Yang Seung Nam, Kim Doo Young
Department of Physical Medicine and Rehabilitation, Korea University Medical Center, Seoul, Korea.
Department of Rehabilitation Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.
Brain Neurorehabil. 2023 Jul 13;16(2):e17. doi: 10.12786/bn.2023.16.e17. eCollection 2023 Jul.
Various interventions to physical rehabilitation have been used after stroke, including musculoskeletal, neurophysiological, and motor learning interventions, with ongoing debates and controversies about their relative effectiveness. In this systematic review, we searched 3 international electronic databases (MEDLINE, Embase, and Cochrane Library) to identify relevant studies. We included only randomized controlled trials (RCTs) that directly compared motor relearning, neurophysiological, and musculoskeletal interventions for improving motor function in adult stroke patients. Risk of bias (RoB) assessment was performed using Cochrane's RoB tool, and meta-analysis was conducted using Revman 5.4 with a random effects model. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations method. The meta-analysis for immediate outcome for physical rehabilitation included 9 RCTs for balance, 10 RCTs for gait velocity, 7 RCTs for lower extremity motor function and 8 RCTs for performance of activities of daily living. There was no statistically significant different on improvement of balance, gait velocity, lower extremity motor function and performance of activity among physical rehabilitation interventions. Moderate-level evidence supports that no single intervention is superior. Clinicians and therapist should consider individual patient characteristics, preferences, and available resources when selecting the intervention for stroke rehabilitation.
中风后已采用多种物理康复干预措施，包括肌肉骨骼、神经生理和运动学习干预，关于它们的相对有效性一直存在争论和争议。在这项系统评价中，我们检索了3个国际电子数据库（MEDLINE、Embase和Cochrane图书馆）以识别相关研究。我们仅纳入了直接比较运动再学习、神经生理和肌肉骨骼干预对改善成年中风患者运动功能的随机对照试验（RCT）。使用Cochrane偏倚风险（RoB）工具进行偏倚风险评估，并使用Revman 5.4和随机效应模型进行荟萃分析。使用推荐分级、评估、制定和评价方法评估证据的确定性。物理康复即时结果的荟萃分析包括9项关于平衡的RCT、10项关于步态速度的RCT、7项关于下肢运动功能的RCT和8项关于日常生活活动表现的RCT。在物理康复干预措施之间，平衡、步态速度、下肢运动功能和活动表现的改善没有统计学上的显著差异。中等质量的证据支持没有单一干预措施更具优势。临床医生和治疗师在选择中风康复干预措施时应考虑个体患者的特征、偏好和可用资源。
