Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College School, London, UK
Physiotherapy Department, Guy's and Saint Thomas' NHS Foundation Trust, London, London, UK.
BMJ Open. 2020 Feb 5;10(2):e033642. doi: 10.1136/bmjopen-2019-033642.
To evaluate the effectiveness of rehabilitation interventions on physical function and immobility-related complications in severe stroke.
Systematic review of electronic databases (Medline, Excerpta Medica database, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Physiotherapy Evidence Database, Database of Research in Stroke, Cochrane Central Register of Controlled Trials) searched between January 1987 and November 2018.
The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guided the review. Randomised controlled trials comparing the effect of one type of rehabilitation intervention to another intervention, usual care or no intervention on physical function and immobility-related complications for patients with severe stroke were included. Studies that recruited participants with all levels of stroke severity were included only if subgroup analysis based on stroke severity was performed. Two reviewers screened search results, selected studies using predefined selection criteria, extracted data and assessed risk of bias for selected studies using piloted proformas. Marked heterogeneity prevented meta-analysis and a descriptive review was performed. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess evidence strength.
28 studies (n=2677, mean age 72.7 years, 49.3% males) were included in the review. 24 studies were rated low or very low quality due to high risk of bias and small sample sizes. There was high-quality evidence that very early mobilisation (ie, mobilisation with 24 hours poststroke) and occupational therapy in care homes were no more effective than usual care. There was moderate quality evidence supporting short-term benefits of wrist and finger neuromuscular electrical stimulation in improving wrist extensor and grip strength, additional upper limb training on improving upper limb function and additional lower limb training on improving upper limb function, independence in activities of daily living, gait speed and gait independence.
There is a paucity of high-quality evidence to support the use of rehabilitation interventions to improve physical function and reduce immobility-related complications after severe stroke. Future research investigating more commonly used rehabilitation interventions, particularly to reduce poststroke complications, is required.
CRD42017077737.
评估康复干预对重度脑卒中患者身体功能和与活动受限相关并发症的疗效。
对电子数据库（Medline、Excerpta Medica 数据库、护理学及相关健康文献累积索引、辅助和补充医学数据库、物理治疗证据数据库、卒中研究数据库、Cochrane 对照试验中心注册库）进行系统检索，检索时间为 1987 年 1 月至 2018 年 11 月。
本研究遵循系统评价和荟萃分析的首选报告项目声明。纳入了比较不同类型康复干预措施（一种康复干预措施与另一种康复干预措施、常规护理或无干预）对重度脑卒中患者身体功能和与活动受限相关并发症影响的随机对照试验。仅当根据卒中严重程度进行了亚组分析时，才纳入招募了所有卒中严重程度患者的研究。两位评审员筛选检索结果，使用预设的选择标准选择研究，使用预编制表格提取数据并评估入选研究的偏倚风险。由于存在明显的异质性，无法进行荟萃分析，因此进行了描述性综述。采用推荐评估、制定与评价分级方法评估证据强度。
共纳入 28 项研究（n=2677 例，平均年龄 72.7 岁，男性占 49.3%）。由于偏倚风险高和样本量小，24 项研究被评为低质量或极低质量。非常早期活动（即卒中后 24 小时内活动）和疗养院中的职业疗法与常规护理相比没有更有效，这方面有高质量证据支持。有中等质量证据支持短期使用腕和手指神经肌肉电刺激改善腕伸肌和握力、增加上肢训练改善上肢功能、增加下肢训练改善上肢功能、提高日常生活活动能力、行走速度和行走独立性的作用。
目前高质量证据很少支持使用康复干预来改善重度脑卒中患者的身体功能和减少与活动受限相关的并发症。需要进一步研究更常用的康复干预措施，特别是减少卒中后并发症的干预措施。
PROSPERO 注册号：CRD42017077737。
