一项关于上肢治疗对中风后运动功能恢复的时机、疗效和成本效益的系统评价方案。
A systematic review protocol of timing, efficacy and cost effectiveness of upper limb therapy for motor recovery post-stroke.
机构信息
Melbourne School of Health Sciences, University of Melbourne, Parkville, Melbourne, Australia.
AVERT Early Rehabilitation Research Group, Stroke Theme, Florey Institute of Neuroscience and Mental Health, Parkville, Melbourne, Australia.
出版信息
Syst Rev. 2019 Jul 25;8(1):187. doi: 10.1186/s13643-019-1093-6.
BACKGROUND
Improving upper limb (UL) motor recovery after stroke represents a major clinical and scientific goal. We aim to complete three systematic reviews to estimate the (1) association between time to start of UL therapy and motor recovery, (2) relative efficacy of different UL therapy approaches post-stroke and (3) cost-effectiveness of UL therapy interventions.
METHODS
We have designed a systematic review protocol to address three systematic review questions that were each registered with PROSPERO. The search will be conducted in MEDLINE, EMBASE, and Cochrane Controlled Register of Trials. We will include randomised controlled trials, non-randomised clinical trials, before-after studies and observational studies of adult stroke survivors with an average stroke onset < 6 months, undergoing hospital-based therapy to improve UL function. Eligible interventions will aim to promote UL functional recovery. Two reviewers will independently screen, select and extract data. Study risk of bias will be appraised using appropriate tools. Clinical measures of motor recovery will be investigated (primary measure Fugl Meyer UL assessment), as well as measures of health-related quality of life (primary measure EQ-5D) and all cost-effectiveness analyses completed. Secondary outcomes include therapy dose (minutes, weeks, repetitions as available) and safety (i.e. adverse events, serious adverse events). A narrative synthesis will describe quality and content of the evidence. If feasible, we will conduct random effects meta-analyses where appropriate.
DISCUSSION
We anticipate the findings of this review will increase our understanding of UL therapy and inform the generation of novel, data-driven hypotheses for future UL therapy research post-stroke.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018019367, http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018111629, http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018111628.
背景
改善脑卒中后上肢（UL）运动功能恢复是一个主要的临床和科学目标。我们旨在完成三项系统评价，以评估：（1）UL 治疗开始时间与运动恢复之间的关系；（2）脑卒中后不同 UL 治疗方法的相对疗效；（3）UL 治疗干预的成本效益。
方法
我们设计了一个系统评价方案，以解决三个系统评价问题，每个问题都在 PROSPERO 中进行了注册。将在 MEDLINE、EMBASE 和 Cochrane 对照试验注册库中进行检索。我们将纳入随机对照试验、非随机临床试验、前后对照研究和观察性研究，研究对象为平均发病时间＜6 个月的成年脑卒中幸存者，接受以改善 UL 功能为目的的住院治疗。纳入的干预措施旨在促进 UL 功能恢复。两名评审员将独立筛选、选择和提取数据。使用适当的工具评估研究的偏倚风险。将调查运动恢复的临床测量指标（主要测量 Fugl Meyer UL 评估），以及健康相关生活质量的测量指标（主要测量 EQ-5D）和所有成本效益分析。次要结局包括治疗剂量（分钟、周、重复次数，如可获得）和安全性（即不良事件、严重不良事件）。叙述性综合将描述证据的质量和内容。如果可行，我们将适当地进行随机效应荟萃分析。
讨论
我们预计该综述的结果将提高我们对 UL 治疗的理解，并为脑卒中后 UL 治疗的新的、基于数据的假说提供信息。
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