背景:运动障碍是中风最常见的并发症之一。针刺疗法(AT)和镜像疗法(MT)是治疗中风后运动障碍的有希望的康复措施。尽管一些研究表明AT和MT对运动障碍是有效和安全的,的影响,由于缺乏强有力的证据,安全性仍然不确定。目的探讨AT联合MT治疗脑卒中后运动障碍的疗效和安全性。
方法:我们搜索了以下数据库:PubMed,WebofScience,科克伦图书馆,EMBASE,Medline,中国知网,万方,和中国生物医学文献数据库,从开始到2023年1月1日,以确定符合条件的研究。总有效率,Fugl-Meyer评估量表(FMA)上肢和下肢评分,修改后的Barthel指数得分,伯格平衡量表,改良的Ashworth秤,并以不良反应作为结局指标。2名独立评审员使用建议评估开发和评估系统来评估研究中包含的结果指标的证据质量。采用RevManV.5.4软件进行统计分析。
结果:共纳入24项随机对照研究,包括2133例脑卒中后运动障碍患者。AT联合MT治疗脑卒中后运动障碍的总有效率更有优势(相对危险度=1.31,95%置信区间[CI][1.22-1.42],Z=6.96,P<.0001)。AT联合MT对FMA上肢评分更有利(平均差[MD]=6.67,95%CI[5.21-8.13],Z=8.97,P<.00001)和FMA下肢评分(MD=3.72,95%CI[2.81-4.63],Z=7.98,P<.00001)。Meta分析显示,AT联合MT治疗脑卒中后运动障碍的改良Barthel指数评分更有优势(MD=9.51,95%CI[7.44-11.58],Z=9.01,P<.00001)。
结论:AT联合MT可有效改善患者的运动功能和日常生活能力。尤其是改善肌肉痉挛.然而,鉴于评估结果的证据质量较低,因此应谨慎对待这些结果。
BACKGROUND: Dyskinesia is one of the most common complications of stroke. Acupuncture therapy (AT) and mirror therapy (MT) are promising rehabilitation measures for the treatment of post-stroke dyskinesia. Although some studies suggested that AT and MT are effective and safe for dyskinesia, the effects, and safety remain uncertain due to lacking strong evidence. The purpose of this study is to investigate the efficacy and safety of AT combined with MT in the treatment of post-stroke dyskinesia.
METHODS: We searched the following databases: PubMed, Web of Science, Cochrane Library, EMBASE, Medline,
China Knowledge Network, WANFANG, and
China Biomedical Literature Database, from inception to 1 January 2023 to identify eligible studies. Total effective rate, the Fugl-Meyer assessment scale (FMA) upper and lower limb scores, modified Barthel index scores, Berg balance scale, modified Ashworth scale, and adverse reactions were adopted as outcome indicators. The Grading of Recommendations Assessment Development and Evaluation system was used by 2 independent reviewers to assess the quality of evidence for the outcome indicators included in the study. The statistical analysis was conducted by RevMan V.5.4 software.
RESULTS: A total of 24 randomized controlled studies included 2133 patients with post-stroke dyskinesia were included. The total effective rate of AT combined with MT was more advantageous in the treatment of post-stroke dyskinesia (relative risk = 1.31, 95% confidence interval [CI] [1.22-1.42], Z = 6.96, P < .0001). AT combined with MT was more advantageous for FMA upper limb score (mean difference [MD] = 6.67, 95% CI [5.21-8.13], Z = 8.97, P < .00001) and FMA lower limb score (MD = 3.72, 95% CI [2.81-4.63], Z = 7.98, P < .00001). Meta-analysis showed that AT combined with MT for post-stroke dyskinesia had a more advantageous modified Barthel index score (MD = 9.51, 95% CI [7.44-11.58], Z = 9.01, P < .00001).
CONCLUSIONS: AT combined with MT is effective in improving motor function and daily living ability of patients, especially in improving muscle spasms. However, these results should be regarded with caution given the low quality of evidence for the evaluation results.