Hainan Medical University International School of Public Health and One Health, Haikou, Hainan, China.
Department of Neurology, First Affiliated Hospital, Hainan Medical University, Haikou, Hainan, China.
BMC Neurol. 2024 Mar 8;24(1):91. doi: 10.1186/s12883-024-03565-8.
At present, stroke has become the first cause of death and disability among Chinese adults. With the coming of the aging population in China, the disease burden brought by stroke will be increasingly aggravated. And stroke is a leading cause of disability. There is a golden plastic period after stroke, during which timely and safe intervention and rehabilitation therapy can effectively improve the disability status. However, there is still controversy about the duration of interventional rehabilitation after stroke. This study conducted a meta-analysis on the influence of intervention in early and late ischemic stroke rehabilitation.
Chinese language databases such as CNKI, Wanfang, and VIP, and English language databases such as Embase, PubMed, Web of Science, and The Cochrane Library were searched, and RCT related to early and late rehabilitation of ischemic stroke from the establishment of the database to October 2023 was collected. Review Manager 5.4.1 was used for relevant analysis. The main outcomes were Barthel Index or Modified Barthel Index, Fugl-Meyer Assessment scale, NIHSS, China Stroke Scale. Standardized Mean Difference (SMD) was used as an effective indicator of continuity variables, and the estimated interval was expressed by 95% confidence interval (CI).
A total of 1908 patients were included in 16 studies. The results showed that, compared with late rehabilitation, early rehabilitation improved clinical efficacy. Barthel Index or Modified Barthel Index score was [SMD = 1.40, 95%CI(1.16,1.63), p < 0.001]; the score of Fugl-Meyer Assessment Scale was [SMD = 1.18, 95%Cl (0.85, 1.52), P < 0.001]; the score of NIHSS was [SMD= -0.44, 95% CI(-0.65, -0.24), P < 0.001]; the result of China Stroke Scale score was [SMD= -0.37, 95%CI(-0.56, -0.18), P < 0.001].
In comparison with late rehabilitation, early rehabilitation can significantly improve self-care abilities, daily activities, and neurological functions of ischemic stroke patients.
This meta-analysis has been registered with Prospero, and the registration number is CRD42022309911. The registration period is March 22, 2022.
目前，脑卒中已成为中国成年人致死和致残的首要原因。随着中国人口老龄化的到来，脑卒中带来的疾病负担将日益加重。而脑卒中是导致残疾的主要原因。脑卒中后存在着黄金康复期，在此期间及时、安全的介入和康复治疗可以有效改善残疾状况。但是，对于脑卒中后介入康复的时间窗仍存在争议。本研究对早期和晚期缺血性脑卒中康复的干预影响进行了荟萃分析。
检索中国知网、万方、维普等中文数据库，以及 Embase、PubMed、Web of Science、The Cochrane Library 等英文数据库，收集建库至 2023 年 10 月有关缺血性脑卒中早期和晚期康复的 RCT。采用 Review Manager 5.4.1 进行相关分析。主要结局指标为 Barthel 指数或改良 Barthel 指数、Fugl-Meyer 评定量表、NIHSS、中国脑卒中量表。连续性变量采用标准化均数差（SMD）作为效应指标，估计区间以 95%置信区间（CI）表示。
共纳入 16 项研究的 1908 例患者。结果显示，与晚期康复相比，早期康复可提高临床疗效。Barthel 指数或改良 Barthel 指数评分[SMD=1.40，95%CI（1.16，1.63），p<0.001]；Fugl-Meyer 评定量表评分[SMD=1.18，95%CI（0.85，1.52），P<0.001]；NIHSS 评分[SMD=-0.44，95%CI（-0.65，-0.24），P<0.001]；中国脑卒中量表评分[SMD=-0.37，95%CI（-0.56，-0.18），P<0.001]。
与晚期康复相比，早期康复可显著提高缺血性脑卒中患者的自理能力、日常生活活动能力和神经功能。
本荟萃分析已在 PROSPERO 注册，注册号为 CRD42022309911。注册日期为 2022 年 3 月 22 日。
