Munoz-Novoa Maria, Kristoffersen Morten B, Sunnerhagen Katharina S, Naber Autumn, Alt Murphy Margit, Ortiz-Catalan Max
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Center for Bionics and Pain Research, Mölndal, Sweden.
Front Hum Neurosci. 2022 May 20;16:897870. doi: 10.3389/fnhum.2022.897870. eCollection 2022.
Upper limb impairment is common after stroke, and many will not regain full upper limb function. Different technologies based on surface electromyography (sEMG) have been used in stroke rehabilitation, but there is no collated evidence on the different sEMG-driven interventions and their effect on upper limb function in people with stroke.
Synthesize existing evidence and perform a meta-analysis on the effect of different types of sEMG-driven interventions on upper limb function in people with stroke.
PubMed, SCOPUS, and PEDro databases were systematically searched for eligible randomized clinical trials that utilize sEMG-driven interventions to improve upper limb function assessed by Fugl-Meyer Assessment (FMA-UE) in stroke. The PEDro scale was used to evaluate the methodological quality and the risk of bias of the included studies. In addition, a meta-analysis utilizing a random effect model was performed for studies comparing sEMG interventions to non-sEMG interventions and for studies comparing different sEMG interventions protocols.
Twenty-four studies comprising 808 participants were included in this review. The methodological quality was good to fair. The meta-analysis showed no differences in the total effect, assessed by total FMA-UE score, comparing sEMG interventions to non-sEMG interventions (14 studies, 509 participants, SMD 0.14, P 0.37, 95% CI -0.18 to 0.46, I 55%). Similarly, no difference in the overall effect was found for the meta-analysis comparing different types of sEMG interventions (7 studies, 213 participants, SMD 0.42, P 0.23, 95% CI -0.34 to 1.18, I 73%). Twenty out of the twenty-four studies, including participants with varying impairment levels at all stages of stroke recovery, reported statistically significant improvements in upper limb function at post-sEMG intervention compared to baseline.
This review and meta-analysis could not discern the effect of sEMG in comparison to a non-sEMG intervention or the most effective type of sEMG intervention for improving upper limb function in stroke populations. Current evidence suggests that sEMG is a promising tool to further improve functional recovery, but randomized clinical trials with larger sample sizes are needed to verify whether the effect on upper extremity function of a specific sEMG intervention is superior compared to other non-sEMG or other type of sEMG interventions.
中风后上肢功能障碍很常见，许多患者无法完全恢复上肢功能。基于表面肌电图（sEMG）的不同技术已应用于中风康复，但对于不同的sEMG驱动干预措施及其对中风患者上肢功能的影响，尚无整理好的证据。
综合现有证据，对不同类型的sEMG驱动干预措施对中风患者上肢功能的影响进行荟萃分析。
系统检索PubMed、SCOPUS和PEDro数据库，以查找符合条件的随机临床试验，这些试验利用sEMG驱动干预措施来改善中风患者通过Fugl-Meyer评估（FMA-UE）评估的上肢功能。使用PEDro量表评估纳入研究的方法学质量和偏倚风险。此外，对比较sEMG干预与非sEMG干预的研究以及比较不同sEMG干预方案的研究进行随机效应模型的荟萃分析。
本综述纳入了24项研究，共808名参与者。方法学质量为良至中。荟萃分析显示，比较sEMG干预与非sEMG干预时，以FMA-UE总分评估的总体效应无差异（14项研究，509名参与者，标准化均数差0.14，P = 0.37，95%可信区间-0.18至0.46，I² = 55%）。同样，比较不同类型sEMG干预的荟萃分析未发现总体效应有差异（7项研究，213名参与者，标准化均数差0.42，P = 0.23，95%可信区间-0.34至1.18，I² = 73%）。24项研究中的20项，包括中风恢复各阶段不同损伤水平的参与者，报告sEMG干预后上肢功能与基线相比有统计学显著改善。
本综述和荟萃分析无法辨别sEMG与非sEMG干预相比的效果，也无法辨别哪种sEMG干预类型对改善中风人群上肢功能最有效。目前的证据表明，sEMG是进一步改善功能恢复的有前景的工具，但需要更大样本量的随机临床试验来验证特定sEMG干预对上肢功能的影响是否优于其他非sEMG或其他类型的sEMG干预。
