机器人辅助训练改善脑卒中患者下肢功能障碍的系统评价①

摘要

Objective To evaluate the effectiveness of robot-assisted training on lower extremities of patients with stroke. Methods PubMed, Medline, EMbase, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Knowledge, Ovid, China National Knowledge Infrastructure (CNKI), Wanfang Data and VIP Database for Chinese Technical Periodicals were searched for the randomized controlled trials (RCTs) about robot-assisted training for lower extremities of patients with stroke from the date of establishment to March 2013. The bibliographies of the retrieved studies were also searched. 2 independent researchers evaluated the included studies using the risk of bias provided by Cochrane Library. The extracted data were analyzed by RevMan 5.1 software. Results A total of 12 trials were discov-ered. Compared with conventional training, the robot-assisted training increased the score of Fugl-Meyer assessment (lower extremity) (WED=3.97, 95%CI:2.84~5.10, Z=6.89, P<0.00001) and Berg Balance Scale (WED=3.13, 95%CI:0.80~5.45, Z=2.63, P=0.008). However, the results of stride frequency (WED=8.40, 95%CI:-0.95~17.75, Z=1.76, P=0.08) and speed (WED=0.03, 95%CI:-0.02~0.07, Z=1.18, P=0.24) were not statistically significant. According to the Jadad Score of included studies, 4 of them were of low quality and 8 of them were of high quality. Conclusion The current evidence shows that to some extent, robot-assisted training could improve the lower extremities function.%　　目的系统评价机器人辅助训练对脑卒中患者下肢功能障碍的康复效果。方法计算机检索PubMed、Medline、EM-base、Cochrane Central Register of Controlled Trials (CENTRAL)、ISI Web of Knowledge、Ovid、中国知网、万方和维普数据库中关于机器人辅助训练改善脑卒中患者下肢运动功能障碍的随机对照试验，同时检索已纳入文献的参考文献。检索时间从建库至2013年3月。2名独立的研究人员依据Cochrane协作网推荐的偏倚风险评估方法，对纳入文献的质量进行严格评估及资料提取，对符合标准的随机对照试验进行Meta合并分析。统计分析采用RevMan 5.1软件。结果共纳入12个随机对照试验。Meta分析显示，机器人辅助训练后，脑卒中患者的Fugl-Meyer评分法下肢部分评分(WED=3.97,95%CI：2.84~5.10, Z=6.89, P<0.00001)及Berg平衡量表评分(WED=3.13,95%CI：0.80~5.45, Z=2.63, P=0.008)与对照组比较，差异有统计学意义；但步频(WED=8.40,95%CI：-0.95~17.75, Z=1.76, P=0.08)及步速(WED=0.03,95%CI：-0.02~0.07, Z=1.18, P=0.24)与对照组比较，差异无统计学意义。纳入文献质量的Jadad评分，低质量4篇，高质量8篇。结论机器人辅助训练在一定程度上能改善脑卒中患者的下肢运动功能。