Scrivener Katharine, Dorsch Simone, McCluskey Annie, Schurr Karl, Graham Petra L, Cao Zheng, Shepherd Roberta, Tyson Sarah
Department of Health Professions, Macquarie University, Sydney, Australia.
Faculty of Health Sciences, Australian Catholic University, Australia; The StrokeEd Collaboration, Sydney, Australia.
J Physiother. 2020 Oct;66(4):225-235. doi: 10.1016/j.jphys.2020.09.008. Epub 2020 Oct 14.
In adults with stroke, does Bobath therapy improve lower limb activity performance, strength or co-ordination when compared with no intervention or another intervention?
Systematic review of randomised trials with meta-analyses.
Adults after stroke.
Bobath therapy compared with another intervention or no intervention.
Lower limb activity performance (eg, sit to stand, walking, balance), lower limb strength and lower limb co-ordination. Trial quality was assessed using the PEDro scale.
Twenty-two trials were included in the review and 17 in the meta-analyses. The methodological quality of the trials varied, with PEDro scale scores ranging from 2 to 8 out of 10. No trials compared Bobath therapy to no intervention. Meta-analyses estimated the effect of Bobath therapy on lower limb activities compared with other interventions, including: task-specific training (nine trials), combined interventions (four trials), proprioceptive neuromuscular facilitation (one trial) and strength training (two trials). The pooled data indicated that task-specific training has a moderately greater benefit on lower limb activities than Bobath therapy (SMD 0.48), although the true magnitude of the benefit may be substantially larger or smaller than this estimate (95% CI 0.01 to 0.95). Bobath therapy did not clearly improve lower limb activities more than a combined intervention (SMD -0.06, 95% CI -0.73 to 0.61) or strength training (SMD 0.35, 95% CI -0.37 to 1.08). In one study, Bobath therapy was more effective than proprioceptive neuromuscular facilitation for improving standing balance (SMD -1.40, 95% CI -1.92 to -0.88), but these interventions did not differ on any other outcomes. Bobath therapy did not improve strength or co-ordination more than other interventions.
Bobath therapy was inferior to task-specific training and not superior to other interventions, with the exception of proprioceptive neuromuscular facilitation. Prioritising Bobath therapy over other interventions is not supported by current evidence.
PROSPERO CRD42019112451.
对于中风成人患者，与不进行干预或其他干预措施相比，Bobath疗法是否能改善下肢活动表现、力量或协调性？
对随机试验进行系统评价并进行荟萃分析。
中风后的成年人。
将Bobath疗法与另一种干预措施或不进行干预相比较。
下肢活动表现（如从坐到站、行走、平衡）、下肢力量和下肢协调性。使用PEDro量表评估试验质量。
该评价纳入了22项试验，荟萃分析纳入了17项试验。试验的方法学质量各不相同，PEDro量表评分在2至8分（满分10分）之间。没有试验将Bobath疗法与不进行干预进行比较。荟萃分析估计了Bobath疗法与其他干预措施相比对下肢活动的影响，这些干预措施包括：特定任务训练（9项试验）、联合干预（4项试验）、本体感觉神经肌肉促进法（1项试验）和力量训练（2项试验）。汇总数据表明，特定任务训练对下肢活动的益处略大于Bobath疗法（标准化均数差0.48），尽管实际益处的大小可能比该估计值大得多或小得多（95%可信区间0.01至0.95）。Bobath疗法在改善下肢活动方面并不比联合干预（标准化均数差-0.06，95%可信区间-0.73至0.61）或力量训练（标准化均数差0.35，95%可信区间-0.37至1.08）更明显。在一项研究中，Bobath疗法在改善站立平衡方面比本体感觉神经肌肉促进法更有效（标准化均数差-1.40，95%可信区间-1.92至-0.88），但在其他任何结局方面，这些干预措施并无差异。Bobath疗法在改善力量或协调性方面并不比其他干预措施更有效。
Bobath疗法不如特定任务训练，除本体感觉神经肌肉促进法外，也不优于其他干预措施。目前的证据不支持将Bobath疗法置于其他干预措施之上优先考虑。
PROSPERO CRD42019112451
