Yang Fu-An, Lee Ting-Hsuan, Huang Shih-Wei, Liou Tsan-Hon, Escorpizo Reuben, Chen Hung-Chou
School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Department of Family Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
Clin Rehabil. 2023 Apr;37(4):516-533. doi: 10.1177/02692155221137698. Epub 2022 Nov 4.
There are different upper limb manual training protocols, namely constraint-induced movement therapy, modified constraint-induced movement therapy, hand-arm bimanual intensive training, hand-arm bimanual intensive training including lower extremity, action observation training, and mirror therapy, available for improving functional outcomes in children with cerebral palsy. However, the effect and priority of these strategies remain unclear.
We searched the PubMed, Cochrane Library, and Embase databases for relevant articles from inception to October 12, 2022.
To assess the effect and priority of different strategies of upper limb manual training protocols through a systematic review and network meta-analysis of randomized controlled trials.
We included 22 randomized controlled trials in this network meta-analysis. The ranking probability and standard mean differences with 95% credible intervals of the comparison between placebo and other forms of upper limb manual training were as follows: mirror therapy = 2.83 (1.78, 3.88), hand-arm bimanual intensive training including the lower extremity = 0.53 (0.09, 0.96), constraint-induced movement therapy = 0.44 (0.18, 0.71), hand-arm bimanual intensive training = 0.41 (0.15, 0.67), modified constraint-induced movement therapy = 0.39 (0.03, 0.74), and action observation training = 0.18 ( - 0.29, 0.65). No significant inconsistency was noted between the results of direct and indirect comparisons.
We suggest that mirror therapy could be the upper limb manual training protocol of choice for improving functional outcomes in patients with cerebral palsy.
有不同的上肢手法训练方案，即强制性运动疗法、改良强制性运动疗法、手-臂双侧强化训练、包括下肢的手-臂双侧强化训练、动作观察训练和镜像疗法，可用于改善脑瘫儿童的功能结局。然而，这些策略的效果和优先级仍不明确。
我们检索了PubMed、Cochrane图书馆和Embase数据库，以获取从创刊到2022年10月12日的相关文章。
通过对随机对照试验的系统评价和网络荟萃分析，评估上肢手法训练方案不同策略的效果和优先级。
我们在该网络荟萃分析中纳入了22项随机对照试验。安慰剂与其他形式上肢手法训练比较的排序概率和95%可信区间的标准平均差如下：镜像疗法=2.83（1.78，3.88），包括下肢的手-臂双侧强化训练=0.53（0.09，0.96），强制性运动疗法=0.44（0.18，0.71），手-臂双侧强化训练=0.41（0.15，0.67），改良强制性运动疗法=0.39（0.03，0.74），动作观察训练=0.18（-0.29，0.65）。直接和间接比较结果之间未发现明显不一致。
我们建议镜像疗法可能是改善脑瘫患者功能结局的首选上肢手法训练方案。
