体外冲击波疗法治疗上运动神经元损伤后痉挛：系统评价和荟萃分析。
Extracorporeal Shock Wave Therapy on Spasticity After Upper Motor Neuron Injury: A Systematic Review and Meta-analysis.
机构信息
From the School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China (H-LZ, R-JJ, D-LZ, X-BL, JL); Department of Rehabilitation, Fushun County People's Hospital, Zigong, People's Republic of China (LG); School of Acupuncture Moxibustion and Tuina/The Third Affiliated Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China (Y-XL, Q-WX); and Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan, People's Republic of China (X-LX).
出版信息
Am J Phys Med Rehabil. 2022 Jul 1;101(7):615-623. doi: 10.1097/PHM.0000000000001977. Epub 2022 Feb 15.
OBJECTIVE
The aim of the study was to evaluate the effectiveness and safety of extracorporeal shock wave therapy on spasticity after upper motor neuron injury.
DESIGN
Eight electronic databases were searched systematically from their inception to August 3, 2021, to provide robust evidence for the efficacy of extracorporeal shock wave therapy for spasticity and range of motion after upper motor neuron injury. Study screening, data extraction, risk of bias assessment, and evaluation of the certainty of evidence were performed independently by two independent reviewers. Data analysis was conducted using RevMan 5.3.5 and R 3.6.1 software.
RESULTS
Forty-two studies with 1973 patients who met the eligibility criteria were selected from articles published from 2010 to 2021, of which 34 were included in the meta-analysis. A comparison intervention revealed that extracorporeal shock wave therapy significantly decreased the Modified Ashworth Scale score and increased the passive range of motion of a joint. Regarding the safety of extracorporeal shock wave therapy, slightly adverse effects, such as skin injury, bone distortion, muscle numbness, pain, petechiae, and weakness, were reported in five studies.
CONCLUSIONS
Extracorporeal shock wave therapy may be an effective and safe treatment for spasticity after upper motor neuron injury. However, because of poor methodological qualities of the included studies and high heterogeneity, this conclusion warrants further investigation.
TO CLAIM CME CREDITS
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.
CME OBJECTIVES
Upon completion of this article, the reader should be able to: (1) Determine the impact of extracorporeal shock wave therapy on spasticity after upper motor neuron injury; (2) Describe the factors that affect the efficacy of extracorporeal shock wave therapy on spasticity; and (3) Discuss the mechanism of action of extracorporeal shock wave therapy on spasticity.
LEVEL
Advanced.
ACCREDITATION
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
目的
本研究旨在评估体外冲击波疗法对上运动神经元损伤后痉挛的疗效和安全性。
设计
系统检索了从建立到 2021 年 8 月 3 日的 8 个电子数据库，为体外冲击波疗法治疗上运动神经元损伤后痉挛和关节活动范围提供了有力证据。由两名独立的审查员独立进行研究筛选、数据提取、偏倚风险评估和证据确定性评估。使用 RevMan 5.3.5 和 R 3.6.1 软件进行数据分析。
结果
从 2010 年至 2021 年发表的文章中筛选出符合纳入标准的 42 项研究，共纳入 1973 例患者，其中 34 项研究纳入荟萃分析。比较干预措施显示，体外冲击波疗法可显著降低改良 Ashworth 量表评分，增加关节被动活动范围。关于体外冲击波疗法的安全性，有 5 项研究报道了轻微的不良反应，如皮肤损伤、骨骼变形、肌肉麻木、疼痛、瘀斑和无力。
结论
体外冲击波疗法可能对上运动神经元损伤后痉挛有效且安全。然而，由于纳入研究的方法学质量较差且异质性较高，这一结论尚需进一步研究。
索取 CME 学分：在线完成自我评估活动和评估，网址为：http://www.physiatry.org/JournalCME。
CME 目标：完成本文后，读者应能够：（1）确定体外冲击波疗法对上运动神经元损伤后痉挛的影响；（2）描述影响体外冲击波疗法治疗痉挛效果的因素；（3）讨论体外冲击波疗法治疗痉挛的作用机制。
级别
高级。
认可
学术物理治疗医师协会经继续教育认证委员会认可，可为医生提供继续医学教育。学术物理治疗医师协会将本次基于期刊的 CME 活动指定为最多 1.0 个 AMA PRA 类别 1 学分。医生应仅要求与其参与活动的程度相称的学分。
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