Efficacy of Early Physical Rehabilitation for Stroke-induced Hemiplegia: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 LIUChun-ying ¹ ,  GUOYi ² , YANGHuan ³ , LIUMiao ¹ , LIFei ¹ , PENGLei ¹

1. Department of Neurology, People's Hospital of Wuhan University, Wuhan 430060, China;
2. Department of Epidemiology, College of Public Health, Wuhan University, Wuhan 430071, China;
3. Hope School of Nursing, Wuhan University, Wuhan 430071, China;

Corresponding author：

GUOYi, Email: guoyi@whu.edu.cn

Keywords：

Early physical therapy; Stroke; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.20160028

Video：

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Objective To systematically review the efficacy of early physical rehabilitation for patients with stroke-induced hemiplegia. Methods Databases including PubMed, Web of Knowledge, The Cochrane Library (Issue 7, 2014), EMbase, CNKI, VIP and WanFang Data were searched to collect randomized controlled trials (RCTs) about early physical rehabilitation for patients with stroke-induced hemiplegia from inception to 1st August 2014. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, metaanalysis was performed using RevMan 5.2 software. Results A total of 6 RCTs were included. The results of metaanalysis showed that, after 1 month of treatment, the Fugl-Meyer scores (MD=18.02, 95%CI 6.24 to 29.80, P=0.003) and BI scores (MD=32.32, 95%CI 24.28 to 40.36, P<0.000 01) in the early physical rehabilitation group were higher than that in the conventional rehabilitation group. But after 3 months of treatment, there were no statistical differences between two groups in the proportion of patients with 0-2 MRS scores, mortality and the incidence of complications. Conclusion Current evidence shows that early physical rehabilitation can effectively improve the limb motor function and daily living ability in patients with stroke-induced hemiplegia. However, due to the limited quantity and quality of the include studies, more large-scale, high quality RCTs are needed to verify the above conclusion.

Citation： LIUChun-ying, GUOYi, YANGHuan, LIUMiao, LIFei, PENGLei. Efficacy of Early Physical Rehabilitation for Stroke-induced Hemiplegia: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2016, 16(2): 166-171. doi: 10.7507/1672-2531.20160028 Copy

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3.	Zhang Y, Chapman A, Plested M, et al. The Incidence, Prevalence, and Mortality of Stroke in France, Germany, Italy, Spain, the UK, and the US:A Literature Review. Stroke Res Treat, 2012, 12(3):1-11.
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17.	薛嘉, 罗祖明. 脑卒中偏瘫运用运动再学习方法训练的随机对照分析. 中国临床康复, 2003, 7(19):2747.
18.	潘翠环, 何镜清, 蒲蜀湘, 等. 早期康复干预对老年急性期脑卒中偏瘫患者上下肢功能及日常生活能力恢复的影响. 中国临床康复, 2004, 8(13):2404-2405.
19.	霍瑞霞. 早期运动疗法对脑卒中偏瘫患者肢体功能康复效果的影响. 中国实用护理杂志, 2011, 27(21):15-16.
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22.	Sundseth A, Thommessen B, Ronning OM. Outcome after mobilization within 24 hours of acute stroke:a randomized controlled trial. Stroke, 2012, 43(9):2389-2394.

1. C. Warlow, J. van Gijn, M. Dennis, et al. Stroke:practical management. Blackwell Publishing, 2008:995-998.
2. Demyttenaere K, Bruffaerts R, Posada-Villa J, et al. Prevalence, Severity, and Unmet Need for Treatment of Mental Disorders in the World Health Organization World Mental Health Surveys. JAMA, 2004, 291(21):2581.
3. Zhang Y, Chapman A, Plested M, et al. The Incidence, Prevalence, and Mortality of Stroke in France, Germany, Italy, Spain, the UK, and the US:A Literature Review. Stroke Res Treat, 2012, 12(3):1-11.
4. Liu L, Wang D, Wong K S L, et al. Stroke and Stroke Care in China: Huge Burden, Significant Workload, and a National Priority. Stroke, 2011, 42(12):3651-3654.
5. Fishbain D A, Bruns D, Meyer L, et al. Exploration of the relationship between disability perception, preference for death over disability, and suicidality in patients with acute and chronic pain. Pain Med, 2012, 13(4):552-561.
6. Norrie P. Physical fitness training for stroke patients. Int J Evid Based Healthc, 2010, 8(4):284-285.
7. Brazzelli M, Saunders D H, Greig C A, et al. Physical fitness training for patients with stroke:updated review. Stroke, 2012, 43(4):39-40.
8. Lynch E, Hillier S, Cadilhac D. When should physical rehabilitation commence after stroke:a systematic review. Int J Stroke, 2014, 9(4): 468-478.
9. National Stroke Foundation. Clinical Guidelines for Stroke Management 2010. Melbourne Australia. National Stroke Foundation, 2010.
10. The European Stroke Organisation Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis, 2008, 25(5):457-507.
11. Management of Stroke Rehabilitation Working Group. VA/ DOD Clinical practice guideline for the management of stroke rehabilitation. J Rehabil Res Dev, 2010, 47(9):1-43.
12. 中华医学会. 各类脑血管病诊断要点. 中华神经内科杂志, 1996, 29(6):379-381.
13. World Health Organization. Cerebrbrovascular disorders (Offset Publications). Geneva:World Health Organization, 1978.
14. Quinn TJ, Langhorne P, Stott DJ. Barthel index for stroke trials: development, properties, and application. Stroke, 2011, 42(4):1146-1151.
15. Sulter G, Steen C, De Keyser J. Use of the Barthel index and modified Rankin scale in acute stroke trials. Stroke, 1999, 30(8): 1538-1541.
16. Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011.
17. 薛嘉, 罗祖明. 脑卒中偏瘫运用运动再学习方法训练的随机对照分析. 中国临床康复, 2003, 7(19):2747.
18. 潘翠环, 何镜清, 蒲蜀湘, 等. 早期康复干预对老年急性期脑卒中偏瘫患者上下肢功能及日常生活能力恢复的影响. 中国临床康复, 2004, 8(13):2404-2405.
19. 霍瑞霞. 早期运动疗法对脑卒中偏瘫患者肢体功能康复效果的影响. 中国实用护理杂志, 2011, 27(21):15-16.
20. Bernhardt J, Dewey H, Thrift A, et al. A very early rehabilitation trial for stroke (AVERT):phase II safety and feasibility. Stroke, 2008, 39(2):390-396.
21. Diserens K, Moreira T, Hirt L, et al. Early mobilization out of bed after ischaemic stroke reduces severe complications but not cerebral blood flow:a randomized controlled pilot trial. Clin Rehabil, 2012, 26(5):451-459.
22. Sundseth A, Thommessen B, Ronning OM. Outcome after mobilization within 24 hours of acute stroke:a randomized controlled trial. Stroke, 2012, 43(9):2389-2394.

Chinese Journal of Evidence-Based Medicine

Efficacy of Early Physical Rehabilitation for Stroke-induced Hemiplegia: A Systematic Review

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