不同物理刺激疗法对脑卒中幸存者脑卒中后上肢痉挛性瘫痪和运动功能障碍的疗效比较：一项随机对照试验的网状Meta分析

Comparison of the effects of different physical stimulation therapies on reducing upper limb spastic paralysis and motor dysfunction in stroke survivors after stroke: a network meta-analysis of randomized controlled trials.

作者信息

Bian Mingtong, Chen Fuyan, Su Huizhen, Li Zhiying, Sun Xiaowei, Liu Yang, Shi Jinyuan, Liu Shuo, Rong Ru

机构信息

Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.

National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.

出版信息

Front Neurol. 2025 Apr 15;16:1554583. doi: 10.3389/fneur.2025.1554583. eCollection 2025.

DOI:10.3389/fneur.2025.1554583

PMID:40303894

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12037403/

Abstract

BACKGROUND

Upper limb spasticity is a common and disabling sequela of stroke, which significantly impairing motor function and the capacity to perform activities of daily living (ADL). The relative efficacy of different physical therapies and their combinations compared to monotherapies remains unclear.

METHODS

A comprehensive database search was conducted to identify randomized controlled trials (RCTs) published from database inception to 2024 that evaluated physical therapies for post-stroke upper limb spasticity. Data were analyzed using RevMan and STATA/R software with a Bayesian framework for network meta-analysis. Evidence consistency was assessed via node-splitting approaches, and intervention efficacy was ranked using the surface under the cumulative ranking curve (SUCRA). Effect sizes were expressed as mean differences (MD) with 95% confidence intervals (CI), and study quality was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system.

RESULTS

Forty-nine RCTs involving 3,219 patients were included. The combination of physical rehabilitation (PR) with repetitive transcranial magnetic stimulation (rTMS) and electro-acupuncture (EA) demonstrated the highest improvement in Fugl-Meyer Assessment for Upper Extremity (FMA-UE) scores (91.1%), outperforming PR alone (13.2%) or EA monotherapy (30.3%). PR combined with rTMS and body acupuncture (BA) shows the most significant improvement in the Modified Barthel Index (MBI) (83.1%), superior to PR (20.8%) or BA (23.8%) alone. Adverse events (e.g., minor bruising from EA) were infrequent and self-resolving.

CONCLUSION

Current evidence indicates that synergistic application of PR with rTMS and acupuncture (EA/BA) significantly enhances upper limb motor function and ADL capacity. However, GRADE evaluations rated most evidence as moderate quality, limited by implementation bias, insufficient subgroup analyses, and lack of long-term follow-up data. Future studies should adopt standardized protocols and investigate efficacy variations across stroke subtypes.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/view/CRD42025633289, identifier [CRD42025633289].

摘要

背景

上肢痉挛是中风常见且致残的后遗症，严重损害运动功能及日常生活活动（ADL）能力。不同物理疗法及其联合疗法与单一疗法相比的相对疗效尚不清楚。

方法

进行全面的数据库检索，以识别从数据库建立至2024年发表的评估中风后上肢痉挛物理疗法的随机对照试验（RCT）。使用RevMan和STATA/R软件并采用贝叶斯框架进行网络荟萃分析来分析数据。通过节点拆分方法评估证据一致性，并使用累积排序曲线下面积（SUCRA）对干预疗效进行排名。效应大小以平均差（MD）及95%置信区间（CI）表示，并使用推荐分级、评估、制定与评价（GRADE）系统评估研究质量。

结果

纳入49项涉及3219例患者的RCT。物理康复（PR）联合重复经颅磁刺激（rTMS）和电针（EA）在上肢Fugl-Meyer评估（FMA-UE）评分方面改善最高（91.1%），优于单独的PR（13.2%）或EA单一疗法（30.3%）。PR联合rTMS和体针（BA）在改良Barthel指数（MBI）方面改善最显著（83.1%），优于单独的PR（20.8%）或BA（23.8%）。不良事件（如EA引起的轻微瘀伤）很少见且可自行缓解。