Chinese Journal of Tissue Engineering Research ›› 2021, Vol. 25 ›› Issue (14): 2287-2296.doi: 10.3969/j.issn.2095-4344.3132
Wu Cunshu1, Zhan Xiaoxuan1, Zhao Siyi2, Huang Fan2, Zhang Yue1, Qiu Mingwang1, Xia Jingxian1, Lu Xiaobo3#br#
Received:
2020-05-25
Revised:
2020-05-26
Accepted:
2020-08-19
Online:
2021-05-18
Published:
2020-12-31
Contact:
Lu Xiaobo, Department of Rehabilitation, Jieyang Hospital of Traditional Chinese Medicine, Jieyang 522000, Guangdong Province, China
About author:
Wu Cunshu, Acupuncture and Rehabilitation School of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
Supported by:
CLC Number:
Wu Cunshu, Zhan Xiaoxuan, Zhao Siyi, Huang Fan, Zhang Yue, Qiu Mingwang, Xia Jingxian, Lu Xiaobo. Gait training for spinal cord injury based on radar plotting: an overview of systematic reviews[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(14): 2287-2296.
2.2 纳入文献基本特征 文章最终共纳入20篇文献[18-37],均已在国内外期刊上发表。文献发表的年份在2009至2018年,其中纳入文献题名标注为“A Systematic Review”的有14篇[19-20,22,24,27,29-37],为“A System Review and Meta-analysis”的有2篇[21,23],为“Meta分析”的有2篇[18,28],“Review”的有2篇[25-26]。纳入的文献中,有2篇所属国家为中国[18, 28],有4篇所属国家为美国[19,23,29-31],有4篇所属国家为加拿大[22,26,33-34],有2篇所属国家为巴西[20,36],有2篇所属国家为伊朗[24-25],有2篇所属国家为英国[27,32],另外有4篇分别属于墨西哥、加拿大、德国和韩国[21,28,35,37],有16篇文献没有具体的实验组与对照组[18-27,28-30,34-36],但都是以研究步态训练的有效性为前提,使用机器人辅助或其他康复机器辅助训练,有1篇以外骨骼辅助运动作为试验组对比传统膝踝足矫形器的疗效[31],有1篇以下肢步态训练、机器人康复作为试验组对比康复理疗和步态训练的疗效[32],有1篇以虚拟现实、强化运动疗法、BWS训练、BWST训练作为试验组对比常规理疗的疗效[33],有1篇以急性RAGT疗法作为试验组对比慢性RAGT疗法的疗效[37];在对纳入随机对照试验偏倚风险评价中,其中有6篇采用Cochrane系统评价员手册推荐的偏倚风险评估工具[18,21-22,25,29, 37],有1篇使用PEDro量表作为偏倚风险评价工具[33],有7篇没有采用采用量表评价偏倚风险[19-20,23-27]。 结局指标总结:①主要结局指标:有12篇报道了步行速度[18-19,23-24,27-31,35-37],有10篇文献报道了步态参数-仪表化步态评估[19-22,24,26,29-32];②次要结局指标:有5篇报道了步行能力[19,27,30-31,37],有5篇报道了步行距离[22-24, 30,35],有4篇报道了脊髓损伤的步行独立性测量[19,22,32,37],有4篇报道了脊髓损伤独立量表(SCIM)功能评分、功能独立量表(FIM)评分[21,31-32,34],有2篇报道了下肢运动评分[19,32],有2篇报道了肌电图[19,29],有2篇报道了步行时间[24,27],有2篇报道了步行能量消耗情况[25-26]。 纳入研究的基本特征见表1。 "
2.3 发表年份比较 每1篇文献所研究的问题对临床的指导意义的强度与研究文献年份、涵盖范围和时间跨度有关。研究越新及时间跨度越大,对临床的指导意义越强。文章纳入20篇系统评价/Meta分析,故将2018年发表文献秩数定为20,在系统评价/Meta分析文献中,出版时间较新最早为2007年,包含1篇[34];最晚为2018年,包含4篇[19,29,32,36];期间2017年5篇[20-21,33,35,37],2016年2篇[22,31],2015年2篇[24-25],2014年2篇[23,26],2013年2篇[18,27],2012年1篇[30],2009年1篇[28]。 2.4 研究类型比较 评价某项治疗的有效性的最高级别临床证据是临床的随机对照试验(随机对照试验)。此次研究发现,多数文献仅纳入随机对照试验,共有12篇[18,21-22,27-29,31-36],另外,有4篇文献纳入了随机对照试验和不同程度的观察性研究(包括病例分析、病例对照研究和队列研究)[23,25-26,36],有3篇仅纳入了不同程度观察性研究(包括病例分析、病例对照研究、队列研究)[19-20,24],有1篇文献未说明研究类型[30]。 2.5 AMSTAR-2评价结果 AMSTAR-2方法学评分量表共16项条目。有20篇文献的分值区间为3.5-14分。其中评价为3.5分的文章为3篇[20,26,34],4分的有1篇[28],4.5分的有1篇[29],5分的有1篇[30],5.5分的有1篇[19],6分的有3篇[23-24,35],6.5分的有1篇[25],8.5分的有一篇[31],9分的有3 篇[18,27,33],10分的有1篇[32],10.5分的有1篇[22],11分的有1篇[36],11.5分的有1篇[21],14分的有1篇[37],总体总分分值偏低。其中评价AMSTAR-2评价结果根据结果效度关键的7个条目,分别为条目2,4,7,9,11,13和15,分为高、中、低、极低4个等级,有18篇文献均为极低,只有2篇为低[21,37]。主要存在的问题:①在第2项(是否声明在系统评价实施前已经确定了系统评价的研究方法?对于与研究方案不一致处是否进行说明?)中,仅4篇研究为 “是”[33,35-37],仅1篇为部分“是”[27],其他均为“否”;②在第4项(系统评价作者是否采用了全面的检索策略?)中,仅4篇研究[27,33,36-37]为“是”,5篇研究为“否”[25-26,29,34-35],其他为部分“是”;③在第9项(系统评价作者是否采用合适工具评估每个纳入研究的偏倚风险?)中,仅5篇研究为“ “是”[18,29,33,35,37],仅3篇研究为部分“是”[21-22,32],其他均为“否”;④在第11项(作Meta分析时,系统评价作者是否采用了合适的统计方法合并研究结果?)中,7篇研究为“是”[21-24,28,36-37],其他均为“否”;⑤在第13项(系统评价作者解释或讨论每个研究结果时是否考虑纳入研究的偏倚风险?)中,仅5篇研究为“是”[21-22,27,31-32,37],其他均为“否”;⑥在第15项(如果系统评价作者进行定量合并,是否对发表偏倚(小样文章偏倚)进行充分的调查,并讨论其对结果可能的影响?)中,仅3篇研究为“是”[18,21,28],其他均为“否”。 2.6 PRISMA评价结果比较 PRISMA满分为27分,20篇文献分值为10-22.5分[18-37]。文献分值偏低的因素有:①有18篇文章均没有提供注册号[18-28,30-32,34-37];②除了2篇研究[29,33],其他纳入文献的摘要信息不充分;③除7篇研究[21-22,28, 30,33-34,37]外,其他文献没有评估可能影响数据综合结果的可能存在的偏倚;④除2篇研究外[28,31],其他纳入文献没有其他分析方法;⑤除了6篇研究[21-22,24,28,33,37],其他均没有报告研究间的偏倚;⑥除7篇研究使用了漏斗图或森林图进行分析[18,21,23,28,33,35,37],其他均未使用漏斗图或者森林图分析结果;⑦除9篇研究外[18,21-22,29,31-33,36-37],其他文献均没有报告研究内部偏倚。 2.7 雷达图多元评价条目 见表2。"
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