Abdullahi Auwal, Wong Thomson Wai-Lung, Ng Shamay Sheung-Mei
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China.
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China.
Mult Scler Relat Disord. 2023 Mar;71:104569. doi: 10.1016/j.msard.2023.104569. Epub 2023 Feb 17.
Multiple sclerosis (MS) is a chronic neurodegenerative disorder of the central nervous system (CNS) that commonly affects young and middle-aged adults. Neurodegeneration of the CNS affects its functions such as sensorimotor, autonomic and cognitive functions. Affectation of motor function can result in disability in performance of daily life activities. Thus, effective rehabilitation interventions are needed to help prevent disability in patients with MS. One of these interventions is the constraint induced movement therapy (CIMT). The CIMT is used to improve motor function in patients with stroke and other neurological conditions. Recently, its use in patients with MS is gaining ground. The aim of this study is to carry out a systematic review and meta-analysis to determine from the literature, the effects of CIMT on upper limb function in patients with MS.
PubMED, Embase, Web of Science (WoS), PEDro, and CENTRAL were searched until October 2022. Randomized controlled trials in patients with MS who were 18 years and above were included. Data on the characteristics of the study participants such as disease duration, type of MS, the mean scores of the outcomes of interest such as motor function and use of the arm in daily activities, and white matter integrity were extracted. Methodological quality and risks of bias of the included studies were assessed using PEDro scale and Cochrane risks of bias tool. The data was analysed using both narrative and quantitative syntheses. In the quantitative synthesis, random effect model meta-analysis of the mean and standard deviation of the scores on the outcomes of interest and the study sample size (for both the CIMT and the control group) post intervention was carried out. In addition, percentage of variation across the studies due to heterogeneity (I) was considered significant when it is between 50% and 90% at p < 0.05.
Two studies comprising of 4 published articles with good methodological quality were included in the study. The results showed that, CIMT is safe and improved white matter integrity, motor function, muscle strength, dexterity, real-world arm use and biomechanical parameters post intervention. However, although there was a trend towards better improvement in the CIMT group in all the outcomes, there was no statistically significant difference between groups in motor function (SMD=0.44, 95% CI=-0.20 to 1.07, p = 0.18) and quality of movement (SMD=0.96, -1.15 to 3.07, p = 0.37).
CIMT can be used in patients with MS since it is safe as well as effective at improving functional outcomes. However, more studies are required to confirm its safety and effectiveness.
多发性硬化症（MS）是一种中枢神经系统（CNS）的慢性神经退行性疾病，通常影响中青年。中枢神经系统的神经退行性变会影响其感觉运动、自主神经和认知等功能。运动功能受影响会导致日常生活活动能力出现残疾。因此，需要有效的康复干预措施来帮助预防MS患者出现残疾。其中一种干预措施是强制性运动疗法（CIMT）。CIMT用于改善中风和其他神经系统疾病患者的运动功能。最近，其在MS患者中的应用越来越广泛。本研究的目的是进行一项系统评价和荟萃分析，以从文献中确定CIMT对MS患者上肢功能的影响。
检索了截至2022年10月的PubMed、Embase、科学引文索引（WoS）、循证医学数据库（PEDro）和考克兰系统评价数据库（CENTRAL）。纳入18岁及以上MS患者的随机对照试验。提取了研究参与者的特征数据，如疾病持续时间、MS类型、感兴趣的结局的平均得分，如运动功能和日常生活中手臂的使用情况，以及白质完整性。使用PEDro量表和考克兰偏倚风险工具评估纳入研究的方法学质量和偏倚风险。采用叙述性和定量综合分析数据。在定量综合分析中，对干预后感兴趣结局的得分均值和标准差以及研究样本量（CIMT组和对照组）进行随机效应模型荟萃分析。此外，当p<0.05时，研究间异质性（I）导致的变异百分比在50%至90%之间被认为具有显著性。
本研究纳入了两项研究，包括4篇方法学质量良好的已发表文章。结果表明，CIMT是安全的，并且干预后可改善白质完整性、运动功能、肌肉力量、灵活性、实际生活中手臂的使用情况和生物力学参数。然而，尽管在所有结局中CIMT组都有更好改善的趋势，但两组在运动功能（标准化均数差[SMD]=0.44，95%置信区间[CI]=-0.20至1.07，p=0.18）和运动质量（SMD=0.96，-1.15至3.07，p=0.37）方面无统计学显著差异。
CIMT可用于MS患者，因为它既安全又能有效改善功能结局。然而，需要更多研究来证实其安全性和有效性。
