運動想象療法對腦卒中后患者上肢運動功能康復效果的系統評價_《中國循證醫學雜志》

作者：

王樸 ¹ ,  郭毅 ^2,3 , 張君梅 ^4,5 , 趙磊 ² , 崔曉晨 ² , 廖維靖 ¹ , 岳光輝 ⁵

1. 武漢大學中南醫院康復醫學科（武漢?430071）；2. 武漢大學公共衛生學院流行病學教研室（武漢?430071）；3. 武漢大學病毒學國家重點實驗室（武漢?430071）；;

關鍵詞：

腦卒中后期運動想象療法康復治療隨機對照試驗系統評價 Meta分析

DOI：

10.7507/1672-2531.20110095

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目的　系統評價運動想象療法對腦卒中后患者功能康復的效果。
方法　計算機檢索Cochrane Database of Systematic Reviews、MEDLINE、EMbase、PEDro、OpenSIGLE、National Technical Information Service（NTIS）、CNKI、VlP、萬方數據庫和CBM中關于運動想象療法改善腦卒中后患者肢體功能障礙的隨機對照試驗，同時追索納入文獻的參考文獻。檢索時限均為從建庫至2010年10月。由3名研究者根據GRADE 系統推薦分級方法，對納入研究的質量進行嚴格評價和資料提取，對符合質量標準的RCT進行Meta分析。統計學分析采用RevMan 5.0.25軟件和GRAEDprofiler 3.2.2軟件。
結果　共納入16個RCT。Meta分析四個主要結局的結果顯示：Furl-Meyer運動評分量表（FMA）持續8周、6周和4周的運動想象療法訓練對患者上肢運動功能障礙的康復效果與腦卒中后常規康復治療比較，其差異均有統計學意義［WMD（95%CI）分別為13.89（4.53，23.25）、9.45（3.67，15.23）和7.81（1.96，13.65）］，上肢動作研究量表（ARAT）持續6周的運動想象療法訓練對患者上肢運動功能障礙的康復效果與其他腦卒中后康復治療方法（物理治療或作業治療）比較，其差異也有統計學意義［WMD=5.70，95%CI（3.17，8.22），P=0.30］。每個結局的GRADE系統推薦分級均為低等級。
結論　現有研究顯示，運動想象療法可明顯改善患者上肢運動功能，且副作用甚小，操作簡便，與腦卒中后其他康復治療方法相比成本較低，臨床醫生可將實施運動想象療法作為強推薦。但鑒于納入研究較少，樣本量小，且質量不高，各研究評價方法變異性較大，并且存在評價時間的不同，故仍需開展大樣本、多中心、方法科學和規范的高質量RCT，以求進一步驗證運動想象療法的實施方式與方法對腦卒中后患者肢體功能障礙的康復效果。

引用本文： 王樸,郭毅,張君梅,趙磊,崔曉晨,廖維靖,岳光輝. 運動想象療法對腦卒中后患者上肢運動功能康復效果的系統評價. 中國循證醫學雜志, 2011, 11(5): 529-539. doi: 10.7507/1672-2531.20110095 復制

1.	7 Duncan PW, Zorowitz R, Bates B, et al . Management of Adult Stroke Rehabilitation Care: a clinical practice guideline. Stroke , 2005, 36(9): e100-e143.
2.	8 Page SJ, Levine P, Leonard AC. Effects of mental practice on affected limb use and function in chronic stroke. Arch Phys Med Rehab , 2005, 86(3): 399-402.
3.	9 Callow N, Hardy L. Types of imagery associated with sport confidence in netball players of varying skill levels. J Appl Sport Psychol , 2001, 13(1): 1-17.
4.	10 Ryan ED, Simons J. Cognitive demand, imagery, and frequency of mental rehearsal as factors influencing acquisition of motor skills. Journal of Sport Psychology , 1981, 3(1): 35-45.
5.	11 Decety J, Jeannerod M, Prablanc C. The timing of mentally represented actions. Behav Brain Res , 1989, 34(1-2): 35-42.
6.	12 Sharma N, Pomeroy VM, Baron JC. Motor imagery: a backdoor to the motor system after stroke? Stroke , 2006, 37(7): 1941-1952.
7.	13 Jackson PL, Lafleur MF, Malouin F, et al . Potential role of mental practice using motor imagery in neurologic rehabilitation. Arch Phys Med Rehab , 2001, 82(8): 1133.
8.	16 Atkins D, Best D, Briss PA, et al . Grading quality of evidence and strength of recommendations. BMJ (Clinical research ed.) , 2004, 328(7454): 1490.
9.	21 Riccio I, Iolascon G, Barillari MR, et al . Mental practice is effective in upper limb recovery after stroke: a randomized single-blind cross-over study. Eur J Phys Rehabil Med , 2010, 46(1): 19-25.
10.	26 Müller K, Butefisch CM, Seitz RJ, et al . Mental practice improves hand function after hemiparetic stroke. Restor Neurol Neurosci , 2007, 25(5-6): 501-511.
11.	27 Page SJ, Levine P, Leonard A. Mental practice in chronic stroke: results of a randomized, placebo-controlled trial. Stroke , 2007, 38(4): 1293-1297.
12.	28 Page SJ, Levine P, Leonard AC. Effects of mental practice on affected limb use and function in chronic stroke. Arch Phys Med Rehab , 2005, 86(3): 399-402.
13.	29 Dijkerman HC, Ietswaart M, Johnston M, et al. Does motor imagery training improve hand function in chronic stroke patients? A pilot study. Clin Rehabil , 2004, 18(5): 538-549.
14.	30 Liu KP, Chan CC, Lee TM, et al . Mental imagery for promoting relearning for people after stroke: a randomized controlled trial. Arch Phys Med Rehabil , 2004, 85(9): 1403-1408.
15.	31 Page SJ, Levine P, Sisto S, et al . A randomized efficacy and feasibility study of imagery in acute stroke. Clin Rehabil , 2001, 15(3): 233-240.
16.	33 Fugl-Meyer AR, Jaasko L, Leyman I, et al . The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance. Scand J Rehabil Med , 1975, 7(1): 13-31.
17.	34 Lyle RC. A performance test for assessment of upper limb function in physical rehabilitation treatment and research. Int J Rehabil Res , 1981, 4(4): 483-492.
18.	35 Schünemann HJ, Oxman AD, Vist GE, et al . Cochrane Handbook for Systematic Reviews of Interventionss. In: Higgins JPT, Green S, Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008.
19.	6 Langhorne P, Coupar F, Pollock A. Motor recovery after stroke: a systematic review. Lancet Neurol , 2009, 8(8): 741-754.
20.	Warlow C, Van Gijn J, Sandercock P, et al. Stroke: practical management. Blackwell Pub, 2008.
21.	World Health Organization. World health report 2003. Geneva: World Health Organization, 2003.
22.	吳兆蘇, 姚崇華, 趙冬. 我國人群腦卒中發病率、死亡率的流行病學研究. 中華流行病學雜志, 2003, 24(3): 236-239.
23.	World Health Organization. International classification of functioning, disability and health: ICF. Geneva: World Health Organization, 2001.
24.	Wade DT. Measurement in neurological rehabilitation. Oxford University Press, 1992.
25.	World Health Organisation. Cerebrovascular Disorders (Offset Publications). Geneva: World Health Organization, 1978.
26.	中華醫學會全國第4次腦血管病學術會議. 各類腦血管病診斷要點. 中華神經科雜志, 1996, 29: 379-381.
27.	符俏, 陳文遠, 喻錦成, 等. 運動想象療法對腦卒中偏癱患者上肢運動功能的影響. 中國康復醫學雜志, 2010, 25(1): 53-55.
28.	胡永新, 王強, 孟萍萍, 等. 運動想象療法對腦卒中偏癱患者上肢功能恢復的影響. 中華物理醫學與康復雜志, 2010, 32(4): 273-276.
29.	李媛, 沈貴榮, 王強, 等. 運動想像療法對腦卒中上肢癱瘓病人日常生活活動功能的影響. 青島大學醫學院學報, 2010, 46(3): 244-246.
30.	張謙, 郭根平. "運動想像"療法對腦卒中偏癱上肢運動功能恢復的影響. 中國全科醫學, 2010, 13(19): 2145-2146.
31.	朱琳, 賈曉紅, 劉霖, 等. 運動想象對卒中后偏癱患者手功能康復的療效觀察. 中國腦血管病雜志, 2009, 6(9): 451-455, 460.
32.	李橋軍. 運動想象對腦卒中偏癱患者上肢運動功能恢復療效觀察. 中國實用醫藥, 2008, 3(34): 220-221.
33.	王剛, 張德清, 何建永. "運動想像"療法對腦卒中偏癱患者上肢功能恢復的影響. 中華物理醫學與康復雜志, 2007, 29(11): 759-761.
34.	張洪軍. 運動想象聯合常規康復治療對腦損傷偏癱患者上肢功能障礙恢復的影響. 山東醫藥, 2007, 47(26): 114-115.
35.	Page SJ. Imagery improves upper extremity motor function in chronic stroke patients: A pilot study. Occupational Therapy Journal of Research, 2000.

1. 7 Duncan PW, Zorowitz R, Bates B, et al . Management of Adult Stroke Rehabilitation Care: a clinical practice guideline. Stroke , 2005, 36(9): e100-e143.
2. 8 Page SJ, Levine P, Leonard AC. Effects of mental practice on affected limb use and function in chronic stroke. Arch Phys Med Rehab , 2005, 86(3): 399-402.
3. 9 Callow N, Hardy L. Types of imagery associated with sport confidence in netball players of varying skill levels. J Appl Sport Psychol , 2001, 13(1): 1-17.
4. 10 Ryan ED, Simons J. Cognitive demand, imagery, and frequency of mental rehearsal as factors influencing acquisition of motor skills. Journal of Sport Psychology , 1981, 3(1): 35-45.
5. 11 Decety J, Jeannerod M, Prablanc C. The timing of mentally represented actions. Behav Brain Res , 1989, 34(1-2): 35-42.
6. 12 Sharma N, Pomeroy VM, Baron JC. Motor imagery: a backdoor to the motor system after stroke? Stroke , 2006, 37(7): 1941-1952.
7. 13 Jackson PL, Lafleur MF, Malouin F, et al . Potential role of mental practice using motor imagery in neurologic rehabilitation. Arch Phys Med Rehab , 2001, 82(8): 1133.
8. 16 Atkins D, Best D, Briss PA, et al . Grading quality of evidence and strength of recommendations. BMJ (Clinical research ed.) , 2004, 328(7454): 1490.
9. 21 Riccio I, Iolascon G, Barillari MR, et al . Mental practice is effective in upper limb recovery after stroke: a randomized single-blind cross-over study. Eur J Phys Rehabil Med , 2010, 46(1): 19-25.
10. 26 Müller K, Butefisch CM, Seitz RJ, et al . Mental practice improves hand function after hemiparetic stroke. Restor Neurol Neurosci , 2007, 25(5-6): 501-511.
11. 27 Page SJ, Levine P, Leonard A. Mental practice in chronic stroke: results of a randomized, placebo-controlled trial. Stroke , 2007, 38(4): 1293-1297.
12. 28 Page SJ, Levine P, Leonard AC. Effects of mental practice on affected limb use and function in chronic stroke. Arch Phys Med Rehab , 2005, 86(3): 399-402.
13. 29 Dijkerman HC, Ietswaart M, Johnston M, et al. Does motor imagery training improve hand function in chronic stroke patients? A pilot study. Clin Rehabil , 2004, 18(5): 538-549.
14. 30 Liu KP, Chan CC, Lee TM, et al . Mental imagery for promoting relearning for people after stroke: a randomized controlled trial. Arch Phys Med Rehabil , 2004, 85(9): 1403-1408.
15. 31 Page SJ, Levine P, Sisto S, et al . A randomized efficacy and feasibility study of imagery in acute stroke. Clin Rehabil , 2001, 15(3): 233-240.
16. 33 Fugl-Meyer AR, Jaasko L, Leyman I, et al . The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance. Scand J Rehabil Med , 1975, 7(1): 13-31.
17. 34 Lyle RC. A performance test for assessment of upper limb function in physical rehabilitation treatment and research. Int J Rehabil Res , 1981, 4(4): 483-492.
18. 35 Schünemann HJ, Oxman AD, Vist GE, et al . Cochrane Handbook for Systematic Reviews of Interventionss. In: Higgins JPT, Green S, Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008.
19. 6 Langhorne P, Coupar F, Pollock A. Motor recovery after stroke: a systematic review. Lancet Neurol , 2009, 8(8): 741-754.
20. Warlow C, Van Gijn J, Sandercock P, et al. Stroke: practical management. Blackwell Pub, 2008.
21. World Health Organization. World health report 2003. Geneva: World Health Organization, 2003.
22. 吳兆蘇, 姚崇華, 趙冬. 我國人群腦卒中發病率、死亡率的流行病學研究. 中華流行病學雜志, 2003, 24(3): 236-239.
23. World Health Organization. International classification of functioning, disability and health: ICF. Geneva: World Health Organization, 2001.
24. Wade DT. Measurement in neurological rehabilitation. Oxford University Press, 1992.
25. World Health Organisation. Cerebrovascular Disorders (Offset Publications). Geneva: World Health Organization, 1978.
26. 中華醫學會全國第4次腦血管病學術會議. 各類腦血管病診斷要點. 中華神經科雜志, 1996, 29: 379-381.
27. 符俏, 陳文遠, 喻錦成, 等. 運動想象療法對腦卒中偏癱患者上肢運動功能的影響. 中國康復醫學雜志, 2010, 25(1): 53-55.
28. 胡永新, 王強, 孟萍萍, 等. 運動想象療法對腦卒中偏癱患者上肢功能恢復的影響. 中華物理醫學與康復雜志, 2010, 32(4): 273-276.
29. 李媛, 沈貴榮, 王強, 等. 運動想像療法對腦卒中上肢癱瘓病人日常生活活動功能的影響. 青島大學醫學院學報, 2010, 46(3): 244-246.
30. 張謙, 郭根平. "運動想像"療法對腦卒中偏癱上肢運動功能恢復的影響. 中國全科醫學, 2010, 13(19): 2145-2146.
31. 朱琳, 賈曉紅, 劉霖, 等. 運動想象對卒中后偏癱患者手功能康復的療效觀察. 中國腦血管病雜志, 2009, 6(9): 451-455, 460.
32. 李橋軍. 運動想象對腦卒中偏癱患者上肢運動功能恢復療效觀察. 中國實用醫藥, 2008, 3(34): 220-221.
33. 王剛, 張德清, 何建永. "運動想像"療法對腦卒中偏癱患者上肢功能恢復的影響. 中華物理醫學與康復雜志, 2007, 29(11): 759-761.
34. 張洪軍. 運動想象聯合常規康復治療對腦損傷偏癱患者上肢功能障礙恢復的影響. 山東醫藥, 2007, 47(26): 114-115.
35. Page SJ. Imagery improves upper extremity motor function in chronic stroke patients: A pilot study. Occupational Therapy Journal of Research, 2000.

《中國循證醫學雜志》

運動想象療法對腦卒中后患者上肢運動功能康復效果的系統評價

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《中國循證醫學雜志》

運動想象療法對腦卒中后患者上肢運動功能康復效果的系統評價

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