干针疗法治疗脑卒中后患者痉挛、疼痛和运动功能的效果如何？系统评价和荟萃分析。

Is Dry Needling Effective for the Management of Spasticity, Pain, and Motor Function in Post-Stroke Patients? A Systematic Review and Meta-Analysis.

机构信息

Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain.

Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.

出版信息

Pain Med. 2021 Feb 4;22(1):131-141. doi: 10.1093/pm/pnaa392.

DOI:10.1093/pm/pnaa392

PMID:33338222

Abstract

OBJECTIVE

To evaluate the effects of muscle dry needling alone or combined with other interventions on post-stroke spasticity (muscle tone), related pain, motor function, and pressure sensitivity.

DATABASES AND DATA TREATMENT

Electronic databases were searched for randomized controlled trials including post-stroke patients where at least one group received dry needling and outcomes were collected on spasticity and related pain. Secondary outcomes included motor function and pressure pain sensitivity. Data were extracted by two reviewers. The risk of bias was assessed with the Cochrane Risk of Bias tool, methodological quality was assessed with the Physiotherapy Evidence Database score, and the quality of evidence was assessed by the Grading of Recommendations Assessment, Development, and Evaluation approach. Between-groups mean differences (MDs) and standardized mean differences (SMDs) were calculated.

RESULTS

Seven studies (three within the lower extremity, four in the upper extremity) were included. The meta-analysis found significantly large effect sizes of dry needling for reducing spasticity (SMD: -1.01, 95%confidence interval [CI] -1.68 to -0.34), post-stroke pain (SMD -1.01, 95%CI -1.73 to -0.30), and pressure pain sensitivity (SMD 1.21, 95% CI: 0.62 to 1.80) as compared with a comparative group at short-term follow-up. The effect on spasticity was found mainly in the lower extremity (MD -1.05, 95% CI: -1.32 to -0.78) at short-term follow-up. No effect on spasticity was seen at 4 weeks. No significant effect on motor function (SMD 0.16, 95% CI: -0.13 to 0.44) was observed. The risk of bias was generally low, but the imprecision of the results downgraded the level of evidence.

CONCLUSION

Moderate evidence suggests a positive effect of dry needling on spasticity (muscle tone) in the lower extremity in post-stroke patients. The effects on related pain and motor function are inconclusive.

摘要

目的

评估单独使用肌筋膜触发点针刺或联合其他干预措施对脑卒中后痉挛（肌肉张力）、相关疼痛、运动功能和压痛的影响。

数据库和数据处理

检索了包括脑卒中患者的随机对照试验电子数据库，其中至少有一组接受了干针治疗，并收集了痉挛和相关疼痛的结果。次要结果包括运动功能和压痛敏感性。两名审查员提取数据。使用 Cochrane 偏倚风险工具评估偏倚风险，使用物理治疗证据数据库评分评估方法学质量，使用推荐评估、制定和评价方法评估证据质量。计算组间均数差值（MDs）和标准化均数差值（SMDs）。

结果

纳入了 7 项研究（3 项下肢，4 项上肢）。荟萃分析发现，干针治疗在降低痉挛（SMD：-1.01，95%置信区间[CI] -1.68 至 -0.34）、脑卒中后疼痛（SMD -1.01，95%CI -1.73 至 -0.30）和压痛敏感性（SMD 1.21，95%CI：0.62 至 1.80）方面的效果显著较大，与短期随访时的对照组相比。在短期随访时，干针治疗对痉挛的影响主要在下肢（MD -1.05，95%CI：-1.32 至 -0.78）。在 4 周时，对痉挛没有影响。对运动功能没有显著影响（SMD 0.16，95%CI：-0.13 至 0.44）。偏倚风险普遍较低，但结果的不精确性降低了证据水平。