台灣職能治療研究與實務雜誌 
Journal of Taiwan Occupational Therapy Research and Practice
ISSN-1819-7167
半年刊,正常發行
沿革
2005年11月1日創刊
制動療法對於中風病人療效之系統性回顧
Effects of Constraint-induced Therapy in Patients with Stroke: A Systematic Review
陳玥岑(Yueh-Tsen Chen);吳菁宜(Ching-Yi Wu);林克忠(Keh-Chung Lin)
制動療法;中風患者;動作功能;日常生活功能;文獻回顧;Constraint-induced Therapy;Cerebral Vascular Accidents;Motor Function;Daily Functioning;Literature Review
摘要
中文 English

目的:探討制動療法(constraint-induced therapy)於中風患者療效的隨機臨床試驗近年漸增,但尚未有系統性回顧與整合,以釐清療效證據,本文透過系統性文獻回顧,整合制動療法相較於傳統復健治療對於中風患者之成效。方法:檢索電子資料庫中1993年至2006年發表之文獻,並徵詢國內從事中風復健治療試驗的專家,找出以制動療法(或修正式制動療法)、傳統復健治療為自變項,上肢動作功能、動作控制之運動學參數、日常生活功能、神經塑性及生活品質為依變項之隨機控制試驗,並計算效果值。結果:共收錄15篇適用文獻報告。分析結果顯示制動療法組在上肢動作功能、反應時間、動作單位、患側手使用量、動作品質及自覺生活品質等,皆優於傳統治療組,呈現中度至高度效應,且治療後腦活化型態較接近健康人。結論:制動療法較傳統治療可有效改善中風患者動作控制能力、動作品質及上肢動作功能,增加執行日常生活的效率,提升整體生活品質,並引發大腦功能重組。未來可透過設計嚴謹的臨床試驗,並增加樣本數,來釐清侷限健側手、大量練習、行為雕塑等要素的相對重要性,以發展具實證基礎與學理依據的中風復健治療。

Objective: Randomized controlled trials (RCTs) that investigated the effects of constraint-induced therapy (CIT) after stroke have accumulated. This body of literature awaits a quantitative review to inform the evidence-based practice of stroke rehabilitation. This study reported the quantitative results of a systematic review of the literature that includes RCTs comparing CIT to tradition rehabilitation for stroke. Methods: To retrieve RCTs relevant for this review, articles published during 1993 to 2006 were searched from electronic databases. Researchers who have investigated the effects of stroke rehabilitation in Taiwan were contacted for providing local RCTs. The independent variables of the target studies were CIT or modified CIT and traditional rehabilitation. The dependent variables were motor function, kinematic parameters of motor control, daily functioning, neuroplasticity, and quality of life. To be eligible for inclusion, the study design must be randomized controlled trials. The effect size estimates were calculated based on statistics presented in the reports. Results: Fifteen articles were eligible for analysis. The results showed that patients receiving CIT performed better in motor function, kinematic performance (i.e., reaction time and movement units), amount of use and quality of movement of the affected arm, activities of daily living, and quality of life, with moderate to large effects. In addition, the therapy altered brain plasticity based on studies of PET activations. Conclusion: CIT was more effective than traditional rehabilitation in improving motor function, motor control, daily functioning, and quality of life. The brain imaging literature provides evidence for functional reorganization of the brain. Further research may investigate the relative importance of components of CIT to facilitate development of theory-and evidence-based rehabilitation after stroke.

來源資料:2卷1期