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康复干预改善脑瘫患儿步速的有效性:系统回顾和荟萃分析

  2017-02-04

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【文献标题】Effectiveness of Rehabilitation Interventions to Improve Gait Speed in Children With Cerebral Palsy: Systematic Review and Meta-analysis(康复干预改善脑瘫患儿步速的有效性:系统回顾和荟萃分析

【文献来源】Physical Therapy 96(12) · June 2016

【文献简介】背景 儿童脑瘫(CP)的步态速度减少,这可能会对他们的社区参与度和生活质量产生负面影响。然而,有效的康复干预用以提高步态速度的证据仍不明确。

 

目的 本研究的目的是确定干预措施对于改善步行儿童CP步态速度的有效性。

 

数据源 对于MEDLINE / PubMed,CINAHL,ERIC和PEDro从2014年4月的内容开始搜索。

研究选择 所选研究是随机对照试验或具有对照组的实验设计,包括对儿童脑瘫的物理治疗或康复干预,并且报告步态速度作为结果测量。

 

数据提取 方法学质量通过PEDro评分评估。提取步态速度的平均值,标准偏差和变化分数。记录干预的一般研究信息和剂量参数(频率,持续时间,强度和体积)。

 

数据合成 纳入了24个研究。确定了三类干预措施:步态训练(n = 8),阻力训练(n = 9)和杂项(n = 7)。 Meta分析显示,步态训练有效增加步态速度,标准化效应大小为0.92(95%置信区间= 0.19,1.66; P = 0.01),而阻力训练显示效果可以忽略不计= 0.06; 95%置信区间= -0.12,0.25; P = 0.51)。在杂项类别中效应大小从负向到大。

 

局限性 步态速度是唯一被分析的结果测量。


结论 步态训练是改善CP儿童步行速度的最有效的干预措施。力量训练,即使适当的剂量,没有表现出有效改善步态速度。速度训练,肌电图生物反馈训练和全身振动有效地提高个体研究中的步态速度,值得进一步调查。


Purpose The purpose of this study was to determine the effectiveness of interventions for improving gait speed in ambulatory children with CP.

Data Sources MEDLINE/PubMed, CINAHL, ERIC, and PEDro were searched from inception through April 2014.

Study Selection The selected studies were randomized controlled trials or had experimental designs with a comparison group, included a physical therapy or rehabilitation intervention for children with CP, and reported gait speed as an outcome measure.

Data Extraction Methodological quality was assessed by PEDro scores. Means, standard deviations, and change scores for gait speed were extracted. General study information and dosing parameters (frequency, duration, intensity, and volume) of the intervention were recorded.

Data Synthesis Twenty-four studies were included. Three categories of interventions were identified: gait training (n=8), resistance training (n=9), and miscellaneous (n=7). Meta-analysis showed that gait training was effective in increasing gait speed, with a standardized effect size of 0.92 (95% confidence interval=0.19, 1.66; P=.01), whereas resistance training was shown to have a negligible effect (effect size=0.06; 95% confidence interval=−0.12, 0.25; P=.51). Effect sizes from negative to large were reported for studies in the miscellaneous category.

Limitations Gait speed was the only outcome measure analyzed.

Conclusions Gait training was the most effective intervention in improving gait speed for ambulatory children with CP. Strength training, even if properly dosed, was not shown to be effective in improving gait speed. Velocity training, electromyographic biofeedback training, and whole-body vibration were effective in improving gait speed in individual studies and warrant further investigation.

 





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