Effectiveness of Rehabilitation Interventions to Improve Gait Speed in Children With Cerebral Palsy: Systematic Review and Meta-analysis
Effectiveness of Rehabilitation Interventions to Improve Gait Speed in Children With Cerebral Palsy: Systematic Review and Meta-analysis
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DOI：
10.2522/ptj.20150401
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发表时间：
2016-12-01
期刊：
影响因子：
3.2
通讯作者：
Lahasky, Kay
中科院分区：
文献类型：
--
作者：
Moreau, Noelle G.;Bodkin, Amy Winter;Lahasky, Kay
背景脑瘫（CP）儿童的步态速度下降，这可能会对他们的社区参与和生活质量产生负面影响。然而，有效的康复干预措施，以提高步态速度的证据仍然不清楚。本研究的目的是确定干预措施的有效性，以提高步行速度与CP儿童。从开始到2014年4月检索MEDLINE/PubMed、CINAHL、ERIC和PEDro。所选的研究是随机对照试验或具有对照组的实验设计，包括CP儿童的物理治疗或康复干预，并报告步态速度作为结果指标。数据提取。方法学质量通过PEDro评分进行评估。提取步态速度的平均值、标准差和变化评分。记录干预的一般研究信息和给药参数（频率、持续时间、强度和体积）。纳入了24项研究。确定了三类干预措施：步态训练（n=8）、阻力训练（n=9）和其他（n=7）。Meta分析显示，步态训练对提高步态速度有效，且有标准。0.92（95%可信区间=0.19，1.66; P= 0.01），而阻力训练的效果可以忽略不计（效应值=0.06; 95%可信区间=-0.12，0.25; P= 0.51）。在其他类别的研究中报告了从阴性到大的效应量。步态速度是分析的唯一结果指标。步态训练是改善CP行走儿童步态速度的最有效干预措施。力量训练，即使剂量适当，也不能有效地提高步态速度。速度训练、肌电生物反馈训练和全身振动在个体研究中对提高步态速度有效，值得进一步研究。
Background. Children with cerebral palsy (CP) have decreased gait speeds, which can negatively affect their community participation and quality of life. However, evidence for effective rehabilitation interventions to improve gait speed remains unclear.Purpose. The purpose of this study was to determine the effectiveness of interventions for improving gait speed in ambulatory children with CP.Data Sources. MEDLINE/PubMed, CINAHL, ERIC, and PEDro were searched from inception through April 2014.Study Selection. The selected studies were randomized controlled trials or had experimental designs with a comparison group, included a physical therapy or rehabilitation intervention for children with CP, and reported gait speed as an outcome measure.Data Extraction. Methodological quality was assessed by PEDro scores. Means, standard deviations, and change scores for gait speed were extracted. General study information and dosing parameters (frequency, duration, intensity, and volume) of the intervention were recorded.Data Synthesis. Twenty-four studies were included. Three categories of interventions were identified: gait training (n=8), resistance training (n=9); and miscellaneous (n=7). Meta-analysis showed that gait training was effective in increasing gait speed, with a standard. ized effect size of 0.92 (95% confidence interval=0.19, 1.66; P=.01), whereas resistance training was shown to have a negligible effect (effect size=0.06; 95% confidence interval= -0.12, 0.25; P=.51). Effect sizes from negative to large were reported for studies in the miscellaneous category.Limitations. Gait speed was the only outcome measure analyzed.Conclusions. Gait training was the most effective intervention in improving gait speed for ambulatory children with CP. Strength training, even if properly dosed, was not shown to be effective in improving gait speed. Velocity training, electromyographic biofeedback training, and whole -body vibration were effective in improving gait speed in individual studies and warrant further investigation.