < 0.0001). Three studies assessed balance using the Brunel Balance Assessment (BBA) scale. There was also a significant improvement in balance with a pooled increase in BBA score of 2.7 points (CI95:1.5-4.03, p < 0.0001). The Berg Balance Scale was used for balance assessment in three studies. The meta-analysis of their results showed a pooled increase of 13.2 points (CI95:9.49-16.84, p < 0.0001). Weight transfer was evaluated in four studies using different methods. The addition of inpatient trunk exercises was associated with an improvement in the ability to transfer the trunk laterally in three studies.
The introduction of trunk-based inpatient training protocols brings short-term benefits in trunk performance and balance in stroke patients.
虽然人们已经认识到躯干运动在中风慢性期的作用，但在亚急性期增加特定的住院训练仍然存在争议，且不同中心的做法也存在差异。最近的新证据表明，这个问题应该重新审视。
评估在最近发生中风后，将特定的躯干训练加入住院康复方案中对患者的影响。
我们进行了一项系统评价，评估了住院躯干训练对患者的影响。我们在 LILACS、SciELO、PEDro、Cochrane 和 NCBI PubMed 数据库中检索了截至 2017 年 12 月 31 日发表的临床试验，进行了文献检索。最初的文献检索确定了 3202 篇文章。在分析了标题之后，选择了 19 篇摘要进行详细分析。在应用纳入标准后，最终选择了 9 项研究。来自相同评估工具的结果测量数据被提交进行荟萃分析以提高同质性（7 项研究）。
所有纳入研究的患者均在中风后不到三个月时入组。7 项研究使用躯干损伤量表（TIS）评估躯干控制。TIS 评分的平均基线增加了 3.3 分（95%CI：2.54-4.06，p<0.0001），躯干控制有显著改善。3 项研究使用 Brunel 平衡评估量表（BBA）评估平衡。BBA 评分的平均基线增加了 2.7 分（95%CI：1.5-4.03，p<0.0001），平衡也有显著改善。3 项研究使用 Berg 平衡量表评估平衡。对这些结果的荟萃分析显示，平均基线增加了 13.2 分（95%CI：9.49-16.84，p<0.0001）。4 项研究使用不同的方法评估躯干转移。在 3 项研究中，住院躯干训练的引入与改善躯干向侧方转移的能力相关。
在中风患者中引入基于躯干的住院训练方案可带来短期的躯干运动和平衡改善。
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