脑卒中患者早期肌力训练的最佳证据总结

doi:10.3761/j.issn.0254-1769.2020.08.027

摘要/Abstract

摘要：

目的筛选国内外脑卒中患者早期肌力训练的相关证据,并对最佳证据进行总结,为制订科学的脑卒中患者早期肌力训练方案提供参考。方法系统检索UpToDate、乔安娜布里格斯研究所（Joanna Briggs Institute,JBI）循证卫生保健中心数据库、美国国立指南库、英国国家卫生与临床优化研究所、加拿大安大略注册护士协会、美国危重症护理网、澳大利亚国家脑卒中基金会、Cochrane Library、PubMed、Web of Science、Embase、中国知网、万方数据库、维普数据库和中国生物医学文献数据库等数据库内关于脑卒中患者早期肌力训练的证据,包括指南、系统评价、最佳实践信息册、证据总结、专家共识及原始研究。检索时限为建库至2019年10月30日。由2名研究员对文献质量进行独立评价,并结合专业判断,提取符合标准的文献。结果共纳入18篇文献,其中指南5篇,证据总结1篇,系统评价12篇。最佳证据包括评估、干预时机、干预计划、肌力训练干预措施、质量控制、效果评价和经济效益,共总结出28条证据。结论本研究总结了脑卒中患者早期肌力训练的最佳证据,为临床医护人员有针对性地开展证据应用提供循证依据。

关键词: 脑卒中, 肌力训练, 循证, 证据总结, 护理

Abstract:

Objective To collect and summarize the latest relevant evidence of early muscle strength training for stroke patients at home and abroad,so as to provide a reference for the establishment of a scientific program of early muscle strength training after stroke. Methods We systematically searched in UpToDate,Joanna Briggs Institute evidence-based health care center database,National Guideline Clearinghouse,National Institute for Health and Care Excellence,Registered Nurses’ Association of Ontario,American Association of Critical-Care Nurses,National Stroke Foundation of Australia,Cochrane Library,PubMed,Web of Science,Dutch Medical Abstracts database,CNKI,Wanfang database,VIP database and Chinese biomedical literature database for all evidence on early muscle strength training for stroke patients,including guidelines,system reviews,best practice information booklets,evidence summaries,expert consensuses and original research. The retrieval time is from the establishment of the databases to October 30,2019. 2 researchers independently evaluated the quality of literature,and extracted the literature that met the standards with their professional judgment. Results A total of 18 pieces of literature were included,including 5 guidelines,1 evidence summary and 12 systematic reviews. The best evidence includes evaluation,intervention timing,intervention plan,muscle strength training interventions,quality control,effect evaluation and economic benefits. A total of 28 pieces of evidence are summarized. Conclusion We summarized the best evidence of early muscle strength training for stroke patients,and provided evidence-based references for clinical staff to carry out evidence application. It is suggested that the clinical staff should actively carry out the early muscle strength training for stroke patients in combination with the specific situation of the room,the willingness of patients and the evidence of promoting factors,obstacles and coping strategies. At the same time,the evidence should be updated dynamically to ensure the quality.

Key words: Stroke, Muscle Strength Training, Evidence-Based, Evidence Summary, Nursing Care

陈晓艳, 王娅, 黄娟, 吴娟, 仲悦萍. 脑卒中患者早期肌力训练的最佳证据总结[J]. 中华护理杂志, 2020, 55(8): 1253-1259.

CHEN Xiaoyan, WANG Ya, HUANG Juan, WU Juan, ZHONG Yueping. Summary of the best evidence of early muscle strength training in stroke patients[J]. Chinese Journal of Nursing, 2020, 55(8): 1253-1259.

图/表 4

图1 文献纳入排除流程图注:美国指南网（National Guideline Clearinghouse,NGC）,英国国家卫生与临床优化研究所（National Institute for Health and Care Excellence,NICE）,加拿大安大略注册护士协会（Registered Nurses’ Association of Ontario, RNAO）,美国危重症护理网（American Association of Critical-Care Nurses,AACN）,澳大利亚国家脑卒中基金会（National Stroke Foundation,NSF）,乔安娜布里格斯研究所（Joanna Briggs Institute,JBI）。

表1 纳入文献的基本资料

表2 指南各维度标准化百分比及2项综合评价结果

表3 最佳证据总结

参考文献 41

[1]	中华医学会神经病学分会, 中华医学会神经病学分会神经康复学组, 中华医学会神经病学分会脑血管病学组. 中国脑卒中早期康复治疗指南[J]. 中华神经科杂志, 2017,50(6):405-412.
[2]	国家卫生健康委员会.《脑脑卒中综合防治工作方案》[EB/OL].( 2018 -10-16). http://www.nhc.gov.cn/jkj/s5879/201612/620d7b78-a73b40d098055742336365dc.shtml.
[3]	Andrews AW, Bohannon RW. Short-term recovery of limb muscle strength after acute stroke[J]. Arch Phys Med Rehabil, 2003,84(1):125-130. DOI URL PMID
[4]	Andrews AW, Bohannon RW. Distribution of muscle strength impairments following stroke[J]. Clin Rehabil, 2000,14(1):79-87. DOI URL PMID
[5]	Neckel N, Pelliccio M, Nichols D, et al. Quantification of func-tional weakness and abnormal synergy patterns in the lower limb of individuals with chronic stroke[J]. J Neuroeng Rehabil, 2006,3:17. DOI URL PMID
[6]	Horstman AM, Beltman MJ, Gerrits KH, et al. Intrinsic muscle strength and voluntary activation of both lower limbs and functional performance after stroke[J]. Clin Physiol Funct Ima-ging, 2008,28(4):251-261.
[7]	李燕, 黄丽华. 老年人平衡能力评估及干预的研究进展[J]. 中华护理杂志, 2019,54(4):603-608.
[8]	张健华, 黄真. 脑卒中患者肌力训练的研究进展[J]. 中国康复医学杂志, 2010,25(2):190-194.
[9]	Brouwers MC, Kho ME, Browman GP, et al. AGREE Ⅱ:adva-ncing guideline development,reporting and evaluation in health care[J]. J Clin Epidemiol, 2010,63(12):1308-1311. DOI URL PMID
[10]	胡雁. 循证护理学[M]. 北京: 人民卫生出版社, 2012.
[11]	The Management of Stroke Rehabilitation Work Group. Va/dod clinical practice guideline for the management of stroke rehabilitation[EB/OL].( 2019 -07-05). https://www.healthquality.va.gov/index.asp
[12]	Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American heart association/American stroke association[J]. Stroke, 2018,49(3):e46-e110. DOI URL PMID
[13]	National Stroke Foundation. DRAFT clincial guidelines for stroke management 2017[EB/OL].( 2018-10-10). https://informme.org.au/.
[14]	National Institute for Health and Care Excellence. Stroke rehabilitation in adults[EB/OL].( 2013 -06-12). https://www.nice.org.uk/guidance/cg162.
[15]	The Joanna Briggs Institute (JBI).Stroke physical fitness training[EB/OL].( 2019 -07-17)[2019-08-07]. http://ovidsp.dc2.ovid.com/sp-4.03.0b/ovidweb.cgi?&S=PCGKFPOKELEBFNIFJPBKC-FHGDGFEAA00&Link+Set=S.sh.22%7c2%7csl_190.
[16]	Kim Y, Lai B, Mehta T, et al. Exercise training guidelines for multiple sclerosis,stroke,and parkinson disease:rapid review and synjournal[J]. Am J Phys Med Rehabil, 2019,98(7):613-621. DOI URL PMID
[17]	Pogrebnoy D, Dennett A. Exercise programs delivered according to guidelines improve mobility in people with stroke:a systematic review and meta-analysis[J]. Arch Phys Med Reha-bil, 2020,101(1):154-165.
[18]	Mehrholz J, Pohl M, Platz T, et al. Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke[J]. Cochrane Database Syst Rev, 2018, 9:CD006876. DOI URL PMID
[19]	Dorsch S, Ada L, Alloggia D. Progressive resistance training increases strength after stroke but this may not carry over to activity:a systematic review[J]. J Physiother, 2018,64(2):84-90. DOI URL PMID
[20]	de Sousa DG, Harvey LA, Dorsch S, et al. Interventions involving repetitive practice improve strength after stroke:a systematic review[J]. J Physiother, 2018,64(4):210-221. DOI URL PMID
[21]	Ramlee MH, Gan KB. Function and biomechanics of upper limb in post-stroke patients - a systematic review[J]. J Mech Med Biol, 2017,17(6):1750099. DOI URL
[22]	Beaulieu LD, Milot MH. Changes in transcranial magnetic sti-mulation outcome measures in response to upper-limb physical training in stroke:a systematic review of randomized controlled trials[J]. Ann Phys Rehabil Med, 2018,61(4):224-234. DOI URL PMID
[23]	Jeon BJ, Kim WH, Park EY. Effect of task-oriented training for people with stroke:a meta-analysis focused on repetitive or circuit training[J]. Top Stroke Rehabilitation, 2015,22(1):34-43.
[24]	Klinke ME, Hafsteinsdóttir TB, Hjaltason H, et al. Ward-based interventions for patients with hemispatial neglect in stroke rehabilitation:a systematic literature review[J]. Int J Nurs Stud, 2015,52(8):1375-1403. DOI URL PMID
[25]	Corbetta D, Sirtori V, Castellini G, et al. Constraint-induced move-ment therapy for upper extremities in people with stroke[J]. Cochrane Database Syst Rev, 2015(10):CD004433. URL PMID
[26]	Chan B. Effect of increased intensity of physiotherapy on patient outcomes after stroke:an economic literature review and cost-effectiveness analysis[J]. Ont Health Technol Assess Ser, 2015,15(7):1-43. URL PMID
[27]	Pollock A, Baer G, Campbell P, et al. Physical rehabilitation approaches for the recovery of function and mobility following stroke[J]. Cochrane Database Syst Rev, 2014(4):CD001920. DOI URL PMID
[28]	Saunders DH, Sanderson M, Hayes S, et al. Physical fitness training for stroke patients[J]. Cochrane Database Syst Rev, 2020, 3:CD003316. DOI URL PMID
[29]	Mehta S, Pereira S, Janzen S, et al. Cardiovascular conditioning for comfortable gait speed and total distance walked during the chronic stage of stroke:a meta-analysis[J]. Top Stroke Re-habil, 2012,19(6):463-470.
[30]	Stoller O, de Bruin ED, Knols RH, et al. Effects of cardiovascular exercise early after stroke:systematic review and meta-analysis[J]. BMC Neurol, 2012,12:45. DOI URL PMID
[31]	Tally Z, Boetefuer L, Kauk C, et al. The efficacy of treadmill training on balance dysfunction in individuals with chronic stroke:a systematic review[J]. Top Stroke Rehabil, 2017,24(7):539-546. URL PMID
[32]	van Duijnhoven HJ, Heeren A, Peters MA, et al. Effects of exercise therapy on balance capacity in chronic stroke:systematic review and meta-analysis[J]. Stroke, 2016,47(10):2603-2610. DOI URL PMID
[33]	Gomes-Neto M, Saquetto MB, Silva CM, et al. Effects of respiratory muscle training on respiratory function,respiratory muscle strength,and exercise tolerance in patients poststroke:a systematic review with meta-analysis[J]. Arch Phys Med Re-habil, 2016,97(11):1994-2001.
[34]	Wiener J, McIntyre A, Janssen S, et al. Effectiveness of high-intensity interval training for fitness and mobility post stroke:a systematic review[J]. PMR, 2019,11(8):868-878.
[35]	Letombe A, Cornille C, Delahaye H, et al. Early post-stroke phy-sical conditioning in hemiplegic patients:a preliminary study[J]. Ann Phys Rehabil Med, 2010,53(10):632-642. DOI URL PMID
[36]	Langhammer B, Lindmark B. Functional exercise and physical fitness post stroke:the importance of exercise maintenance for motor control and physical fitness after stroke[J]. Stroke Res Treat, 2012,2012:864835. DOI URL PMID
[37]	Simpson LA, Eng JJ, Tawashy AE. Exercise perceptions among people with stroke:barriers and facilitators to participation[J]. Int J Ther Rehabil, 2011,18(9):520-530. DOI URL PMID
[38]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015,30(11):964-967.
[39]	Langhorne P, Collier JM, Bate PJ, et al. Very early versus delayed mobilisation after stroke[J]. Cochrane Database Syst Rev, 2018, 10:CD006187. URL PMID
[40]	Salter K, Musovic AF, Taylor N. In the first 3 months after stroke is progressive resistance training safe and does it improve activity? A systematic review[J]. Top Stroke Rehabil, 2016,23(5):366-375. DOI URL PMID
[41]	韩汝宁, 李秀川, 赵士兵, 等. ICU患者早期康复方案的构建及应用研究[J]. 中华护理杂志, 2020,55(1):8-15.