Meiling Carbajal Galarza, Nathaly Olga Chinchihualpa Paredes, Sergio Alejandro Abanto Perez, Gustavo Saposnik, Maria Lazo-Porras
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Technology-based interventions offer potential for improving motor function and rehabilitation adherence; however, their impact in LMICs remains unknown.</p><p><strong>Objective: </strong>To measure the efficacy of technological interventions compared to conventional physical rehabilitation in improving post- stroke upper limb motor function in LMICs.</p><p><strong>Methods: </strong>We conducted a systematic review (PROSPERO registration: CRD42020213333) of randomized clinical trials (RCTs) from PubMed, Global Index Medicus, and Physiotherapy Evidence Databases. Studies included stroke survivors receiving technological interventions for upper limb rehabilitation. Effectiveness outcomes included upper limb motor function, performance for activities of daily living, and quality of life. A meta-analysis was performed using mean differences (MD) and 95% confidence intervals (95% CI). Risk of bias was assessed using the Cochrane Collaboration tool for RCTs.</p><p><strong>Results: </strong>Fifty studies were included after the screening phase, comprising a total of 2646 participants. Nine technological interventions were evaluated, including: virtual reality (40%), robotics (22%), telerehabilitation (10%), among others. Meta-analysis showed significant effect of immersive virtual reality on upper limb function using the Fugl-Meyer Scale (MD 5.65; 95% CI 4.88 to 6.43) and on daily activity performance using the Functional Independence Measure (MD 4,82; 95% CI 2,45-7,19). 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引用次数: 0
摘要
背景：卒中是全世界致残的主要原因之一，低收入和中等收入国家占卒中发病率的69%。基于技术的干预提供了改善运动功能和康复依从性的潜力；然而，它们对中低收入国家的影响尚不清楚。目的：比较技术干预与常规物理康复在改善中低收入人群脑卒中后上肢运动功能方面的效果。方法：我们对来自PubMed、Global Index Medicus和物理治疗证据数据库的随机临床试验（rct）进行了系统评价（PROSPERO注册：CRD42020213333）。研究包括接受上肢康复技术干预的中风幸存者。疗效指标包括上肢运动功能、日常生活活动表现和生活质量。采用平均差异（MD）和95%置信区间（95% CI）进行meta分析。使用Cochrane协作工具评估随机对照试验的偏倚风险。结果：筛选阶段后纳入了50项研究，共包括2646名参与者。对九项技术干预进行了评估，包括：虚拟现实（40%）、机器人（22%）、远程康复（10%）等。采用Fugl-Meyer量表(MD 5.65；95% CI 4.88 - 6.43)和使用功能独立性测量(MD 4,82；95% ci 2,45-7,19)。采用改良Barthel指数进行远程康复治疗与常规治疗也有显著差异(MD为3.28；95% CI 0.86 ~ 5.70)。结论：与传统康复相比，沉浸式虚拟现实和远程康复是中低收入国家有效的干预措施。
Effectiveness of technology-based stroke interventions to improve upper limb functioning in low- and middle-income countries: a systematic review and meta-analysis.
Background: Stroke is one of the leading causes of disability worldwide, with low- and middle- income countries (LMICs) representing 69% of stroke incidence. Technology-based interventions offer potential for improving motor function and rehabilitation adherence; however, their impact in LMICs remains unknown.
Objective: To measure the efficacy of technological interventions compared to conventional physical rehabilitation in improving post- stroke upper limb motor function in LMICs.
Methods: We conducted a systematic review (PROSPERO registration: CRD42020213333) of randomized clinical trials (RCTs) from PubMed, Global Index Medicus, and Physiotherapy Evidence Databases. Studies included stroke survivors receiving technological interventions for upper limb rehabilitation. Effectiveness outcomes included upper limb motor function, performance for activities of daily living, and quality of life. A meta-analysis was performed using mean differences (MD) and 95% confidence intervals (95% CI). Risk of bias was assessed using the Cochrane Collaboration tool for RCTs.
Results: Fifty studies were included after the screening phase, comprising a total of 2646 participants. Nine technological interventions were evaluated, including: virtual reality (40%), robotics (22%), telerehabilitation (10%), among others. Meta-analysis showed significant effect of immersive virtual reality on upper limb function using the Fugl-Meyer Scale (MD 5.65; 95% CI 4.88 to 6.43) and on daily activity performance using the Functional Independence Measure (MD 4,82; 95% CI 2,45-7,19). A significant difference was also found between telerehabilitation and conventional therapy using the modified Barthel index (MD of 3.28; 95% CI 0.86 to 5.70).
Conclusions: Immersive virtual reality and telerehabilitation are effective interventions compared to conventional rehabilitation in LMICs.
期刊介绍：
Topics in Stroke Rehabilitation is the leading journal devoted to the study and dissemination of interdisciplinary, evidence-based, clinical information related to stroke rehabilitation. The journal’s scope covers physical medicine and rehabilitation, neurology, neurorehabilitation, neural engineering and therapeutics, neuropsychology and cognition, optimization of the rehabilitation system, robotics and biomechanics, pain management, nursing, physical therapy, cardiopulmonary fitness, mobility, occupational therapy, speech pathology and communication. There is a particular focus on stroke recovery, improving rehabilitation outcomes, quality of life, activities of daily living, motor control, family and care givers, and community issues.
The journal reviews and reports clinical practices, clinical trials, state-of-the-art concepts, and new developments in stroke research and patient care. Both primary research papers, reviews of existing literature, and invited editorials, are included. Sharply-focused, single-issue topics, and the latest in clinical research, provide in-depth knowledge.
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