結合運動及認知訓練對於中風患者認知功能及步態表現的效果：系統性回顧與統合分析

背景與目的：中風影響動作及步態功能，也可能影響認知功能。先前研究發現運動訓練或是認知訓練對於中風患者的認知功能有改善效果，運動訓練對於中風患者的步態表現也是有效的，而結合兩者介入方式則可以涵蓋動作及認知層面的訓練。本研究目的為以統合分析及系統性回顧的方式，探討結合認知及運動訓練較僅運動訓練對於中風患者的認知功能及步態表現的差異。方法：本研究使用相關資料庫進行文獻搜尋，納入近十年（2011年9月至2021年9月）的隨機對照試驗，並使用Review Manager 5.4版軟體進行統合分析。結果：共計納入7篇隨機對照試驗之文獻，統合分析結果顯示中風患者經過結合認知及運動訓練後，在單一任務下的行走速度（p=0.02）、步頻（p=0.004）較僅運動訓練有顯著改善效果，但步長則未達顯著差異。但認知功能中的記憶能力及執行功能則未達到顯著差異。結論：結合認知及運動的訓練方式比起僅進行運動訓練更可改善中風患者在單一任務下的行走速度及步頻。

關鍵字

結合運動及認知訓練；步態表現；認知功能；中風

並列摘要

Background and Purpose: The impairments in motor function, gait performance, and cognition are frequently demonstrated in people with stroke. It has been reported that exercise or cognitive training exerted beneficial effects on cognitive function, while exercise training resulted in positive effects on gait performance in people with stroke. Therefore, combining these two interventions may be more effective on motor and cognitive function than single exercise training. The purpose of this meta-analysis was to determine the effects of combining cognitive and exercise training on the cognitive function and gait performance compared with exercise training in people with stroke. Methods: The searched databases included Pubmed, MEDLINE, PEDro, Cochrane, and CINAHL. The randomized controlled trials in English published from September 2011 to September 2021 meeting the inclusion criteria were included. The quality of eligible studies was evaluated using PEDro Scale. Meta-analysis was conducted using Review Manager Version 5.4 software. Results: A total of seven articles meeting the inclusion criteria were analyzed. The results of meta-analysis showed that combining cognitive and exercise training significantly improved more in gait speed (effect size [ES] = 0.45, 95% confidence interval [CI]: 0.08-0.82, p = 0.02) and cadence (ES = 0.73, 95% CI: 0.23-1.23, p = 0.004), but not in step length, as compared with exercise training in people with stroke. Moreover, combined intervention did not exert better effects on memory and executive function than exercise training alone. Conclusion: Combining cognitive and exercise training improved more in gait speed and cadence as compared with exercise only in people with stroke.

並列關鍵字

Combining cognitive and exercise training ； Gait performance ； Cognitive function ； Stroke

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