机器人辅助治疗对脑卒中后患者上肢运动功能和日常生活活动能力的短期和长期影响：随机对照试验的荟萃分析。

Short and long-term effects of robot-assisted therapy on upper limb motor function and activity of daily living in patients post-stroke: a meta-analysis of randomized controlled trials.

机构信息

Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong, Chongqing, 400010, China.

Department of Neurology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, 400013, China.

出版信息

J Neuroeng Rehabil. 2022 Jul 21;19(1):76. doi: 10.1186/s12984-022-01058-8.

DOI:10.1186/s12984-022-01058-8

PMID:35864524

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9306153/

Abstract

OBJECTIVE

To investigate the effect of robot-assisted therapy (RAT) on upper limb motor control and activity function in poststroke patients compared with that of non-robotic therapy.

METHODS

We searched PubMed, EMBASE, Cochrane Library, Google Scholar and Scopus. Randomized controlled trials published from 2010 to nowadays comparing the effect of RAT and control treatment on upper limb function of poststroke patients aged 18 or older were included. Researchers extracted all relevant data from the included studies, assessed the heterogeneity with inconsistency statistics (I statistics), evaluated the risk of bias of individual studies and performed data analysis.

RESULT

Forty-six studies were included. Meta-analysis showed that the outcome of the Fugl-Meyer Upper Extremity assessment (FM-UE) (SMD = 0.20, P = 0.001) and activity function post intervention was significantly higher (SMD = 0.32, P < 0.001) in the RAT group than in the control group. Differences in outcomes of the FM-UE and activity function between the RAT group and control group were observed at the end of treatment and were not found at the follow-up. Additionally, the outcomes of the FM-UE (SMD = 0.15, P = 0.005) and activity function (SMD = 0.32, P = 0.002) were significantly different between the RAT and control groups only with a total training time of more than 15 h. Moreover, the differences in outcomes of FM-UE and activity post intervention were not significant when the arm robots were applied to patients with severe impairments (FM-UE: SMD = 0.14, P = 0.08; activity: SMD = 0.21, P = 0.06) or when patients were provided with patient-passive training (FM-UE: SMD = - 0.09, P = 0.85; activity: SMD = 0.70, P = 0.16).

CONCLUSION

RAT has the significant immediate benefits for motor control and activity function of hemiparetic upper limb in patients after stroke compared with controls, but there is no evidence to support its long-term additional benefits. The superiority of RAT in improving motor control and activity function is limited by the amount of training time and the patients' active participation.

摘要

目的

与非机器人治疗相比，探究机器人辅助治疗（RAT）对脑卒中后患者上肢运动控制和活动功能的影响。

方法

我们检索了 PubMed、EMBASE、Cochrane 图书馆、Google Scholar 和 Scopus。纳入了 2010 年至今比较 RAT 和对照组治疗对 18 岁及以上脑卒中患者上肢功能影响的随机对照试验。研究人员从纳入的研究中提取所有相关数据，用不一致性统计量（I 统计量）评估异质性，评估单个研究的偏倚风险，并进行数据分析。

结果

共纳入 46 项研究。Meta 分析显示，治疗后 Fugl-Meyer 上肢评估（FM-UE）（SMD=0.20，P=0.001）和活动功能的结果在 RAT 组明显更高（SMD=0.32，P<0.001）。RAT 组和对照组在治疗结束时观察到 FM-UE 和活动功能结果的差异，而在随访时未发现差异。此外，仅当总训练时间超过 15 小时时，RAT 组和对照组的 FM-UE（SMD=0.15，P=0.005）和活动功能（SMD=0.32，P=0.002）的结果才有显著差异。此外，当手臂机器人应用于运动功能严重受损的患者（FM-UE：SMD=0.14，P=0.08；活动：SMD=0.21，P=0.06）或为患者提供患者被动训练时（FM-UE：SMD=-0.09，P=0.85；活动：SMD=0.70，P=0.16），干预后 FM-UE 和活动的结果无显著差异。