神经调节干预联合机器人辅助步态训练对脑卒中患者下肢运动功能的影响：网络荟萃分析

IF 2.4 3区医学 Q3 GERIATRICS & GERONTOLOGY

Geriatric Nursing Pub Date : 2025-07-28 DOI:10.1016/j.gerinurse.2025.103535

Haiping Huang , Beisi Zheng , Xinyi Su , Shishi Chen , Jianer Chen

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引用次数: 0

摘要

背景神经调节干预与机器人辅助步态训练（RAGT）相结合以增强脑卒中患者下肢运动功能恢复仍存在争议。目的探讨神经调节联合RAGT对脑卒中后下肢运动功能障碍患者的影响，并分析最佳联合治疗策略。方法系统检索PubMed、Web of Science、Cochrane Library、Embase、CNKI、VIP、万方、SinoMed等数据库。两名独立研究人员进行了文献筛选、数据提取和偏倚评估。数据整合后，采用Cochrane偏倚风险工具和PEDro量表评价研究质量。采用RevMan 5.4.1和Stata 18.0软件对数据进行分析，采用GRADE系统评价证据质量。结果用95%置信区间（CI）的均值差（MD）表示。结果纳入445例脑卒中患者的6项研究。meta分析显示，神经调节（针刺、tDCS、rTMS）联合RAGT与单独RAGT相比，可显著改善FMA-LE评分、BBS评分和6MWT距离，而FAC评分无显著差异。SUCRA结果显示：rTMS+RAGT (98.6%) >；针灸+RAGT (67.5%) >；RAGT (23.0%) >；Dcs + ragt (10.9%)；针灸+RAGT (89.1%) >；rTMS+RAGT (72.0%) >；tDCS+RAGT (34.3%)；Ragt (4.6%)；针灸+RAGT (83.4%) >；rTMS+RAGT (83.2%) >；RAGT (26.0%) >；tDCS+RAGT（7.4%）。结论神经调节干预（rTMS、tDCS、针刺）联合RAGT可显著增强脑卒中患者下肢运动功能。针刺或rTMS联合RAGT可能是最佳策略。

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Effects of neuromodulation interventions combined with robot-assisted gait training on lower extremity motor function in stroke patients: A network meta-analysis

Background

The combination of neuromodulation interventions with robot-assisted gait training (RAGT)

for enhancing lower limb motor function recovery in stroke patients remains contentious.

Objective

This study aims to investigate the effects of neuromodulation combined with RAGT on patients with lower limb motor dysfunction following a stroke and to analyze the optimal combined treatment strategies.

Methods

A systematic search was conducted across PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, Wanfang, and SinoMed databases. Two independent researchers performed literature screening, data extraction, and bias assessment. After data integration, the Cochrane risk of bias tool and PEDro scale were used to evaluate study quality. Data were analyzed using RevMan 5.4.1 and Stata 18.0 software, and the GRADE system was employed to assess evidence quality. Results are expressed as mean differences (MD) with 95 % confidence intervals (CI).

Results

Eleven studies involving 445 stroke patients were included. Meta-analysis indicated that neuromodulation (acupuncture, tDCS, rTMS) combined with RAGT significantly improved FMA-LE scores ,BBS scores ,and 6MWT distances compared to RAGT alone, with no significant difference in FAC scores .In the order of FMA-LE , FAC , and BBS ,SUCRA results show: rTMS+RAGT (98.6 %) > acupuncture+RAGT (67.5 %) > RAGT (23.0 %) > DCS+RAGT (10.9 %); acupuncture+RAGT (89.1 %) > rTMS+RAGT (72.0 %) > tDCS+RAGT (34.3 %) > RAGT (4.6 %); acupuncture+RAGT (83.4 %) > rTMS+RAGT (83.2 %) > RAGT (26.0 %) > tDCS+RAGT (7.4 %).

Conclusion

Neuromodulation interventions (rTMS, tDCS, acupuncture) combined with RAGT can significantly enhance lower limb motor function in stroke patients. Acupuncture or rTMS combined with RAGT may represent the optimal strategy.

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来源期刊

Geriatric Nursing 医学-护理

CiteScore

3.80

自引率

7.40%

发文量

257

审稿时长

>12 weeks

期刊介绍： Geriatric Nursing is a comprehensive source for clinical information and management advice relating to the care of older adults. The journal''s peer-reviewed articles report the latest developments in the management of acute and chronic disorders and provide practical advice on care of older adults across the long term continuum. Geriatric Nursing addresses current issues related to drugs, advance directives, staff development and management, legal issues, client and caregiver education, infection control, and other topics. The journal is written specifically for nurses and nurse practitioners who work with older adults in any care setting.