水療對於多發性硬化症患者的療效：系統性回顧與統合分析

Effects of Hydrotherapy in Patients with Multiple Sclerosis: Systematic Review & Meta-Analysis

周俊宏(Jung-Hong Zhou) ； 許格寧(Ko-Ning Hsu) ； 陳玨良(Jyue-Liang Chen) ； 王瑞瑤(Ray-Yau Wang) ； 楊雅如(Yea-Ru Yang)

《物理治療》 42卷2期 (2017/06) Pp. 95-105

https://doi.org/10.6215/FJPT.PTS20170642026

摘要

背景和目的：多發性硬化症（multiple sclerosis）是由於免疫系統攻擊神經細胞外的髓鞘組織，而導致神經系統病變。患者常見的症狀包含有容易疲勞、痙攣、疼痛、肢體無力、平衡失調、行走困難、感覺麻木與視力受損等。另外，多發性硬化症患者具有「熱敏感（heat sensitivity）」的現象，亦即患者在高熱環境下容易引發疲勞甚至引起疾病復發。水療的特性，如浮力可以幫助患者維持姿勢也可使患者容易在水中運動；黏滯性可以提供患者在活動時給予肢體的阻力，藉此加強肌力；最重要的是水療的水溫皆低於體溫，如此可快速帶走患者在運動時身體產生的熱，避免不良反應的發生。本研究目的為利用統合分析與系統性回顧，探討水療對於多發性硬化症患者之療效。方法：搜尋實證醫學資料庫（Cochrane）、醫學資料庫（MEDLINE、PubMed）、生物醫學索引摘要資料庫（EMBAS）、護理學資料庫（CINAHL）、物理治療證據資料庫（PEDro）與臺灣碩博士論文系統等國際電子資料庫，限制為過去至2015年4月1日以英文與中文發表之文獻。使用皮卓量表與新版牛津實證醫學中心證據等級分析文獻的品質與證據等級。若有兩篇以上，使用相同療效評估，就會使用Review Manager Version 5.3軟體，將其列入統合分析。結果：符合收入條件之文獻共有17篇，隨之進行系統性回顧；其中5篇納入統合分析，皮卓分數為3至9分，證據等級為1b至2c。統合分析結果顯示水療有降低多發性硬化症患者疲勞程度之趨勢（組內比較95%信賴區間：-23.98～0.01，p=0.05；組間比較95%信賴區間：-17.17～0.18，p=0.06），但對增進手握力則無顯著影響（優勢側手95%信賴區間：-1.53～5.28，p=0.28；非優勢側手95%信賴區間：-2.15～4.10，p=0.54）。而根據系統性文獻回顧可知，水療運動介入後，亦可改善多發性硬化症患者的平衡能力、功能性行走與生活品質。結論：水療對於多發性硬化症患者而言是一項有效可實施之運動介入，除了顯著改善患者日常疲勞程度與生活品質，並可增進功能性行走以及平衡能力；另外，統合分析結果雖顯示水療無法顯著改善肌力，但可維持患者肌力表現。未來應有更多高品質研究進一步探討水療對於多發性硬化症患者之療效。

關鍵字

多發性硬化症 ； 水療 ； 運動

並列摘要

Background and purpose: Multiple sclerosis (MS) is a chronic progressive inflammatory demyelinating disease of the central nervous system, due to the autoimmune system attacked on oligodendrocytes and myelin. The most common symptoms are fatigue, spasticity, pain, weakness, poor balance response, functional walking disability, sensory and visual impairments. Further, ＂heat sensitivity＂ results in more fatigue and an increase in neurological symptoms. Aquatic therapy has unique properties, such as ＂buoyancy＂ that can assist patients to maintain posture and easily to do exercise in water; ＂viscosity＂ resists the extremities during exercise to provide strength training. The cold condition in water can decrease the heat from exercise to prevent adverse events. The purpose of this study is using meta-analysis and systematic review to investigate the effect of aquatic therapy on patients with multiple sclerosis. Methods: A systematic search of the literature to the end of 1st April 2015 was conducted. The following databases were searched: Cochrane library, MEDLINE, Pubmed, EMBAS, CINAHL, PEDro, and National Digital Library of Theses and Dissertations in Taiwan. The quality of eligible studies was evaluated using PEDro Scale and Oxford classification. Meta-analysis was conducted using Review Manager Version 5.0 software. Results: Eventually, 17 studies were included in systematic review. Because of the limited data, five articles were included in meta-analysis. The scale of PEDro was 3 to 9 points, and the level of evidence was 1b to 2c. The results of meta-analysis showed that aquatic therapy significantly decrease the fatigue in MS (within-group comparison 95% CI: -23.98 ～ 0.01, p = 0.05; between-group comparison 95% CI: -17.17 ～ 0.18, p = 0.06). However, aquatic therapy couldn’t improve the grip strength (dominant hand 95% CI: -1.53 ～ 5.28, p = 0.28; nondominant hand 95% CI: -2.15 ～ 4.10, p = 0.54). According to systematic review, aquatic therapy improved the balance response, functional ambulation and quality of life in patients with MS. Conclusions: Aquatic therapy is a feasible treatment for patients with MS and with no negative effects or adverse events reported. Aquatic therapy improved the fatigue, quality of life, balance and functional ambulation in MS. Otherwise, aquatic therapy can maintain the strength of MS patients. Future high quality studies can investigate the effects of aquatic therapy on patients with MS.

並列關鍵字

Multiple sclerosis ； Hydrotherapy ； Exercise