哪种步态训练干预措施能最有效地改善脑瘫患者的步态能力？一项系统评价和网状Meta分析。

Which gait training intervention can most effectively improve gait ability in patients with cerebral palsy? A systematic review and network meta-analysis.

作者信息

Qian Guoping, Cai Xiaoye, Xu Kai, Tian Hao, Meng Qiao, Ossowski Zbigniew, Liang Jinghong

机构信息

Department of Sport, Gdansk University of Physical Education and Sport, Gdańsk, Poland.

Department of General Education, Shanghai Normal University Tianhua College, Shanghai, China.

出版信息

Front Neurol. 2023 Jan 10;13:1005485. doi: 10.3389/fneur.2022.1005485. eCollection 2022.

DOI:10.3389/fneur.2022.1005485

PMID:36703638

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9871496/

Abstract

BACKGROUND

A vital objective to treat people with cerebral palsy (CP) is to increase gait velocity and improve gross motor function. This study aimed to evaluate the relative effectiveness of gait training interventions for persons with CP.

METHODS

Studies published up to October 26, 2022 were searched from four electronic databases [including Medline ( PubMed), Web of Science, Embase and Cochrane]. Studies with randomized controlled trials (RCTs), people with CP, comparisons of different gait training interventions and outcomes of gait velocity and gross motor function measures (GMFM) were included in this study. The quality of the literature was evaluated using the risk of bias tool in the Cochrane Handbook, the extracted data were analyzed through network meta-analysis (NMA) using Stata16.0 and RevMan5.4 software.

RESULTS

Twenty RCTs with a total of 516 individuals with CP were included in accordance with the criteria of this study. The results of the NMA analysis indicated that both external cues treadmill training (ECTT) [mean difference (MD) = 0.10, 95% confidence interval CI (0.04, 0.17), < 0.05] and partial body weight supported treadmill training (BWSTT) [MD = 0.12, 95% CI (0.01, 0.23), < 0.05] had better gait velocity than over ground gait training (OGT), BWSTT [MD = 0.09, 95%CI(0.01,0.18), < 0.05] had a better gait velocity than robot-assisted gait training (RAGT), BWSTT [MD = 0.09, 95% CI (0.06, 0.13) < 0.05] had a better gait velocity than treadmill training (TT), and BWSTT [MD = 0.14, 95% CI (0.07, 0.21), < 0.05] had a better gait velocity than conventional physical therapy (CON). The SUCRA ranking indicated that BWSTT optimally improved the gait velocity, and the other followed an order of BWSTT (91.7%) > ECTT (80.9%) > RAGT (46.2%) > TT (44%) > OGT (21.6%) > CON (11.1%). In terms of GMFM, for dimension D (GMFM-D), there was no statistical difference between each comparison; for dimension E (GMFM-E), RAGT [MD = 10.45, 95% CI (2.51, 18.40), < 0.05] was significantly more effective than CON. Both SUCRA ranking results showed that RAGT improved GMFM-D/E optimally, with rankings of RAGT (69.7%) > TT (69.3%) > BWSTT (67.7%) > OGT (24%) > CON (20.3%), and RAGT (86.1%) > BWSTT (68.2%) > TT (58%) > CON (20.1%) > OGT (17.6%) respectively.

CONCLUSION

This study suggested that BWSTT was optimal in increasing the gait velocity and RAGT was optimal in optimizing GMFM in persons with CP. Impacted by the limitations of the number and quality of studies, randomized controlled trials with larger sample sizes, multiple centers, and high quality should be conducted to validate the above conclusion. Further studies will be required to focus on the total duration of the intervention, duration and frequency of sessions, and intensity that are optimal for the promotion of gait ability in this population.

SYSTEMATIC REVIEW REGISTRATION

https://doi.org/10.37766/inplasy2022.10.0108, identifier: INPLASY2022100108.

摘要

背景

治疗脑瘫（CP）患者的一个重要目标是提高步态速度并改善粗大运动功能。本研究旨在评估针对CP患者的步态训练干预措施的相对有效性。

方法

从四个电子数据库[包括Medline（PubMed）、科学网、Embase和Cochrane]中检索截至2022年10月26日发表的研究。本研究纳入了随机对照试验（RCT）、CP患者、不同步态训练干预措施的比较以及步态速度和粗大运动功能测量（GMFM）结果的研究。使用Cochrane手册中的偏倚风险工具评估文献质量，通过网络荟萃分析（NMA）使用Stata16.0和RevMan5.4软件对提取的数据进行分析。

结果

根据本研究的标准，纳入了20项RCT，共516例CP患者。NMA分析结果表明，外部线索跑步机训练（ECTT）[平均差（MD）=0.10，95%置信区间CI（0.04，0.17），P<0.05]和部分体重支持跑步机训练（BWSTT）[MD = 0.12，95%CI（0.01，0.23），P<0.05]的步态速度均优于地面步态训练（OGT），BWSTT[MD = 0.09，95%CI（0.01，0.18），P<0.05]的步态速度优于机器人辅助步态训练（RAGT），BWSTT[MD = 0.09，95%CI（0.06，0.13），P<0.05]的步态速度优于跑步机训练（TT），且BWSTT[MD = 0.14，95%CI（0.07，0.21），P<0.05]的步态速度优于传统物理治疗（CON）。SUCRA排名表明，BWSTT在改善步态速度方面最佳，其他依次为BWSTT（91.7%）>ECTT（80.9%）>RAGT（46.2%）>TT（44%）>OGT（21.6%）>CON（11.1%）。在GMFM方面，对于D维度（GMFM-D），各比较之间无统计学差异；对于E维度（GMFM-E），RAGT[MD = 10.45，95%CI（2.51，18.40），P<0.05]比CON显著更有效。两个SUCRA排名结果均显示，RAGT在改善GMFM-D/E方面最佳，排名分别为RAGT（69.7%）>TT（69.3%）>BWSTT（67.7%）>OGT（24%）>CON（20.3%），以及RAGT（86.1%）>BWSTT（68.2%）>TT（58%）>CON（20.1%）>OGT（17.6%）。