Im Sun, Kim Yeo Hyung
Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Brain Neurorehabil. 2024 Oct 22;17(3):e16. doi: 10.12786/bn.2024.17.e16. eCollection 2024 Nov.
Although the benefits of exercise therapy in stroke rehabilitation are well-documented, the optimal amount remains a matter of debate. This study investigated the impact of the total amount of exercise therapy on clinical outcomes in adult patients with stroke. We conducted a comprehensive search of three major international databases (Medline, Embase, and the Cochrane Library) and included 18 randomized controlled trials that compared the effects of different amounts of exercise therapy on activities of daily living, upper limb function, lower limb function, and adverse events in stroke patients. We performed a risk of bias assessment, conducted a meta-analysis using a random-effects model, and evaluated the certainty of the evidence. The results indicated that more time spent in exercise therapy significantly improved activities of daily living compared to less time (standardized mean difference [SMD], 0.18; 95% confidence interval [CI], 0.06, 0.30; p = 0.002), with moderate evidence. Additionally, higher intensity of exercise therapy enhanced lower limb function compared to lower intensity (SMD, 0.66; 95% CI, 0.18, 1.13; p = 0.007), with a low level of evidence. No significant differences were found in the incidence of adverse events. Based on these findings, physicians may consider increasing the total amount of exercise therapy for stroke patients in order to improve their activities of daily living and motor function, while carefully considering each patient's neurological and medical condition.
尽管运动疗法在中风康复中的益处已有充分记录，但最佳运动量仍存在争议。本研究调查了运动疗法总量对成年中风患者临床结局的影响。我们对三个主要国际数据库（Medline、Embase和Cochrane图书馆）进行了全面检索，纳入了18项随机对照试验，这些试验比较了不同运动量的运动疗法对中风患者日常生活活动、上肢功能、下肢功能和不良事件的影响。我们进行了偏倚风险评估，使用随机效应模型进行了荟萃分析，并评估了证据的确定性。结果表明，与较少时间相比，更多时间用于运动疗法可显著改善日常生活活动（标准化均数差[SMD]，0.18；95%置信区间[CI]，0.06，0.30；p = 0.002），证据强度为中等。此外，与较低强度相比，较高强度的运动疗法可增强下肢功能（SMD，0.66；95%CI，0.18，1.13；p = 0.007），证据水平较低。不良事件发生率未发现显著差异。基于这些发现，医生在仔细考虑每位患者的神经和医疗状况的同时，可能会考虑增加中风患者的运动疗法总量，以改善他们的日常生活活动和运动功能。
