非侵入性干预治疗I期脑卒中后肩手综合征的疗效比较：随机对照试验的网状Meta分析。
完整摘要 · 中文译文
背景：采用网状荟萃分析比较非侵入性干预措施对I期脑卒中后肩手综合征（SHS）患者疼痛、上肢运动功能及日常生活活动能力的疗效。 方法：系统检索评价I期SHS非侵入性干预措施的随机对照试验。结局指标包括视觉模拟量表（VAS）、Fugl-Meyer上肢运动功能评定量表（FMA-UE）及Barthel指数（BI）。估算均数差（MD）或标准化均数差（SMD）及其95%置信区间（CI），并计算累积排序曲线下面积（SUCRA）值。 结果：共纳入36项随机对照试验，涉及2,769例受试者。VAS、FMA-UE和BI网络分别纳入24项、28项和18项随机对照试验。与常规治疗（CT）相比，肌内效贴扎（KT）（MD = -1.95，95% CI -2.85至-1.05）、气压治疗（AT）（MD = -2.30，-4.31至-0.29）、中医外治法（TCM-EHT）（MD = -1.36，-2.08至-0.64）、中医外部物理刺激（TCM-EPS）（MD = -1.43，-2.36至-0.50）及艾灸（MD = -1.52，-2.53至-0.51）可显著降低VAS评分。TCM-EPS（SMD = 2.12，0.03至4.21）、TCM-EHT（SMD = 2.07，0.62至3.52）及KT（SMD = 2.32，0.04至4.61）可改善FMA-UE。TCM-EHT（SMD = 3.64，1.76至5.51）、TCM-EPS（SMD = 2.55，0.60至4.50）及KT（SMD = 1.98，0.27至3.70）可改善BI。然而，所有具有统计学显著性的比较的95%预测区间均跨越了 null。AT、KT和TCM-EHT分别在VAS、FMA-UE和BI方面排名最高。未检测到具有统计学显著性的全局不一致性，但在VAS网络中发现了CT与TCM-EHT之间的局部不一致。 结论：非侵入性干预显示出针对特定结局的潜在益处，但没有一种干预在所有结局上表现出一致的优越性。尽管AT和KT在疼痛方面排名较优，KT、TCM-EPS和TCM-EHT在功能结局方面排名较优，但较宽的预测区间表明存在相当大的不确定性。鉴于方法学局限性和不精确性，研究结果应谨慎解读，并需通过把握度充分的多中心随机对照试验加以证实。 系统评价注册：公开可查的注册记录可通过PROSPERO数据库获取：https://www.crd.york.ac.uk/PROSPERO/view/CRD420251276361。该系统评价已在PROSPERO注册（注册号：CRD420251276361）。
完整摘要 · 英文原文
BACKGROUND: To compare the effectiveness of non-invasive interventions for pain, upper-limb motor function, and activities of daily living in patients with stage I post-stroke shoulder-hand syndrome (SHS) using network meta-analysis. METHODS: Randomized controlled trials evaluating non-invasive interventions for stage I SHS were systematically retrieved. Outcomes included visual analogue scale (VAS), Fugl-Meyer Assessment-Upper Extremity (FMA-UE), and Barthel Index (BI). Mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs) were estimated, and surface under the cumulative ranking curve (SUCRA) values were calculated. RESULTS: Thirty-six RCTs involving 2,769 participants were included. The VAS, FMA-UE, and BI networks included 24, 28, and 18 RCTs, respectively. Compared with conventional treatment (CT), VAS scores were significantly reduced by kinesiology taping (KT) (MD = -1.95, 95% CI - 2.85 to -1.05), air pressure therapy (AT) (MD = -2.30, -4.31 to -0.29), Traditional Chinese Medicine External Herbal Therapy (TCM-EHT) (MD = -1.36, -2.08 to -0.64), Traditional Chinese Medicine External Physical Stimulation (TCM-EPS) (MD = -1.43, -2.36 to -0.50), and moxibustion (MD = -1.52, -2.53 to -0.51). FMA-UE improved with TCM-EPS (SMD = 2.12, 0.03 to 4.21), TCM-EHT (SMD = 2.07, 0.62 to 3.52), and KT (SMD = 2.32, 0.04 to 4.61). BI improved with TCM-EHT (SMD = 3.64, 1.76 to 5.51), TCM-EPS (SMD = 2.55, 0.60 to 4.50), and KT (SMD = 1.98, 0.27 to 3.70). However, 95% prediction intervals for all statistically significant comparisons crossed the null. AT, KT, and TCM-EHT ranked highest for VAS, FMA-UE, and BI, respectively. No statistically significant global inconsistency was detected, although localized disagreement was identified for CT versus TCM-EHT in the VAS network. CONCLUSION: Non-invasive interventions showed outcome-specific potential benefits, but no intervention demonstrated consistent superiority across all outcomes. Although AT and KT ranked favorably for pain and KT, TCM-EPS, and TCM-EHT for functional outcomes, wide prediction intervals indicated substantial uncertainty. Given methodological limitations and imprecision, findings should be interpreted cautiously and confirmed by adequately powered multicentre RCTs. SYSTEMATIC REVIEW REGISTRATION: The publicly accessible registration record is available through the PROSPERO database: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251276361. The systematic review was registered in PROSPERO (registration number: CRD420251276361).