慢性脊髓损伤患者步行训练有效性的Meta分析

关键词：脊髓损伤  Meta分析  步行训练  功能性电刺激  减重步行训练

Keywords:spinal cord injury  Meta analysis  walking locomotor training  functional electrical stimulation  partial body weight support treadmill training

摘要：

      目的：循证评价步行训练对慢性脊髓损伤（SCI）患者步行功能恢复的有效性。方法：检索MEDLINE和中国生物医学文献数据库中，病程大于1年SCI患者步行训练的临床试验研究，计算步行速度的加权均数差（WMD）进行Meta分析。结果：Meta分析发现，步行训练能提高慢性运动不完全SCI患者的步行速度；其中功能电刺激（FES）加减重步行训练（PBWSTT）和FES辅助的平地步行训练的疗效较肯定。结论：步行训练对改善步行功能有利，但鉴于目前关于步行训练临床研究的高质量文献较少，所以证据仍不充分，尚需要严格设计的大样本临床随机对照试验来进一步证实其效果。

Abstract:

      Objective：To get a systematic overview of the efficacy of walking locomotor training on improving walking locomotion in chronic spinal cord injury(SCI) with Meta-analysis. Method：MEDLINE and China Biological Medicine Disc were searched for clinical trials about walking studies in the locomotor training after SCI. Meta-analysis were performed, calculating weighted mean difference(WMD), to examine the effectiveness of walking locomotor training on improving walk speed in chronic(>1 year after accident) SCI subjects. Result：A Meta-analysis showed that locomotor training could significantly enhance the walking speed in individuals with chronic motor-incomplete SCI. There was a greater improvement after walking locomotor training approaches of partial body weight support treadmill training（PBWSTT） combined with functional electrical stimulation(FES) and overground training with FES. Conclusion： Systematic evaluation indicated that walking locomotor training was effective on improving walking locomotor ability for individuals with SCI. However, it should be noted that the evidences were insufficient due to only obtaining a few high quality clinical studies. So, more clinical trials should attempt to use a large sample, randomized controlled design with blinding and standardized outcome measures for stronger evidences.