Rasheed Ahamed Mohammed Meeran, Venugopal Durairaj, Padmanaban Sekaran, Sybil E Farmer, Anand D Pandyan
{"title":"用于控制成人中风后挛缩的辅助技术,包括矫形器。","authors":"Rasheed Ahamed Mohammed Meeran, Venugopal Durairaj, Padmanaban Sekaran, Sybil E Farmer, Anand D Pandyan","doi":"10.1002/14651858.CD010779.pub2","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Contractures (reduced range of motion and increased stiffness of a joint) are a frequent complication of stroke. Contractures can interfere with function and cause cosmetic and hygiene problems. Preventing and managing contractures might improve rehabilitation and recovery after stroke.</p><p><strong>Objectives: </strong>To assess the effects of assistive technologies for the management of contractures in adults after a stroke.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, five other databases, and three trials registers in May 2022. We also searched for reference lists of relevant studies, contacted experts in the field, and ran forward citation searches.</p><p><strong>Selection criteria: </strong>Randomised controlled studies (RCTs) that used electrical, mechanical, or electromechanical devices to manage contractures in adults with stroke were eligible for inclusion in this review. We planned to include studies that compared assistive technologies against no treatment, routine therapy, or another assistive technology.</p><p><strong>Data collection and analysis: </strong>Three review authors (working in pairs) selected all studies, extracted data, and assessed risk of bias. The primary outcomes were passive joint range of motion (PROM) with and without standardised force, and indirect measures of PROM. The secondary outcomes included hygiene. We also wanted to evaluate the adverse effects of assistive technology. Effects were expressed as mean differences (MDs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs).</p><p><strong>Main results: </strong>Seven studies fulfilled the inclusion criteria. Five of these were meta-analysed; they included 252 adults treated in acute and subacute rehabilitation settings. All studies compared assistive technology with routine therapy; one study also compared assistive technology with no treatment, but we were unable to obtain separate data for stroke participants. The assistive technologies used in the studies were electrical stimulation, splinting, positioning using a hinged board, and active repetitive motor training using a non-robotic device with electrical stimulation. Only one study applied stretching to end range. Treatment duration ranged from four to 12 weeks. The overall risk of bias was high for all studies. We are uncertain whether: • electrical stimulation to wrist extensors improves passive range of wrist extension (MD -7.30°, 95% CI -18.26° to 3.66°; 1 study, 81 participants; very low-certainty evidence); • a non-robotic device with electrical stimulation to shoulder flexors improves passive range of shoulder flexion (MD -9.00°, 95% CI -25.71° to 7.71°; 1 study; 50 participants; very low-certainty evidence); • assistive technology improves passive range of wrist extension with standardised force (SMD -0.05, 95% CI -0.39 to 0.29; four studies, 145 participants; very low-certainty evidence): • a non-robotic device with electrical stimulation to elbow extensors improves passive range of elbow extension (MD 0.41°, 95% CI -0.15° to 0.97°; 1 study, 50 participants; very low-certainty evidence). One study reported the adverse outcome of pain when using a hinged board to apply stretch to wrist and finger flexors, and another study reported skin breakdown when using a thumb splint. No studies reported hygiene or indirect measures of PROM.</p><p><strong>Authors' conclusions: </strong>Only seven small RCTs met the eligibility criteria of this review, and all provided very low-certainty evidence. Consequently, we cannot draw firm conclusions on the effects of assistive technology compared with routine therapy or no therapy. It was also difficult to confirm whether there is a risk of harm associated with treatment using assistive technology. Future studies should apply adequate treatment intensity (i.e. magnitude and the duration of stretch) and use valid and reliable outcome measures. Such studies might better identify the role of assistive technology in the management of contractures in adults after a stroke.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD010779"},"PeriodicalIF":8.8000,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418973/pdf/","citationCount":"0","resultStr":"{\"title\":\"Assistive technologies, including orthotic devices, for the management of contractures in adults after a stroke.\",\"authors\":\"Rasheed Ahamed Mohammed Meeran, Venugopal Durairaj, Padmanaban Sekaran, Sybil E Farmer, Anand D Pandyan\",\"doi\":\"10.1002/14651858.CD010779.pub2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Contractures (reduced range of motion and increased stiffness of a joint) are a frequent complication of stroke. Contractures can interfere with function and cause cosmetic and hygiene problems. Preventing and managing contractures might improve rehabilitation and recovery after stroke.</p><p><strong>Objectives: </strong>To assess the effects of assistive technologies for the management of contractures in adults after a stroke.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, five other databases, and three trials registers in May 2022. We also searched for reference lists of relevant studies, contacted experts in the field, and ran forward citation searches.</p><p><strong>Selection criteria: </strong>Randomised controlled studies (RCTs) that used electrical, mechanical, or electromechanical devices to manage contractures in adults with stroke were eligible for inclusion in this review. We planned to include studies that compared assistive technologies against no treatment, routine therapy, or another assistive technology.</p><p><strong>Data collection and analysis: </strong>Three review authors (working in pairs) selected all studies, extracted data, and assessed risk of bias. The primary outcomes were passive joint range of motion (PROM) with and without standardised force, and indirect measures of PROM. The secondary outcomes included hygiene. We also wanted to evaluate the adverse effects of assistive technology. Effects were expressed as mean differences (MDs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs).</p><p><strong>Main results: </strong>Seven studies fulfilled the inclusion criteria. Five of these were meta-analysed; they included 252 adults treated in acute and subacute rehabilitation settings. All studies compared assistive technology with routine therapy; one study also compared assistive technology with no treatment, but we were unable to obtain separate data for stroke participants. The assistive technologies used in the studies were electrical stimulation, splinting, positioning using a hinged board, and active repetitive motor training using a non-robotic device with electrical stimulation. Only one study applied stretching to end range. Treatment duration ranged from four to 12 weeks. The overall risk of bias was high for all studies. We are uncertain whether: • electrical stimulation to wrist extensors improves passive range of wrist extension (MD -7.30°, 95% CI -18.26° to 3.66°; 1 study, 81 participants; very low-certainty evidence); • a non-robotic device with electrical stimulation to shoulder flexors improves passive range of shoulder flexion (MD -9.00°, 95% CI -25.71° to 7.71°; 1 study; 50 participants; very low-certainty evidence); • assistive technology improves passive range of wrist extension with standardised force (SMD -0.05, 95% CI -0.39 to 0.29; four studies, 145 participants; very low-certainty evidence): • a non-robotic device with electrical stimulation to elbow extensors improves passive range of elbow extension (MD 0.41°, 95% CI -0.15° to 0.97°; 1 study, 50 participants; very low-certainty evidence). One study reported the adverse outcome of pain when using a hinged board to apply stretch to wrist and finger flexors, and another study reported skin breakdown when using a thumb splint. No studies reported hygiene or indirect measures of PROM.</p><p><strong>Authors' conclusions: </strong>Only seven small RCTs met the eligibility criteria of this review, and all provided very low-certainty evidence. Consequently, we cannot draw firm conclusions on the effects of assistive technology compared with routine therapy or no therapy. It was also difficult to confirm whether there is a risk of harm associated with treatment using assistive technology. Future studies should apply adequate treatment intensity (i.e. magnitude and the duration of stretch) and use valid and reliable outcome measures. 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引用次数: 0
摘要
背景:挛缩(关节活动范围减小、僵硬度增加)是中风的常见并发症。挛缩会影响功能,造成外观和卫生问题。预防和控制挛缩可改善中风后的康复和恢复:评估辅助技术对控制成人中风后挛缩的效果:我们检索了 CENTRAL、MEDLINE、Embase、其他五个数据库以及 2022 年 5 月的三个试验登记册。我们还检索了相关研究的参考文献列表,联系了该领域的专家,并进行了前向引文检索:使用电动、机械或机电设备治疗成人中风患者挛缩的随机对照研究(RCT)均可纳入本综述。我们计划纳入将辅助技术与无治疗、常规治疗或其他辅助技术进行比较的研究:三位综述作者(两人一组)选择了所有研究,提取了数据并评估了偏倚风险。主要研究结果为使用和不使用标准化力量时的被动关节活动范围(PROM),以及间接测量PROM的方法。次要结果包括卫生。我们还希望评估辅助技术的不良影响。效果以平均差(MDs)或标准化平均差(SMDs)及 95% 置信区间(CIs)表示:七项研究符合纳入标准。主要结果:七项研究符合纳入标准,其中五项进行了荟萃分析;这些研究纳入了在急性和亚急性康复环境中接受治疗的 252 名成人。所有研究都对辅助技术与常规治疗进行了比较;一项研究还对辅助技术与无治疗进行了比较,但我们无法获得中风患者的单独数据。研究中使用的辅助技术包括电刺激、夹板、使用铰链板定位,以及使用非机器人设备进行电刺激的主动重复运动训练。只有一项研究对终末范围进行了拉伸。治疗时间从 4 周到 12 周不等。所有研究的总体偏倚风险都很高。我们不能确定00°, 95% CI -25.71° to 7.71°; 1 项研究;50 名参与者;极低确定性证据); - 辅助技术可改善腕关节在标准化力量作用下的被动伸展范围(SMD -0.05, 95% CI -0.39 to 0.29; 4 项研究,145 名参与者;极低确定性证据):- 对肘部伸肌进行电刺激的非机器人设备可改善肘部被动伸展范围(MD 0.41°,95% CI -0.15°至 0.97°;1 项研究,50 名参与者;极低确定性证据)。一项研究报告了使用铰链板拉伸腕部和手指屈肌时出现疼痛的不良后果,另一项研究报告了使用拇指夹板时皮肤破损的情况。没有研究报告了PROM的卫生或间接测量指标:只有七项小型 RCT 符合本综述的资格标准,而且所有研究都提供了确定性很低的证据。因此,我们无法就辅助技术与常规疗法或无疗法相比的效果得出确切结论。此外,我们也很难确认使用辅助技术进行治疗是否存在伤害风险。未来的研究应采用适当的治疗强度(即拉伸的幅度和持续时间),并使用有效可靠的结果测量方法。此类研究可能会更好地确定辅助技术在中风后成人挛缩治疗中的作用。
Assistive technologies, including orthotic devices, for the management of contractures in adults after a stroke.
Background: Contractures (reduced range of motion and increased stiffness of a joint) are a frequent complication of stroke. Contractures can interfere with function and cause cosmetic and hygiene problems. Preventing and managing contractures might improve rehabilitation and recovery after stroke.
Objectives: To assess the effects of assistive technologies for the management of contractures in adults after a stroke.
Search methods: We searched CENTRAL, MEDLINE, Embase, five other databases, and three trials registers in May 2022. We also searched for reference lists of relevant studies, contacted experts in the field, and ran forward citation searches.
Selection criteria: Randomised controlled studies (RCTs) that used electrical, mechanical, or electromechanical devices to manage contractures in adults with stroke were eligible for inclusion in this review. We planned to include studies that compared assistive technologies against no treatment, routine therapy, or another assistive technology.
Data collection and analysis: Three review authors (working in pairs) selected all studies, extracted data, and assessed risk of bias. The primary outcomes were passive joint range of motion (PROM) with and without standardised force, and indirect measures of PROM. The secondary outcomes included hygiene. We also wanted to evaluate the adverse effects of assistive technology. Effects were expressed as mean differences (MDs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs).
Main results: Seven studies fulfilled the inclusion criteria. Five of these were meta-analysed; they included 252 adults treated in acute and subacute rehabilitation settings. All studies compared assistive technology with routine therapy; one study also compared assistive technology with no treatment, but we were unable to obtain separate data for stroke participants. The assistive technologies used in the studies were electrical stimulation, splinting, positioning using a hinged board, and active repetitive motor training using a non-robotic device with electrical stimulation. Only one study applied stretching to end range. Treatment duration ranged from four to 12 weeks. The overall risk of bias was high for all studies. We are uncertain whether: • electrical stimulation to wrist extensors improves passive range of wrist extension (MD -7.30°, 95% CI -18.26° to 3.66°; 1 study, 81 participants; very low-certainty evidence); • a non-robotic device with electrical stimulation to shoulder flexors improves passive range of shoulder flexion (MD -9.00°, 95% CI -25.71° to 7.71°; 1 study; 50 participants; very low-certainty evidence); • assistive technology improves passive range of wrist extension with standardised force (SMD -0.05, 95% CI -0.39 to 0.29; four studies, 145 participants; very low-certainty evidence): • a non-robotic device with electrical stimulation to elbow extensors improves passive range of elbow extension (MD 0.41°, 95% CI -0.15° to 0.97°; 1 study, 50 participants; very low-certainty evidence). One study reported the adverse outcome of pain when using a hinged board to apply stretch to wrist and finger flexors, and another study reported skin breakdown when using a thumb splint. No studies reported hygiene or indirect measures of PROM.
Authors' conclusions: Only seven small RCTs met the eligibility criteria of this review, and all provided very low-certainty evidence. Consequently, we cannot draw firm conclusions on the effects of assistive technology compared with routine therapy or no therapy. It was also difficult to confirm whether there is a risk of harm associated with treatment using assistive technology. Future studies should apply adequate treatment intensity (i.e. magnitude and the duration of stretch) and use valid and reliable outcome measures. Such studies might better identify the role of assistive technology in the management of contractures in adults after a stroke.
期刊介绍:
The Cochrane Database of Systematic Reviews (CDSR) stands as the premier database for systematic reviews in healthcare. It comprises Cochrane Reviews, along with protocols for these reviews, editorials, and supplements. Owned and operated by Cochrane, a worldwide independent network of healthcare stakeholders, the CDSR (ISSN 1469-493X) encompasses a broad spectrum of health-related topics, including health services.