|
| 非侵入性神经调控联合虚拟现实对卒中上肢运动功能影响的Meta分析 |
| A Meta-analysis of Efficacy of Non-invasive Neuromodulation Techniques Combined with Virtual Reality for Upper Limbs Motor Dysfunction in Stroke Patients |
| 投稿时间：2025-03-09 修订日期：2025-03-09 |
| DOI： |
| 中文关键词: 脑卒中 非侵入性神经调控技术 虚拟现实训练 上肢运动功能障碍 Meta分析 |
| 英文关键词: stroke non-invasive neuromodulation techniques virtual reality treatment upper limbs motor dysfunction Meta-analysis |
| 基金项目:北京市科技计划项目—AI+健康协同创新培育（Z241100007724002） |
|
| 摘要点击次数: 82 |
| 全文下载次数: 0 |
| 中文摘要: |
| 目的：系统评价非侵入性神经调控联合虚拟现实技术(non-invasive neuromodulation techniques and virtual reality, NINT-VR)对脑卒中患者上肢运动功能的临床疗效。方法：检索PubMed、Embase、Web of Science、Cochrane Library、Medline和中国知网(CNKI)、万方、维普数据库中关于NINT-VR治疗脑卒中后上肢运动功能障碍的临床随机对照试验，检索时间自建库起至2024年9月。使用物理治疗证据数据库量表(PEDro)进行文献质量评估，RevMan 5.4.1软件进行常规Meta分析，Stata 17.0软件进行网状Meta分析、敏感性分析和发表偏倚评价。结果：纳入12篇文献，共538例受试者。Meta分析显示，NINT-VR可改善脑卒中患者的Fugl-Meyer上肢运动功能评定量表(fugl-meyer assessment upper extremities scale, FMA-UE) 评分 (MD = 8.32, 95%CI 6.18~10.45, P＜0.00001)，上肢动作研究量表(action research arm test, ARAT) 评分 (MD = 9.58, 95%CI 6.24~12.91, P＜0.00001)和改良Barthel指数(modified barthel index, MBI) 评分 (MD = 11.08, 95%CI 8.52~13.65, P＜0.00001)。亚组分析显示，NINT-VR干预方式和单次治疗时间是显著的异质性来源，相比对照组单次治疗时间≤30 min (MD = 4.68, 95%CI 1.93~7.43, P = 0.0008)或＞30 min (MD=10.22, 95%CI 8.55~11.89, P＜0.00001) FMA-UE 评分均有显著改善。对FMA-UE 评分进行网状 Meta 分析，不同NINT-VR干预方式效果的累积概率排序为经颅直流电刺激联合VR非同时治疗＞经颅磁刺激联合VR非同时治疗＞经颅直流电刺激联合VR同时治疗＞单独VR训练。结论：NINT-VR在脑卒中后改善患者上肢运动功能和日常生活活动能力方面具有显著优势，以经颅直流电刺激联合VR非同时治疗的干预方式效果最好。 |
| 英文摘要: |
| Objective: To systematically evaluate the clinical efficacy of non-invasive neuromodulation techniques combined with virtual reality (NINT-VR) for upper limbs motor dysfunction in stroke patients. Methods: A comprehensive search in databases of PubMed, Embase, Web of Science, Cochrane Library, Medline, CNKI, Wanfang, VIP was performed for randomized controlled trials (RCTs) of NINT-VR for upper limbs motor dysfunction in stroke patients. The search time was from databases inception to September 2024. Quality assessment was performed using Physiotherapy Evidence Database (PEDro). Meta-analysis was performed using RevMan 5.4.1. Network meta-analysis was performed and funnel plots were drawn to test for publication bias of the outcome indicators using Stata 17.0 software. Results: A total of 12 RCTs involving 538 patients were included. The meta-analysis results showed that, NINT-VR improved fugl-meyer assessment upper extremities scale (FMA-UE) (MD = 8.32, 95%CI 6.18~10.45, P＜0.00001) in stroke patients . Action research arm test (ARAT) score (MD = 9.58, 95%CI 6.24~12.91, P＜0.00001) and modified barthel index (MBI) score (MD = 11.08, 95%CI 8.52~13.65, P＜0.00001) also had been improved compared to the control group. Subgroup analysis showed that NINT-VR intervention plan and duration of single treatment were significant sources of heterogeneity. FMA-UE score could be improved by NINT-VR for both less than 30 minutes at a time (MD = 4.68, 95%CI 1.93~7.43, P = 0.0008) and more than 30 minutes at a time (MD=10.22, 95%CI 8.55~11.89, P＜0.00001). For the effect of NINT-VR intervention plan, the cumulative probability ranking of network meta-analysis were transcranial direct current stimulation (tDCS) and VR (non-simultaneous) > transcranial magnetic stimulation (TMS) and VR(non-simultaneous) > tDCS and VR (simultaneous) > VR treatment. Conclusion: NINT-VR demonstrates significant benefits for improving upper limbs motor dysfunction and activity of daily living (ADL) in stroke patients, and tDCS and VR (non-simultaneous) was one of the most effective intervention plan. |
|
View Fulltext
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|