Chen Rong, Guo Yijia, Kuang Yashi, Zhang Qi
Sun Yat Sen University, School of Nursing, 74 Zhongshan 2nd Rd, Guangzhou 510080, Guangdong, China.
Sun Yat Sen University, School of Nursing, 74 Zhongshan 2nd Rd, Guangzhou 510080, Guangdong, China.
Int J Nurs Stud. 2024 Apr;152:104698. doi: 10.1016/j.ijnurstu.2024.104698. Epub 2024 Jan 18.
BACKGROUND: Post-stroke depression (PSD) is a common and persistent mental disorder that negatively impacts stroke outcomes. Exercise-based interventions have been shown to be an effective non-pharmacological treatment for improving depression in patients with mild stroke, but no reviews have yet synthesized the effects of home-based exercise on PSD. OBJECTIVE: The purpose of this systematic review and network meta-analysis was to synthesize the available evidence to compare the effectiveness of different types of home-based exercise programs on PSD and identify the optimal home-based exercise modality to inform clinical decision-making for the treatment of PSD. METHODS: PubMed, Embase, the Cochrane Library, CINAHL, and PsycINFO were systematically searched from their inception dates to March 7, 2023. We searched for randomized controlled trials (RCTs) of home-based exercise for PSD in adults aged 18 years and older. Only scores of depression retrieved directly post-treatment were included as the primary endpoint for the analysis. Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB-2) was used to assess the quality of included studies. We conducted traditional pairwise meta-analysis for direct comparisons using Review Manager 5.4.1, followed by network meta-analysis using Stata 15.1 for both the network evidence plot and analysis. The surface under the cumulative ranking curve (SUCRA) was used to estimate the intervention hierarchy. The protocol was registered with PROSPERO under registration number CRD42022363784. RESULTS: A total of 517 participants from nine RCTs were included. Based on the ranking probabilities, mind-body exercise was the most effective way in improving PSD (SUCRA: 90.4 %, Hedges' g: -0.59, 95 % confidence interval [CI]: -1.16 to -0.02), followed by flexibility/neuro-motor skills training (SUCRA: 42.9 %, Hedges' g: -0.10, 95 % CI: -0.70 to 0.49), and aerobic exercise (SUCRA: 39.3 %, Hedges' g: -0.07, 95 % CI: -0.81 to 0.67). We performed a subgroup analysis of mind-body exercise. In mind-body exercise interventions, Tai Chi was the most effective way to improve PSD (SUCRA: 99.4 %, Hedges' g: -0.94, 95 % CI: -1.28 to -0.61). CONCLUSIONS: Our network meta-analysis that provides evidence with very low certainty indicates potential benefits of home-based exercise for alleviating PSD, with mind-body exercises, notably Tai Chi, showing promise as an effective treatment. However, further rigorous studies are needed to solidify these findings. Specifically, multicenter RCTs comparing specific exercises to no intervention are crucial, assessing not only efficacy but also dose, reach, fidelity, and long-term effects for real-world optimization.
背景:中风后抑郁症(PSD)是一种常见且持续存在的精神障碍,对中风预后产生负面影响。基于运动的干预措施已被证明是改善轻度中风患者抑郁症状的一种有效的非药物治疗方法,但尚未有综述综合阐述居家运动对PSD的影响。 目的:本系统评价和网状Meta分析的目的是综合现有证据,比较不同类型的居家运动方案对PSD的有效性,并确定最佳的居家运动方式,为PSD的临床治疗决策提供依据。 方法:对PubMed、Embase、Cochrane图书馆、CINAHL和PsycINFO从创刊至2023年3月7日进行系统检索。我们检索了18岁及以上成年人居家运动治疗PSD的随机对照试验(RCT)。仅将治疗后直接获得的抑郁评分作为分析的主要终点。使用Cochrane随机试验偏倚风险工具(RoB-2)第2版评估纳入研究的质量。我们使用Review Manager 5.4.1进行传统的成对Meta分析以进行直接比较,随后使用Stata 15.1进行网状Meta分析以绘制网状证据图和进行分析。累积排序曲线下面积(SUCRA)用于估计干预层次。该方案已在PROSPERO注册,注册号为CRD42022363784。 结果:共纳入来自9项RCT的517名参与者。根据排序概率,身心运动是改善PSD最有效的方法(SUCRA:90.4%,Hedges' g:-0.59,95%置信区间[CI]:-1.16至-0.02),其次是柔韧性/神经运动技能训练(SUCRA:42.9%,Hedges' g:-0.10,95% CI:-0.70至0.49),以及有氧运动(SUCRA:39.3%,Hedges' g:-0.07,95% CI:-0.81至0.67)。我们对身心运动进行了亚组分析。在身心运动干预中,太极拳是改善PSD最有效的方法(SUCRA:99.4%,Hedges' g:-0.94,95% CI:-1.28至-0.61)。 结论:我们的网状Meta分析提供的证据确定性非常低,表明居家运动对缓解PSD有潜在益处,身心运动,尤其是太极拳,显示出作为一种有效治疗方法的前景。然而,需要进一步严格的研究来巩固这些发现。具体而言,比较特定运动与无干预的多中心RCT至关重要,不仅要评估疗效,还要评估剂量、覆盖面、保真度和长期效果,以实现现实世界中的优化。
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