Effects of kinesio taping at different intervention time on the motor function of lower extremity after stroke: a Meta-analysis

doi:10.3969/j.issn.2095-4344.0400

Abstract

Abstract:

BACKGROUND: Kinesio taping is a method of treating motor dysfunction of lower extremity after stroke, but there is still a lack of evidence-based medical evidence for its intervention time and efficacy.
OBJECTIVE: To systematically review the effect of kinesio taping at different intervention time on the motor function of lower extremity after stroke.
METHODS: PubMed, Web of science, Cochrane Library, EMbase, OVID (MEDLINE), CNKI, WanFang, VIP, CBM, FMRS and grey literature database (Opengrey) were retrieved, from inception to November 3, 2017. Two evaluators independently screened the literature, extracted the data and evaluated the quality according to the inclusion and exclusion criteria. Meta-analysis was conducted on RevMan 5.3.
RESULTS AND CONCLUSION: A total of 15 studies involving 675 patients were included. The results of Meta-analysis showed that the trial group was better than the control group in the improvement of lower limb movement, walking and balance function in stroke patients (SMD=1.17, 95%CI (0.46, 1.87), Z=3.25, P=0.001; SMD=0.80, 95%CI (0.42, 1.18), Z=4.15, P < 0.000 1; SMD=1.18, 95%CI (0.59, 1.77), Z=3.94, P < 0.000 1). The results of subgroup analysis showed that the trial group was better than the control group in the improvement of lower limb movement, walking and balance function in patients with cerebral apoplexy after 4 weeks of treatment (SMD=1.73, 95%CI (0.71, 2.76), Z=3.33, P=0.000 9; SMD=0.85, 95%CI (0.54,1.16), Z=5.43, P < 0.000 01; SMD=0.96, 95%CI (0.54,1.39), Z=4.46, P < 0.000 01). The trial group was better than the control group in the improvement of lower limb movement and walking function in patients with cerebral apoplexy after 8 weeks of treatment (SMD=0.44, 95%CI (0.12, 0.75), Z=2.71, P=0.007; SMD=1.11, 95%CI (0.65, 1.56), Z=4.76, P < 0.000 01). These results indicate that 4-week kinesio taping adjuvant therapy is superior to the simple conventional treatment, rehabilitation therapy or other treatments, which can improve the lower limb movement, walking and balance function of stroke patients. After 8 weeks of treatment, it can improve the lower limb movement and walking function of stroke patients.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: Transdermal Patch, Stroke, Walking, Tissue Engineering

CLC Number:

R318

Wu Yan-hua, Li Zhuang-miao, Dong Xu. Effects of kinesio taping at different intervention time on the motor function of lower extremity after stroke: a Meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(32): 5241-5248.

Figures/Tables 4

2.1 文献检索结果初步检出文献共312篇，最终纳入15个随机对照试验[9-10，13-25]，共675例患者。纳入文献筛选流程见图1，纳入文献的基本特征见表1。 2.2 纳入文献的方法学质量评价纳入15篇文献中[9-10，13-25]，5篇文献描述使用随机数字表法进行随机分组[9，16-17，22，24]，1篇文献描述使用信封进行随机分组[20]；所有纳入文献均未对分配隐藏方案进行描述；2篇文献对研究者和受试者施盲[13，18]，1篇文献未对研究者和受试者施盲[9]，且其结局可能受盲法缺失的影响；3篇文献对结局指标评价实施盲法[13，17，24]，1篇文献未对结局指标评价实施盲法[18]，且结局的测量可能受盲法缺失的影响；11篇文献结果数据完整[9，13，15-17，19-24]，2篇文献未提及结果数据完整性问题[10，18]，2篇文献有脱落失访病例[13，25]，但原因及处理方式未报道；所有纳入文献均未发现选择性报道结果；所有纳入文献的基线资料均具有可比性，1篇文献存在于使用的研究设计方案相关的偏倚[13]，其余文献无其他偏倚来源或不清楚。具体偏倚风险评估见图2，3。 2.3 Meta分析结果通过异质性检验发现各研究间存在异质性(P ≤ 0.1或I2 ≥ 50%)且结局指标评价采用不同评价量表，故以标准化均数差(SMD)作为效应量，采用随机效应模型进行Meta分析，并对不同干预时间行亚组分析。 2.3.1 肌内效贴对脑卒中患者下肢运动功能影响的Meta分析共纳入8篇文献[9，16-17，20-24]，其中6篇采用FMA下肢部分[16-17，20-22，24]、2篇采用下肢Brunnstrom运动功能分期评价[9，23]。Meta分析结果显示，肌内效贴能改善脑卒中患者下肢运动功能，疗效优于对照组，差异具有统计学意义[SMD=1.17，95%CI(0.46，1.87)，Z=3.25，P=0.001，I2=90%]。见图4。 2.3.2 肌内效贴对脑卒中患者步行功能影响的Meta分析共纳入11篇文献[10，13-15，17-21，23-24]，其中3篇评估10 m最大步行速度[17，20，24]、1篇评估10 m步行速度[13]、4篇评估10 m步行时间[10，13，18，23]、1篇评估6 m步行时间[15]、1篇参照Wall的步态测试方法评估步速[19]、1篇评估FAC[21]。Meta分析结果显示，肌内效贴能改善脑卒中患者步行功能，疗效优于对照组，差异有统计学意义[SMD=0.80，95%CI (0.42，1.18)，Z=4.15，P < 0.000 1，I2=68%]。见图5。 2.3.3 肌内效贴对脑卒中患者平衡功能影响的Meta分析共纳入8篇文献[10，14-18，20，25]，其中5篇采用BBS进行评估[10，14-15，18，25]、3篇评估TUGT[16-17，20]。Meta分析结果显示，肌内效贴能改善脑卒中患者平衡功能，疗效优于对照组，差异具有统计学意义[SMD=1.18，95%CI(0.59，1.77，Z=3.94，P < 0.000 1，I2=83%]。见图6。 2.3.4 肌内效贴对脑卒中患者下肢运动、步行和平衡功能影响的亚组分析 (1)肌内效贴不同干预时间对脑卒中患者下肢运动功能影响的Meta分析：5篇文献报道了治疗4周的结果[16-17，20，23-24]，亚组分析结果显示，两组差异有统计学意义[SMD=1.73，95%CI(0.71，2.76)，Z=3.33，P=0.000 9，I2=89%]；3篇文献报道了治疗8周的结果[21-22，24]，亚组分析结果显示，两组差异有统计学意义[SMD=0.44，95%CI (0.12，0.75)，Z=2.71，P=0.007，I2=0%]。见图7。 (2)肌内效贴不同干预时间对脑卒中患者步行功能影响的Meta分析：8篇文献报道了治疗4周的结果[10，13，17-20，23-24]，亚组分析结果显示，两组差异有统计学意义[SMD=0.85，95%CI(0.54，1.16)，Z=5.43，P < 0.000 01，I2=30%]； 2篇文献报道了治疗6周的结果[14-15]，亚组分析结果显示，两组差异无统计学意义[SMD=1.08，95%CI(-1.25，3.42)，Z=0.91，P=0.36，I2=95%]；3篇文献报道了治疗8周的结果[18，21，24]，亚组分析结果显示，两组差异有统计学意义[SMD=1.11，95%CI(0.65，1.56)，Z=4.76，P < 0.000 01，I2=0%]。见图8。 (3)肌内效贴不同干预时间对脑卒中患者平衡功能影响的Meta分析：5篇文献报道了治疗4周的结果[10，16-18，20]，亚组分析结果显示，两组差异有统计学意义[SMD=0.96，95%CI(0.54，1.39)，Z=4.46，P < 0.000 01，I2=47%]；2篇文献报道治疗6周的结果[14-15]，亚组分析结果显示，两组差异无统计学意义[SMD=1.10，95%CI(-0.76，2.95)，Z=1.15，P=0.25，I2=95%]。见图9。 2.3.5 敏感性分析纳入的部分研究间存在统计学异质性(P ≤ 0.1或I2 ≥ 50%)，故对纳入≥3篇文献的组别通过逐篇去除文献进行敏感性分析，探索其异质性来源及其结果的稳定性。虽然去除部分研究可使异质性检验结果I2值发生质的改变(P < 0.01或I2 < 50%)，但均未对Meta分析结果产生本质性的改变，差异仍有统计学意义(P < 0.05)，与敏感性分析前的Meta分析结果一致，说明研究分析结果相对稳定，具体敏感性分析结果见表2。 2.3.6 发表偏倚风险评估绘制漏斗图评估肌内效贴对脑卒中患者步行功能(纳入11篇文献)影响的发表偏倚，结果显示肌内效贴对脑卒中患者步行功能影响的漏斗图基本对称(图10)，存在发表偏倚的风险较低。"

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