摘要
目的系统评价上肢强化训练对脑瘫儿童上肢运动功能的效果。方法构建PICO架构,检索PubMed、Embase、Cochrane Library、Scopus、Web of Science、中国知网、中国生物医学文献数据库、维普和万方数据库,搜集关于上肢强化训练改善脑瘫儿童上肢运动功能的随机对照试验,检索时限均为2010年1月至2024年3月。按照Cochrane系统评价手册和物理治疗证据数据库量表对纳入文献进行质量评价,由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4和Stata 17.0进行网状Meta分析。结果共纳入27篇文献,包括1173例患者,涉及3种上肢强化训练。强制性运动疗法、改良强制性运动疗法和手-臂双侧强化训练均可提高辅助手功能评分与Peabody精细运动功能评分;强制性运动疗法和改良强制性运动疗法可提高上肢技能质量量表评分;手-臂双侧强化训练可提高儿童生活功能量表评分。在提高辅助手功能、上肢技能质量量表评分和Peabody精细运动功能评分方面,强制性运动疗法为最佳干预方式;在提高儿童生活功能量表评分方面,手-臂双侧强化训练为最佳干预方式。结论上肢强化训练可显著改善脑瘫儿童的上肢运动功能、精细运动功能和日常生活活动能力,强制性运动疗法在改善上肢运动功能和精细运动功能方面效果最好,手-臂双侧强化训练在提高日常生活活动能力方面疗效最佳。
Objective To systematically review the effect of upper extremity intensive training on upper limb motor function in children with cerebral palsy.Methods The PICO framework was constructed.PubMed,Embase,Cochrane Library,Scopus,Web of Science,CNKI,CBM,VIP and Wanfang data were retrieved for randomized controlled trials on the improvement of upper limb motor function in children with cerebral palsy by upper extremity intensive training from January,2010 to March,2024.The quality of the included researches was evaluated using the Cochrane System Evaluation Manual and Physiotherapy Evidence Database scale.Two reviewers independently screened literature,extracted data and assessed the risk of bias.Network meta-analysis was conducted using RevMan 5.4 and Stata 17.0.Results A total of 27 randomized controlled trials were selected,including 1173 cases,involving three kinds of upper extremity intensive training.Constraint-induced movement therapy,modified constraint-induced movement thera‐py and hand-arm bimanual intensive therapy improved Assistive Hand Assessment score and Peabody Develop‐mental Motor Scale-Fine Motor score;constraint-induced movement therapy and modified constraint-induced movement therapy improved the Quality of Upper Extremity Skills Test score;hand-arm bimanual intensive ther‐apy improved Pediatric Evaluation of Disability Inventory score.Constraint-induced movement therapy was the best in improving the Assistive Hand Assessment score,Quality of Upper Extremity Skills Test score and Pea‐body Developmental Motor Scale-Fine Motor score,while hand-arm bimanual intensive therapy was the best in improving the Pediatric Evaluation of Disability Inventory score.Conclusion Upper extremity intensive training can significantly improve upper limb motor function,fine motor function and activities of daily living in children with cerebral palsy.Constraint-induced movement therapy is the best in improving upper limb function and fine motor function,and hand-arm bimanual intensive therapy is the best in imp
作者
崔甜甜
杨钰琳
崔腾腾
马丽虹
CUI Tiantian;YANG Yulin;CUI Tengteng;MA Lihong(College of Rehabilitation,Shandong University of Traditional Chinese Medicine,Ji'nan,Shandong 250355,China;College of Rehabilitation,Shandong Second Medical University,Weifang,Shandong 261100,China)
出处
《中国康复理论与实践》
CSCD
北大核心
2024年第4期437-448,共12页
Chinese Journal of Rehabilitation Theory and Practice
基金
山东省高等医学教育研究中心科研规划项目。
关键词
脑性瘫痪
上肢
强化训练
强制性运动疗法
运动功能
网状Meta分析
cerebral palsy
upper extremity
intensive training
constraint-induced movement therapy
motor function
network meta-analysis
