The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Medical College of Georgia, Augusta University, Augusta, USA.
Int J Nurs Stud. 2020 Nov;111:103738. doi: 10.1016/j.ijnurstu.2020.103738. Epub 2020 Aug 1.
Resuming participation in society is an important goal of post-stroke rehabilitation. Exercise-based interventions have been shown to be effective non-pharmacological methods for improving social participation in post-stroke survivors, however it is unclear what the most effective types of exercise interventions are.
To assess the comparative effects and ranks of all exercise-based interventions in improving social participations in patients after a stroke.
A random-effects network meta-analysis was performed to identify evidence from relevant randomized control trials. We searched MEDLINE, CINAHL, EMBASE, PsycINFO, CINHAL, Cochrane Library, AMED, SPORTDiscus, Web of Science and Clinical Trials.gov from their earliest records to January 2020. Included trials must include at least one types of exercise for patients with stroke. The primary e was social participation. Bias will be assessed according to the revised Cochrane risk of bias tool. Data were analysed using Stata v14.0. Registration number of this study is CRD42020152523.
A total of 16 randomized control trials involving 1704 patients and 12 intervention arms were included in our study. We performed three subgroup analyses divided based on follow up time (1 to <6 months post-treatment, and ≥6 months post-treatment), and intervention adherence. Based on the ranking probabilities, motor relearning programme was ranked as the most effective among all exercise interventions (surface under cumulative ranking curve values [SUCRCV]: 95.6%, standardized mean difference [SMD]: 2.72, 95% confidence interval [CI]: 1.76 to 3.69) in overall and short-term treatment efficacy. In the long-term subgroup, home-based combined exercise ranked the best for the efficacy of social participation improvements among stroke survivors (SUCRCV: 71.8%, SMD: -0.23, 95% CI: -0.61 to 0.15). In the analysis of all interventions with adherence of >90%, cognitive-based exercise ranked the best (SUCRCV: 100%, SMD: 2.64, 95% CI: 1.62 to 3.66).
Interventions that emerged with the highest ranks in our analysis might be considered in practice when resources allow. More large, well-designed multicentre trials are needed to support the conclusion of this study.
重新参与社会是中风后康复的一个重要目标。基于运动的干预措施已被证明是改善中风幸存者社会参与的有效非药物方法，但尚不清楚最有效的运动干预类型是什么。
评估所有基于运动的干预措施在改善中风后患者社会参与方面的相对效果和排名。
采用随机效应网络荟萃分析来确定来自相关随机对照试验的证据。我们检索了 MEDLINE、CINAHL、EMBASE、PsycINFO、CINHAL、Cochrane 图书馆、AMED、SPORTDiscus、Web of Science 和 ClinicalTrials.gov，从最早的记录到 2020 年 1 月。纳入的试验必须包括至少一种针对中风患者的运动类型。主要结局是社会参与。偏倚将根据修订后的 Cochrane 偏倚风险工具进行评估。数据采用 Stata v14.0 进行分析。本研究的注册号为 CRD42020152523。
共有 16 项随机对照试验纳入了 1704 名患者和 12 个干预组，纳入了我们的研究。我们根据随访时间（治疗后 1 至<6 个月和≥6 个月）和干预依从性进行了三项亚组分析。基于排名概率，运动再学习方案在所有运动干预措施中被评为最有效（累积排序曲线下面积[SUCRCV]：95.6%，标准化均数差[SMD]：2.72，95%置信区间[CI]：1.76 至 3.69），在整体和短期治疗效果方面。在长期亚组中，家庭联合运动在改善中风幸存者社会参与方面排名最佳（SUCRCV：71.8%，SMD：-0.23，95%CI：-0.61 至 0.15）。在分析依从性>90%的所有干预措施时，基于认知的运动排名最佳（SUCRCV：100%，SMD：2.64，95%CI：1.62 至 3.66）。
在资源允许的情况下，分析中排名最高的干预措施可能会在实践中得到考虑。需要更多大型、精心设计的多中心试验来支持本研究的结论。
