Kwakkel G, Wagenaar R C, Koelman T W, Lankhorst G J, Koetsier J C
Department of Physical Therapy, University Hospital Vrije Universiteit, Amsterdam, Netherlands.
Stroke. 1997 Aug;28(8):1550-6. doi: 10.1161/01.str.28.8.1550.
A research synthesis was performed to (1) critically review controlled studies evaluating effects of different intensities of stroke rehabilitation in terms of disabilities and impairments and (2) quantify patterns by calculating summary effect sizes. The influences of organizational setting of rehabilitation management, blind recording, and amount of rehabilitation on the summary effect sizes were calculated.
A Medline literature search was performed for a critical review of the literature. The internal and external validity of the studies was evaluated. In addition, a meta-analysis was performed by applying the fixed (Hedges's g) effects model.
The effects of different intensities of rehabilitation were studied in nine controlled studies involving 1051 patients. Analysis of the methodological quality revealed scores varying from 14% to 47% of the maximum feasible score. Meta-analysis demonstrated a statistically significant summary effect size for activities of daily living (0.28 +/- 0.12). Lower summary effect sizes (0.19 +/- 0.17) were found for studies in which experimental and control groups were treated in the same setting compared with studies in which the two groups of patients were treated in different settings (0.40 +/- 0.19). Variables defined on a neuromuscular level (0.37 +/- 0.24) showed larger summary effect sizes than variables defined on a functional level (0.10 +/- 0.21). Weighting individual effect sizes for the difference in amount of rehabilitation between experimental and control groups resulted in larger summary effect sizes for activities of daily living and functional outcome parameters for studies that were not confounded by organizational setting.
A small but statistically significant intensity-effect relationship in the rehabilitation of stroke patients was found. Insufficient contrast in the amount of rehabilitation between experimental and control conditions, organizational setting of rehabilitation management, lack of blinding procedures, and heterogeneity of patient characteristics were major confounding factors.
进行一项研究综述，以（1）严格评估对照研究，这些研究从残疾和损伤方面评估不同强度的中风康复效果，以及（2）通过计算汇总效应量来量化模式。计算康复管理的组织环境、盲法记录以及康复量对汇总效应量的影响。
进行Medline文献检索以对文献进行严格综述。评估研究的内部和外部效度。此外，应用固定效应模型（Hedges's g）进行荟萃分析。
在涉及1051例患者的9项对照研究中研究了不同强度康复的效果。方法学质量分析显示得分在最大可行分数的14%至47%之间。荟萃分析表明日常生活活动的汇总效应量具有统计学意义（0.28±0.12）。与两组患者在不同环境中接受治疗的研究（0.40±0.19）相比，在相同环境中对实验组和对照组进行治疗的研究中发现较低的汇总效应量（0.19±0.17）。在神经肌肉水平定义的变量（0.37±0.24）显示出比在功能水平定义的变量（0.10±0.21）更大的汇总效应量。对实验组和对照组之间康复量差异的个体效应量进行加权，对于未受组织环境混淆的研究，日常生活活动和功能结局参数的汇总效应量更大。
在中风患者康复中发现了虽小但具有统计学意义的强度 - 效应关系。实验组和对照组之间康复量的对比不足、康复管理的组织环境、缺乏盲法程序以及患者特征的异质性是主要的混杂因素。
