上肢機器輔助療法於中風復健之成效：系統性回顧與後設分析

目的：機器輔助療法之系統回顧與後設分析陸續發表，近一、兩年來應用機器輔助治療的中風復健臨床試驗增加甚多，本文回顧1950年1月至2013年3月之機器輔助療法文獻，並進行統整，供臨床應用與研究發展參考。方法：檢索PubMed,Medline, PsycINFO, Scopus, CINAHL, 及Cochrane等電子資料庫上之論文，並擴大搜尋相關文獻，更完整納入以中風個案為目標族群、機器輔助療法為實驗組治療介入、控制組為等劑量積極介入，且至少有一項國際功能健康與身心障礙分類系統之身體功能／結構層級、活動層級、或參與層級評量為量測結果之隨機控制臨床試驗，計算個別與統合的效果值並整合分析。結果：本文共收錄22篇論文，依皮卓量表評估，多為高品質研究。研究結果顯示：雖未達統計顯著差異，但接受機器輔助療法之中風患者於身體功能／結構層級呈現中度療效（Hedges's g=0.424, p=.056），於參與層級達低度療效（Hedges's g=0.211, p=.144）；於活動層級與控制組相比，兩種療法間之成效相似（Hedges's g=-0.047, p=.881）。結論：目前機器輔助療法為新興的中風治療方案之一，但各層級療效之解讀，仍需注意研究條件之異質性，如：受試者特徵、機器種類、及治療劑量等。未來可考慮結合機器輔助療法與其他治療，如：結合侷限誘發療法或功能性任務導向治療，以提升中風個案在活動層級之功能改善。

關鍵字

機器輔助療法；中風；半側偏癱；上肢復健；後設分析

並列摘要

Objective: A previous systematic review and meta-analysis indicated the effects of robot-assisted therapy (RT) on arm function and activities of daily living, but not in muscle strength. However, randomized controlled trials of RT in stroke rehabilitation have accumulated in recent years. This systematic review and meta-analysis was to synthesize and analyze studies that examined the effects of RT after stroke on the domains of the International Classification of Functioning, Disability, and Health (ICF). Methods: Articles published between January 1950 and March 2013 were retrieved from electronic databases and manual search. Relevant references were also reviewed. To be eligible for inclusion, the study should involve a randomized controlled trial that studied the effects of RT compared to the matched dose of control interventions in stroke patients on the body function and structure or activity or participation domain of the ICF. The effect size estimates were calculated and integrated for each outcome measure of the included studies. Results: Twenty-two reports were eligible for inclusion. The meta-analysis showed that RT led to better improvements than control interventions on the body function and structure domain with approximately moderate effect sizes (Hedges's g= 0.424, p=.056) and on the participation domain with small effect sizes (Hedges's g= 0.211, p=.144). However, there were similar effect sizes on the activity domain (Hedges's g=-0.047, p=.881). Conclusion: This review supported the effects of RT on the body function and structure and participation domains of the ICF. Future research is needed to study the characteristics of participants and the levels of biomarkers relevant for outcome prediction, and underlying mechanisms of RT.

並列關鍵字

Robot-assisted therapy ； Hemiplegia ； Upper limb ； Rehabilitation ； Meta-analysis

國際替代計量

上肢機器輔助療法於中風復健之成效：系統性回顧與後設分析

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