镜像疗法用于卒中后上肢运动恢复：一项荟萃分析。
完整摘要 · 中文译文
目的：系统评价镜像疗法（MT）对脑卒中患者上肢运动功能的康复效果，从而为临床康复决策提供循证依据。 方法：从PubMed、Web of Science、Cochrane Library和EMBASE数据库中检索有关镜像疗法治疗脑卒中后上肢功能障碍的随机对照试验（RCT）。采用Cochrane偏倚风险评估工具2.0（RoB 2.0）评估纳入研究的偏倚风险。进行荟萃分析，并使用推荐分级评估、制定与评价（GRADE）系统确定证据等级。 结果：最终纳入21项随机对照试验。荟萃分析显示，镜像疗法显著改善了脑卒中患者Fugl-Meyer上肢运动功能评定量表（FMA-UE）的总分（平均差[MD] = 5.45，95%置信区间[95% CI]：3.50-7.41，p < 0.001）。手功能的改善具有统计学意义但临床改善幅度较小（MD = 1.16，95% CI：0.03-2.29，p = 0.04）；然而，敏感性分析表明该统计学意义并不稳健，依赖于少数高权重的研究。肩-肘-前臂功能观察到改善的积极趋势（MD = 1.79，95% CI：-0.02至3.60，p = 0.05）。然而，腕关节功能未见统计学显著改善（MD = 0.65，95% CI：-0.17至1.47，p = 0.12）。各结局指标间异质性较低。未检测到明确的发表偏倚证据；然而， 某些结局的研究数量较少，限制了漏斗图和Egger检验的效能。总体证据质量为中至低。 结论：MT可能改善卒中患者的整体上肢运动功能，而对手功能的作用更为有限且稳健性较差。手功能结果的统计学显著性依赖于少数高权重研究，且手功能的证据质量低；总体证据质量为低至中等。因此，应谨慎解释这些结果，尤其是手功能相关结果，并有必要进一步开展高质量研究。 系统评价注册：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420261395137，PROSPERO注册号：CRD420261395137。
完整摘要 · 英文原文
OBJECTIVE: To systematically evaluate the rehabilitation effect of mirror therapy (MT) on upper limb motor function in stroke patients, thereby providing evidence-based support for clinical rehabilitation decision-making. METHODS: Randomized controlled trials (RCTs) investigating MT for upper limb dysfunction after stroke were retrieved from the PubMed, Web of Science, Cochrane Library, and EMBASE databases. The risk of bias in the included studies was assessed using the Cochrane Risk of Bias tool 2.0 (RoB 2.0). A meta-analysis was performed, and the grade of evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS: A total of 21 RCTs were ultimately included. The meta-analysis showed that MT significantly improved the total score of the Fugl-Meyer Assessment Upper Extremity (FMA-UE) in stroke patients (Mean Difference [MD] = 5.45, 95% Confidence Interval [95% CI]: 3.50-7.41, p < 0.001). Hand function showed a statistically significant but clinically modest improvement (MD = 1.16, 95% CI: 0.03-2.29, p = 0.04); however, sensitivity analysis indicated that this statistical significance was not robust and depended on a small number of high-weight studies. A positive trend toward improvement was observed for shoulder-elbow-forearm function (MD = 1.79, 95% CI: -0.02 to 3.60, p = 0.05). However, no statistically significant improvement was found for wrist joint function (MD = 0.65, 95% CI: -0.17 to 1.47, p = 0.12). Heterogeneity was low across outcomes. No clear evidence of publication bias was detected; however, the number of studies was small for some outcomes, limiting the power of funnel plots and Egger's test. The overall quality of evidence was moderate to low. CONCLUSION: MT may improve global upper limb motor function in stroke patients, with a more modest and less robust effect on hand function. The statistical significance of the hand-function finding depended on a small number of high-weight studies, and the evidence for hand function is of low quality; the overall evidence is low-to-moderate. Therefore, these findings, especially those for hand function, should be interpreted cautiously, and further high-quality studies are warranted. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420261395137, PROSPERO registration number: CRD420261395137.