康复机器人辅助训练对不同阶段脑卒中患者手运动功能恢复效果的meta分析
Effect of Robot-assisted Training on the Recovery of Hand Motor Function in Patients with Different Stages of Stroke：a Meta-analysis
背景 脑卒中手功能障碍严重影响患者的生活质量，近年来，机器人辅助训练用于脑卒中患者功能恢复的研究逐渐增加，但改善效果缺乏有效的系统评价与分析，辅助训练具体方案仍需要进一步探讨。目的 系统评价康复机器人辅助训练对脑卒中患者手运动功能的恢复效果。方法 计算机检索PubMed、Embase、Scopus、Cochrane Library、Web of Science、中国知网（CNKI）、万方数据知识服务平台、维普网（VIP）和中国生物医学文献服务系统（Sinomed）中采用机器人辅助训练干预脑卒中患者手功能恢复的随机对照研究，时限为建库至2023年12月。严格按照纳排除标准进行文献筛选，提取原始数据，对纳入文献进行方法学质量评价，使用RevMan5.4和Stata17.0软件进行Meta分析。结果 共纳入文献23篇，693例脑卒中患者。Meta分析结果显示，试验组上肢运动功能评定量表（FMA-UL）（SMD=0.37，95%CI=0.17~0.58，P<0.001）、手腕FMA-UL（MD=1.66，95%CI=0.14~3.17，P=0.03）、手FMA-UL（MD=2.00，95%CI=1.17~2.83，P<0.001），上肢动作研究量表（SMD=0.27，95%CI=0.01~0.53，P=0.04）、手握力（SMD=0.54，95%CI=0.09~1.00，P=0.02）、手捏力（SMD=0.62，95%CI=0.16~1.09，P=0.008）评分均高于对照组，差异有统计学意义；两组间积木-箱子测验（MD=1.23，95%CI=-0.90~3.35，P=0.26）、改良Ashworth量表（SMD=-0.47，95%CI=-1.28~0.35，P=0.26）、Bathel指数（SMD=0.38，95%CI=-0.07~0.83，P=0.10）评分差异均无统计学意义。结论 康复机器人辅助训练有利于脑卒中患者手运动功能的恢复，能有效提高脑卒中患者手部活动能力、握捏能力，但在手部肌张力、灵活度与日常生活能力评分方面改善较小。未来需要大样本、多中心、更长随访期的研究来进一步评估其疗效和安全性。
Background Stroke hand dysfunction seriously affects the quality of life of patients. In recent yearsstudies of robot-assisted training for functional recovery of stroke patients has gradually increasedbut the improvement effect lacks effective systematic evaluation and analysisand assist specific training programs still needs to be further explored.Objective To systematically evaluate the intervention effect of rehabilitation robot-assisted training on the hand motor function in stroke patients. Methods Randomized controlled trials of rehabilitation robot-assisted training for hand motor function in stroke patients were searched in PubMedEmbaseScopusCochrane LibraryWeb of ScienceCNKIWanfang DataVIP and Sinomedthe time limit for searching was from the establishment of each database to December 2023. Literature screeningextraction of raw data and evaluation of the methodological quality of the literature were carried out in strict accordance with the inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.4 and Stata17.0. Results A total of 23 studies and 693 stroke patients were included in the literature. The results of meta-analysis showed that the experimental group's Fugl-Meyer motor function assessment-upper limbFMA-UL SMD=0.3795%CI=0.17~0.58P<0.001FMA-UL of wrist MD=1.6695%CI=0.14~3.17P=0.03 and hand portion MD=2.0095%CI=1.17~2.83P<0.001Upper Extremity Movement Study Scale SMD=0.2795%CI=0.01~0.53P=0.04handgrip strength SMD=0.5495%CI=0.09~1.00P=0.02and hand pinch SMD=0.6295%CI=0.16~1.09P=0.008 scores improved better than those of the control groupthere were significant differences between two groupsThere were no significant differences in Block-Box Test MD=1.2395%CI=-0.90~3.35P=0.26Modified Ashworth Scale SMD=-0.4795%CI=-1.28~0.35P=0.26and Bathel Index SMD=0.3895%CI=-0.07~0.83P=0.10 scores. Conclusion Rehabilitation robot-assisted training is beneficial to the recovery of hand motor function in stroke patientswhich can effectively improve hand mobilitygrip and pinch abilitybut the improvement in hand tonedexterity and daily living ability scores is relatively smallFuture studies with large samplesmulti-centerand longer follow-up periods are needed to further evaluate its efficacy and safety.
王诗纯、田安妮、杨晶、孙晶
10.12114/j.issn.1007-9572.2024.0229
神经病学、精神病学医学研究方法临床医学
脑卒中机器人辅助训练手运动功能Meta 分析
王诗纯,田安妮,杨晶,孙晶.康复机器人辅助训练对不同阶段脑卒中患者手运动功能恢复效果的meta分析[EB/OL].(2024-11-01)[2025-07-16].https://chinaxiv.org/abs/202411.00006.点此复制
评论