Hsu Che-Wei, Kang Yi-No, Tseng Sung-Hui
Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan.
Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Front Neurol. 2019 Jun 21;10:657. doi: 10.3389/fneur.2019.00657. eCollection 2019.
Intensive physical therapy or exercise has been associated with favorable cerebral palsy (CP) outcomes, but few studies have investigated the effects of exercise intensity on the improvement in CP outcomes. In this study, we assessed the effects of intensive exercise-based therapy on improvement in gross motor function in children with CP. We searched three databases for randomized clinical trials evaluating the effects of therapeutic exercise training by using Gross Motor Function Measurement (GMFM) 66 and 88 among children with CP. Studies that used interventions in addition to therapeutic exercise were excluded from the present meta-analysis. Exercise intensity was defined using the number of training hours per day and duration of intervention (in weeks). The effects of the number of daily training hours and program duration on GMFM improvement were evaluated using meta-regression. The comprehensive search returned 270 references, and 13 of 270 references met our eligibility criteria. The 13 trials recruited 412 children with CP. These trials measured motor improvements by using GMFM-66 ( = 8) and GMFM-88 ( = 5). The GMFM scores in the children who received the therapeutic intervention did not show significantly greater improvement than those of the children who received standard care. Meta-regression analysis revealed that the improvement in GMFM scores was positively associated with the number of daily training hours (point estimate = 0.549; = 0.031) and program duration (point estimate = 0.067; = 0.075). Intensive physical exercise improved CP outcomes in the intervention and standard therapy groups. The duration of therapeutic intervention improved CP outcomes among the children who received the therapeutic intervention, while an increase in the number of daily training hours improved in CP outcomes in the children who received standard therapy.
强化物理治疗或运动与脑瘫（CP）的良好预后相关，但很少有研究调查运动强度对CP预后改善的影响。在本研究中，我们评估了基于强化运动的治疗对CP患儿粗大运动功能改善的影响。我们在三个数据库中检索了评估治疗性运动训练效果的随机临床试验，这些试验使用粗大运动功能测量（GMFM）66项和88项对CP患儿进行评估。本荟萃分析排除了除治疗性运动外还使用其他干预措施的研究。运动强度通过每天的训练小时数和干预持续时间（以周为单位）来定义。使用荟萃回归评估每日训练小时数和项目持续时间对GMFM改善的影响。全面检索返回了270篇参考文献，其中270篇参考文献中有13篇符合我们的纳入标准。这13项试验招募了412名CP患儿。这些试验使用GMFM - 66（n = 8）和GMFM - 88（n = 5）测量运动改善情况。接受治疗性干预的儿童的GMFM评分改善并不显著高于接受标准护理的儿童。荟萃回归分析显示，GMFM评分的改善与每日训练小时数（点估计 = 0.549；P = 0.031）和项目持续时间（点估计 = 0.067；P = 0.075）呈正相关。强化体育锻炼改善了干预组和标准治疗组的CP预后。治疗性干预的持续时间改善了接受治疗性干预儿童的CP预后，而每日训练小时数的增加改善了接受标准治疗儿童的CP预后。
