| 摘要: | 研究背景: 腦中風已成為高齡化社會中常見的慢性疾病之一，雖因醫學進步致死率降低，但後續仍有長期照顧上的負擔。多數中風倖存個案有肌肉力量下降、痙攣、動作與功能表現不佳等肢體上的後遺症，需要透過復健治療協助恢復原本狀態。近年振動治療也被用來改善中風個案的肌力、痙攣以及功能且有耗時較短、不易增加心血管負擔等優點，並在肌力、痙攣以及肢體動作功能的復原有不錯的成效。但目前相關研究多著重於下肢以及全身振動相關探討，對於上肢以及不同模式的振動介入因素，較無統合分析與實務成效探討。
目的:本研究透過系統性回顧與統合分析，探討中風個案在振動治療介入後上肢的肌力、痙攣、動作與功能復原之成效。
方法: 本研究以使用系統性文獻回顧方式，蒐集2011年1月起至2021年5月底為止年份區間內的中、英文研究文章，整合振動治療介入對於腦中風個案之肌力、痙攣及上肢動作與功能等相關評估結果的隨機對照實驗。使用PubMed、MEDLINE、Embase、CINAHL、Cochrane library、ProQuest、Wed of science、華藝中文電子期刊、中國知識資源總庫等共9個資料庫，進行搜尋與文獻檢索。後續採用PEDros評讀文獻品質評讀，並以RevMan 5.4.1軟體之隨機效應模式進行統合分析，再以漏斗圖判定是否有出版偏差。
結果: 本次統合分析共收錄16篇文獻。結果顯示振動治療對於中風個案上肢的肌力提升無明顯介入成效(SMD=0.23, 95%CI[-0.48,0.93], Z=0.63, p=0.53)，至於痙攣降低 (SMD=-0.49, 95%CI[-0.90,-0.08], Z=2.32, p=0.02)、上肢動作恢復(SMD=0.69, 95%CI[0.17,1.21], Z=2.58, p=0.010)與功能增益(SMD=1.88, 95%CI[0.10,3.67], Z=2.07, p=0.04)則有明顯的改善成效。結論:根據本研究結果，顯示振動治療介入對於中風個案之上肢肌力提升無顯著效益，但對於痙攣降低、動作與功能恢復則有明顯效果。此等研究發現，有助於後續臨床人員使用振動治療作為復健訓練項目，改善中風患者偏癱上肢痙攣、動作與功能恢復。
Purpose: Stroke has become one of the most common chronic diseases in aging societies. With the advancing medical science, the fatality rate of stroke has decreased. However, the long-term health care costs are still a burden. Most stroke survivors experience various sequelae, including reduced muscle strength, spasticity, and poor motor functional performance, which require rehabilitation to regain these abilities. The traditional rehabilitation techniques are observed insufficient in improving muscle strength and spasticity. In recent years, vibration therapy has been used to improve muscle strength, spasticity, and functional performance, providing a good recovery of these sequelae in stroke patients. Recent studies predominantly focused on lower limb and whole-body vibration, lacking integrated analysis and practical effect discussion on the upper extremity and different factors that affect vibration intervention. This study aimed to discuss the effectiveness of vibration therapy on muscle strength, spasticity, motor and function in the upper extremity through a systematic review and meta-analysis.
Method: This study reviewed Chinese and English research articles published from Jan 2011 to May 2021 systematically. Integrated randomized controlled trials related to the effectiveness of vibration therapy intervention on muscle strength, spasticity, and upper extremity motor and function of stroke patients were included. A total of nine databases, including PubMed, MEDLINE, Embase, CINAHL, Cochrane Library, ProQuest, Web of science, Airiti Library, and CNKI were used for searching and retrieving the literature. Subsequently, PEDros was used to evaluate the quality of the articles. The random-effects model of RevMan 5.4.1 was used to conduct the meta-analysis, and a funnel plot was used to evaluate the publication bias.
Scientific results and contribution: Sixteen articles were included in this meta-analysis. The results demonstrated that vibration therapy had no obvious intervention effect in improving the upper limb muscle strength in stroke patients (SMD=0.23, 95%CI [-0.48–0.93], Z=0.63, p=0.53); however, it demonstrated intervention effects in improving the spasticity (SMD=-0.49, 95%CI [-0.90–-0.08], Z=2.32, p=0.02), motor (SMD=0.69, 95%CI [0.17–1.21], Z=2.58, p=0.010), and function (SMD=1.88, 95%CI [0.10–3.67], Z=2.07, p=0.04). This study provided a reference for the recovery of vibration therapy intervention on the upper extremity muscle strength, spasticity, motor and function in stroke patients, which is helpful for the clinical staff to use vibration therapy as an interventional method and provides suggestions for future related research directions and design. |
