运动想象疗法对脑卒中后患者上肢运动功能康复效果的系统评价_《中国循证医学杂志》

作者：

王朴 ¹ ,  郭毅 ^2,3 , 张君梅 ^4,5 , 赵磊 ² , 崔晓晨 ² , 廖维靖 ¹ , 岳光辉 ⁵

1. 武汉大学中南医院康复医学科（武汉?430071）；2. 武汉大学公共卫生学院流行病学教研室（武汉?430071）；3. 武汉大学病毒学国家重点实验室（武汉?430071）；;

关键词：

脑卒中后期运动想象疗法康复治疗随机对照试验系统评价 Meta分析

DOI：

10.7507/1672-2531.20110095

视频：

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目的　系统评价运动想象疗法对脑卒中后患者功能康复的效果。
方法　计算机检索Cochrane Database of Systematic Reviews、MEDLINE、EMbase、PEDro、OpenSIGLE、National Technical Information Service（NTIS）、CNKI、VlP、万方数据库和CBM中关于运动想象疗法改善脑卒中后患者肢体功能障碍的随机对照试验，同时追索纳入文献的参考文献。检索时限均为从建库至2010年10月。由3名研究者根据GRADE 系统推荐分级方法，对纳入研究的质量进行严格评价和资料提取，对符合质量标准的RCT进行Meta分析。统计学分析采用RevMan 5.0.25软件和GRAEDprofiler 3.2.2软件。
结果　共纳入16个RCT。Meta分析四个主要结局的结果显示：Furl-Meyer运动评分量表（FMA）持续8周、6周和4周的运动想象疗法训练对患者上肢运动功能障碍的康复效果与脑卒中后常规康复治疗比较，其差异均有统计学意义［WMD（95%CI）分别为13.89（4.53，23.25）、9.45（3.67，15.23）和7.81（1.96，13.65）］，上肢动作研究量表（ARAT）持续6周的运动想象疗法训练对患者上肢运动功能障碍的康复效果与其他脑卒中后康复治疗方法（物理治疗或作业治疗）比较，其差异也有统计学意义［WMD=5.70，95%CI（3.17，8.22），P=0.30］。每个结局的GRADE系统推荐分级均为低等级。
结论　现有研究显示，运动想象疗法可明显改善患者上肢运动功能，且副作用甚小，操作简便，与脑卒中后其他康复治疗方法相比成本较低，临床医生可将实施运动想象疗法作为强推荐。但鉴于纳入研究较少，样本量小，且质量不高，各研究评价方法变异性较大，并且存在评价时间的不同，故仍需开展大样本、多中心、方法科学和规范的高质量RCT，以求进一步验证运动想象疗法的实施方式与方法对脑卒中后患者肢体功能障碍的康复效果。

引用本文： 王朴,郭毅,张君梅,赵磊,崔晓晨,廖维靖,岳光辉. 运动想象疗法对脑卒中后患者上肢运动功能康复效果的系统评价. 中国循证医学杂志, 2011, 11(5): 529-539. doi: 10.7507/1672-2531.20110095 复制

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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.	吴兆苏, 姚崇华, 赵冬. 我国人群脑卒中发病率、死亡率的流行病学研究. 中华流行病学杂志, 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.	中华医学会全国第4次脑血管病学术会议. 各类脑血管病诊断要点. 中华神经科杂志, 1996, 29: 379-381.
27.	符俏, 陈文远, 喻锦成, 等. 运动想象疗法对脑卒中偏瘫患者上肢运动功能的影响. 中国康复医学杂志, 2010, 25(1): 53-55.
28.	胡永新, 王强, 孟萍萍, 等. 运动想象疗法对脑卒中偏瘫患者上肢功能恢复的影响. 中华物理医学与康复杂志, 2010, 32(4): 273-276.
29.	李媛, 沈贵荣, 王强, 等. 运动想像疗法对脑卒中上肢瘫痪病人日常生活活动功能的影响. 青岛大学医学院学报, 2010, 46(3): 244-246.
30.	张谦, 郭根平. "运动想像"疗法对脑卒中偏瘫上肢运动功能恢复的影响. 中国全科医学, 2010, 13(19): 2145-2146.
31.	朱琳, 贾晓红, 刘霖, 等. 运动想象对卒中后偏瘫患者手功能康复的疗效观察. 中国脑血管病杂志, 2009, 6(9): 451-455, 460.
32.	李桥军. 运动想象对脑卒中偏瘫患者上肢运动功能恢复疗效观察. 中国实用医药, 2008, 3(34): 220-221.
33.	王刚, 张德清, 何建永. "运动想像"疗法对脑卒中偏瘫患者上肢功能恢复的影响. 中华物理医学与康复杂志, 2007, 29(11): 759-761.
34.	张洪军. 运动想象联合常规康复治疗对脑损伤偏瘫患者上肢功能障碍恢复的影响. 山东医药, 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. 吴兆苏, 姚崇华, 赵冬. 我国人群脑卒中发病率、死亡率的流行病学研究. 中华流行病学杂志, 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. 中华医学会全国第4次脑血管病学术会议. 各类脑血管病诊断要点. 中华神经科杂志, 1996, 29: 379-381.
27. 符俏, 陈文远, 喻锦成, 等. 运动想象疗法对脑卒中偏瘫患者上肢运动功能的影响. 中国康复医学杂志, 2010, 25(1): 53-55.
28. 胡永新, 王强, 孟萍萍, 等. 运动想象疗法对脑卒中偏瘫患者上肢功能恢复的影响. 中华物理医学与康复杂志, 2010, 32(4): 273-276.
29. 李媛, 沈贵荣, 王强, 等. 运动想像疗法对脑卒中上肢瘫痪病人日常生活活动功能的影响. 青岛大学医学院学报, 2010, 46(3): 244-246.
30. 张谦, 郭根平. "运动想像"疗法对脑卒中偏瘫上肢运动功能恢复的影响. 中国全科医学, 2010, 13(19): 2145-2146.
31. 朱琳, 贾晓红, 刘霖, 等. 运动想象对卒中后偏瘫患者手功能康复的疗效观察. 中国脑血管病杂志, 2009, 6(9): 451-455, 460.
32. 李桥军. 运动想象对脑卒中偏瘫患者上肢运动功能恢复疗效观察. 中国实用医药, 2008, 3(34): 220-221.
33. 王刚, 张德清, 何建永. "运动想像"疗法对脑卒中偏瘫患者上肢功能恢复的影响. 中华物理医学与康复杂志, 2007, 29(11): 759-761.
34. 张洪军. 运动想象联合常规康复治疗对脑损伤偏瘫患者上肢功能障碍恢复的影响. 山东医药, 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.

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《中国循证医学杂志》

运动想象疗法对脑卒中后患者上肢运动功能康复效果的系统评价

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