目的 通过系统评价研究下肢康复机器人辅助步态训练(RAGT)对脑瘫患儿下肢功能的疗效,为下肢康复机器人在临床儿童康复的应用提供循证医学证据。方法 计算机检索中国知网、维普数据库、万方数据库、PubMed数据库、Embase医药数据库、Cochrane Library中关于脑瘫患儿下肢康复机器人步态训练的随机对照试验,文献检索时限限定为从建库至2022年9月。由2名研究员独立按照纳入、排除标准筛选文献,并完成提取数据,核对数据和质量评价等过程,最终采用RevMan5.3对粗大运动功能-站立,走、跑、跳(GMFM-D,GMFM-E),肌张力(MAS),平衡功能(BBS),步速,步长进行Meta分析及相关结果展示。结果 本研究共纳入16篇随机对照试验,共纳入759例脑瘫患儿。试验组干预措施为RAGT/RAGT+常规康复疗法,对照组干预措施为常规康复疗法。分析结果显示,相对于对照组,经RAGT后,试验组GMFM D原始分(MD=5.53, 95%CI:4.47~6.60, P<0.01)、百分比(MD=11.46, 95%CI:6.75~16.17,P<0.01),GMFM E原始分(MD=8.41, 95%CI:5.31~11.51, P<0.01)、百分比(MD=11.20, 95%CI:6.14~16.26, P<0.01),GMFM D+E总分(MD=9.93, 95%CI:5.78~14.08, P<0.01),MAS得分(MD=-0.45, 95%CI:-0.51~-0.38, P<0.01),BBS得分(MD=5.90, 95%CI:3.60~8.20, P<0.01),步速(MD=4.03, 95%CI:0.94~7.11, P=0.01)均有改善,差异具有统计学意义(P<0.05),但试验组与对照组的步长(MD=0.40, 95%CI:-0.02~0.82, P=0.06)差异无统计学意义。结论 RAGT对脑瘫患儿的下肢功能具有积极的改善作用,但现有研究存在一定异质性,未来还需设计严谨的大样本随机对照试验来探究RAGT对脑瘫儿童的疗效。
Abstract
Objective To study the efficacy of robot-assisted gait training (RAGT) on lower limb function in children with cerebral palsy through systematic review, in order to provide evidence-based reference for the application of lower robot-assisted gait training. Methods The randomized controlled trials on robotic gait training for lower limb rehabilitation in children with cerebral palsy were retrieved through CNKI, VIP, Wanfang, PubMed, Embase, and Cochrane Library, which were published from inception to September 2022. Two researchers independently screened the literature according to the inclusion and exclusion criteria, and completed the process of data extraction, checking the data and quality evaluation. RevMan5.3 was used to perform Meta-analysis and present the related results for gross motor functions, including standing, walking, running and jumping (GMFM-D, GMFM-E), muscle tone (MAS), balance function (BBS), step speed, and step length. Results A total of 16 randomized controlled trials with 759 children with cerebral palsy were included in this study. The control group received conventional rehabilitation therapy, while the experimental group was given RAGT/RAGT additionally. Compared with the control group, after RAGT, the GMFM-D raw score (MD=5.53, 95%CI:4.47 - 6.60, P<0.01), GMFM-D percentage (MD=11.46, 95%CI:6.75 - 16.17,P<0.01), and GMFM-E raw score (MD=8.41, 95%CI:5.31 - 11.51, P<0.01), GMFM-E percentage (MD=11.20, 95%CI:6.14 - 16.26, P<0.01), GMFM D+E total score (MD=9.93, 95%CI:5.78 - 14.08, P<0.01), MAS score (MD=-0.45, 95%CI:―0.51 - ―0.38, P<0.01), BBS score (MD=5.90, 95%CI:3.60 - 8.20, P<0.01), and stride speed (MD=4.03, 95%CI:0.94 - 7.11, P=0.01) of children in the experimental group all improved with significant differences (P>0.05), but there was no statistically significant difference in step length (MD=0.40, 95%CI:-0.02 - 0.82, P=0.06) between the two groups. Conclusions RAGT has a positive effect on lower limb function in children with cerebral palsy, but there is heterogeneity in the existing studies. Therefore, randomized controlled trials with large samples and rigorous intervention protocols are warranted in the future.
关键词
脑性瘫痪 /
机器人辅助步态训练 /
粗大运动功能 /
平衡
Key words
cerebral palsy /
robot-assisted gait training /
gross motor function /
balance
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基金
中国康复医疗机构联盟基金资助项目(20160212);浙江省中医药科技计划项目(2022ZB333)
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