背景:支持使用前庭康复疗法(VRT)改善中风后患者的平衡和步态的证据有限。本系统评价旨在评估VRT除常规康复外,与常规康复相比,对改善卒中后患者平衡和步态的效果。
方法:本综述遵循系统评价和Meta分析陈述指南的首选报告项目。截至2023年6月1日,共检索了十个电子数据库,没有语言和出版状态的限制。PEDro量表和建议评估发展分级,和评估用于评估偏倚风险和证据的确定性。使用ReviewManager5.3进行荟萃分析。
结果:纳入了15项随机对照试验,共769名参与者。PEDro量表用于评估偏倚风险,平均得分为5.9(0.7)。VRT可有效改善卒中后患者的平衡(SMD=0.59,95%CI(0.40,0.78),p<0.00001),特别是卒中后发生在6个月内的患者(SMD=0.56,95%CI(0.33,0.79),p<0.00001),证据的确定性适中。亚组分析显示,VRT作为注视稳定性练习结合转椅训练提供(SMD=0.85,95%CI(0.48,1.22),p<0.00001)和头部运动(SMD=0.75,95%CI(0.43,1.07),p<0.00001)可以显著改善平衡。4周VRT对平衡改善效果较好(SMD=0.64,95%CI(0.40,0.89),p<0.00001)比小于4周的VRT。时间Up-and-Go检验值的合并均值差异显示VRT可以显着改善卒中后患者的步态功能(MD=-4.32,95%CI(-6.65,-1.99),p=0.0003),尤其是卒中后发生在6个月内的患者(MD=-3.92,95%CI(-6.83,-1.00),p=0.008),具有中等的证据确定性。
结论:有证据支持VRT在改善卒中后患者平衡和步态方面的积极作用。
背景:PROSPEROCRD42023434304。
There is limited evidence to support the use of vestibular rehabilitation therapy (VRT) on improving balance and gait in patients after stroke. This systematic
review aimed to evaluate the effects of VRT in addition to usual rehabilitation compared with usual rehabilitation on improving balance and gait for patients after stroke.
This
review followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis statement guidelines. Ten electronic databases were searched up to 1 June 2023 without restrictions in language and publication status. The PEDro scale and the Grading of Recommendations Assessment Development, and Evaluation were used to evaluate the risk of bias and the certainty of evidence. The meta-analysis was conducted with
Review Manager 5.3.
Fifteen randomised controlled trials with 769 participants were included. PEDro scale was used to assess the risk of bias with a mean score of 5.9 (0.7). VRT was effective in improving balance for patients after stroke (SMD = 0.59, 95% CI (0.40, 0.78), p < 0.00001), particularly for patients after stroke that occurred within 6 months (SMD = 0.56, 95% CI (0.33, 0.79), p < 0.00001) with moderate certainty of evidence. Subgroup analysis showed that VRT provided as gaze stability exercises combined with swivel chair training (SMD = 0.85, 95% CI (0.48, 1.22), p < 0.00001) and head movements (SMD = 0.75, 95% CI (0.43, 1.07), p < 0.00001) could significantly improve balance. Four-week VRT had better effect on balance improvement (SMD = 0.64, 95% CI (0.40, 0.89), p < 0.00001) than the less than 4-week VRT. The pooled mean difference of values of Timed Up-and-Go test showed that VRT could significantly improve gait function for patients after stroke (MD = -4.32, 95% CI (-6.65, -1.99), p = 0.0003), particularly for patients after stroke that occurred within 6 months (MD = -3.92, 95% CI (-6.83, -1.00), p = 0.008) with moderate certainty of evidence.
There is moderate certainty of evidence supporting the positive effect of VRT in improving balance and gait of patients after stroke.
PROSPERO CRD42023434304.