目的:马蹄足畸形(EFD)是中风后最常见的偏差。已经提出了几种物理治疗干预措施来治疗它。然而,评估这些治疗效果的研究在评估方式上差异很大,数据分析类型,和命名法。这项范围审查旨在绘制有关结果测量的现有证据以及用于评估物理治疗计划在中风患者中减少肱三头肌(TS)痉挛和EFD的有效性的方式。
方法:已使用范围界定审查方法框架。调查了三个数据库。纳入了使用物理疗法干预的成年卒中患者的TS痉挛的主要文献。根据使用的干预措施,将调查结果系统地总结在表格中,干预剂量,对照组,临床,和工具性结果衡量标准。
结果:在获得的642项研究中,共包括53篇论文。TS痉挛通过临床医生进行的手动操作进行评估(主要使用Ashworth量表),功能测试,通过机器人设备进行机械评估,或仪器分析和成像(如扭矩-角度比,H反射,和超声图像)。对量表和所用统计数据的结构有效性进行了彻底的批判性评估,使用序数尺度时,特别关注参数和非参数方法的选择。最后,围绕“痉挛”概念的复杂性以及评估EFD的几个潜在的主动和被动原因的可能性,随之而来的是对他们每个人的定制治疗,进行了讨论。
结论:本范围综述全面描述了文献中用于评估理疗治疗效果的所有结果指标和评估方式,用于减轻卒中患者的TS痉挛和EFD。临床医生和研究人员可以找到一个易于查阅的摘要,可以支持他们的临床和研究活动。
Equinus foot deformity (EFD) is the most common deviation after stroke. Several physiotherapy interventions have been suggested to treat it. However, studies evaluating the efficacy of these treatments vary widely in terms of assessment modalities, type of data analysis, and nomenclature. This scoping
review aimed to map current available evidence on outcome measures and the modalities employed to assess the effectiveness of physiotherapy programs for the reduction of triceps surae (TS) spasticity and EFD in patients with stroke.
Scoping
review methodological frameworks have been used. Three databases were investigated. Primary literature addressing TS spasticity in adult patients with stroke using physiotherapy interventions was included. Findings were systematically summarized in tables according to the intervention used, intervention dosage, control group, clinical, and instrumental outcome measures.
Of the 642 retrieved studies, 53 papers were included. TS spasticity was assessed by manual maneuvers performed by clinicians (mainly using the Ashworth Scale), functional tests, mechanical evaluation through robotic devices, or instrumental analysis and imaging (such as the torque-angle ratio, the H-reflex, and ultrasound images). A thorough critical appraisal of the construct validity of the scales and of the statistics employed was provided, particularly focusing on the choice of parametric and non-parametric approaches when using ordinal scales. Finally, the complexity surrounding the concept of \"spasticity\" and the possibility of assessing the several underlying active and passive causes of EFD, with a consequent bespoke treatment for each of them, was discussed.
This scoping
review provides a comprehensive description of all outcome measures and assessment modalities used in literature to assess the effectiveness of physiotherapy treatments, when used for the reduction of TS spasticity and EFD in patients with stroke. Clinicians and researchers can find an easy-to-consult summary that can support both their clinical and research activities.