Department of Physiotherapy, Eastern Health, Victoria, Australia.
Department of Physiotherapy, Eastern Health, Victoria, Australia.
Arch Phys Med Rehabil. 2021 Apr;102(4):762-775. doi: 10.1016/j.apmr.2020.09.388. Epub 2020 Oct 22.
To systematically review the effect of core stability exercises in addition to usual care physiotherapy on patient outcomes after stroke.
Cumulative Index to Nursing and Allied Health, MEDLINE, Physiotherapy Evidence Database (PEDro), PubMed, and EMBASE were searched to November 2018.
Eleven randomized controlled trials that compared usual care physiotherapy with usual care physiotherapy with additional core stability exercises in people with stroke were included. The initial search yielded 1876 studies.
Two independent reviewers applied inclusion and exclusion criteria and extracted data on methodological quality using the PEDro scale, participant characteristics, intervention details, outcome measures, and results.
Postintervention means and SDs were pooled to calculate either the standardized mean difference (SMD) or the mean difference (MD) and 95% CIs using a random-effects model and inverse variance methods. There was moderate quality evidence to suggest the addition of core stability exercises to usual care physiotherapy improved trunk control (SMD, 0.94; 95% CI, 0.44-1.44; I=69%), functional dynamic balance (SMD, 1.23; 95% CI, 0.5-1.97; I=71%), and walking speed (MD, 0.27m/s; 95% CI, 0.01-0.52; I=40%) in people with acute and chronic stroke. No significant effect was found when assessing functional ambulation categories or the timed Up and Go test, and mixed results were found for global functioning.
The addition of core stability exercises to usual care physiotherapy after stroke may lead to improved trunk control and dynamic balance. Therefore, core stability exercises should be included in rehabilitation if improvements in these domains will help clients achieve their goals. Future trials should consider incorporating outcomes of body kinematics during functional tasks to assess movement quality and assess participation outcomes.
系统评价核心稳定性练习联合常规物理治疗对脑卒中患者的疗效。
计算机检索 Cumulative Index to Nursing and Allied Health、MEDLINE、Physiotherapy Evidence Database（PEDro）、PubMed 和 EMBASE，检索时限均为 2018 年 11 月。
纳入 11 项比较常规物理治疗联合核心稳定性练习与单纯常规物理治疗对脑卒中患者影响的随机对照试验。最初检索得到 1876 篇文献。
2 名评价员按照纳入和排除标准独立筛选文献、提取资料，使用 PEDro 量表评价方法学质量，提取参与者特征、干预措施细节、结局测量指标和结果等数据。
对干预后均数及标准差进行合并，采用随机效应模型和倒方差法计算标准化均数差（SMD）或均数差（MD）及其 95%可信区间。纳入的研究质量为中等，结果显示，核心稳定性练习联合常规物理治疗较单纯常规物理治疗更能改善脑卒中患者躯干控制能力（SMD=0.94，95%CI：0.441.44；I²=69%）、功能性动态平衡（SMD=1.23，95%CI：0.51.97；I²=71%）和步行速度（MD=0.27m/s，95%CI：0.01~0.52；I²=40%），但在评估功能性步行分类和计时起立-行走测试时无显著差异，整体功能评估结果也不一致。
核心稳定性练习联合常规物理治疗可能改善脑卒中患者的躯干控制能力和动态平衡，若能改善这些方面的功能，有助于患者实现其目标，核心稳定性练习可用于脑卒中后的康复治疗。未来的研究应考虑纳入功能性任务中身体运动学的结局指标来评估运动质量，并评估参与结果。
