运动想象训练对全膝关节置换术患者干预效果的分析

目的系统评价运动想象训练(MIT)对全膝关节置换手术(TKA)患者的干预效果。 方法检索荷兰医学文摘数据库(EMBASE)、PubMed、Web of Science、Cochrane Library、卫生保健及护理学数据库(CINAHL)、中国生物医学文献数据库(CBM)、中国知网、万方、维普数据库，收集关于MIT对TKA患者干预效果的随机对照试验。筛选研究对象为采用MIT联合常规物理康复或只进行常规物理康复的TKA术后患者，结局指标涉及股四头肌肌力、膝关节活动范围(ROM)、疼痛视觉模拟评分(VAS)、计时起立－行走测试(TUG)。运用Cochrane协作工具对纳入研究的质量进行评估，采用Stata 16.0软件进行Meta分析。 结果共纳入8篇文献，264例患者。Meta分析结果显示：MIT组与对照组相比，能显著提升TKA患者股四头肌肌力[标准化均数差(SMD)＝0.67，95%置信区间(CI)(0.37，0.96)，P<0.001]、膝关节ROM [SMD＝0.60，95%CI(0.06，1.15)，P＝0.032]，降低VAS评分[SMD＝－0.64，95%CI(－1.00，－0.28)，P＝0.001]，但对TUG的影响无统计学意义[SMD＝－0.59，95%CI(－1.21，0.03)，P＝0.063]。亚组分析显示，在慢性康复期(术后≥2周)，MIT能显著提升膝关节ROM[SMD＝1.65，95%CI(0.84，2.45)，P<0.001]，降低VAS评分[SMD＝－0.63，95%CI(－1.10，－0.16)，P＝0.008]，而在急性康复期(术后24 h)MIT对膝关节ROM与VAS的影响无统计学意义(P>0.05)。 结论当前证据表明，MIT联合常规物理康复能够显著提升TKA术后患者股四头肌力量、膝关节ROM，缓解疼痛。但MIT对膝关节ROM与疼痛的干预效果受康复阶段的影响。

Effect analysis of motor imagery training on patients undergoing total knee arthroplasty

ObjectiveTo systematically evaluate the effect of motor imagery training (MIT) on total knee replacement (TKA) patients. MethodsDatabases including Excerpta Medica Database (EMBASE), PubMed, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Chinese BioMedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Database and China Science and Technology Journal Database(VIP) were searched to collect randomized controlled trials on the efficacy of MIT intervention in TKA patients. The selected subjects were TKA patients who received MIT combined with conventional physical rehabilitation or only conventional physical rehabilitation. The outcome indicators included quadriceps muscle strength, knee range of motion (ROM), visual analogue scale (VAS), and timed up-and-go test (TUG). The Cochrane collaboration tool was used to evaluate the quality of the included studies, and Stata 16.0 software was used for meta-analysis. ResultsEight literatures with 264 patients were included. The results of meta-analysis showed that compared with the control group, the MIT group could significantly improve the quadriceps muscle strength [standardized mean difference (SMD)=0.67, 95% confidence interval (CI) (0.37, 0.96), P<0.001] and knee ROM [SMD=0.60, 95%CI (0.06, 1.15), P=0.032] in TKA patients. VAS score decreased [SMD=-0.64, 95%CI (-1.00, -0.28), P=0.001], but TUG had no significant effect [SMD =-0.59, 95%CI (-1.21, 0.03), P=0.063]. Subgroup analysis showed that MIT significantly improved knee ROM [SMD=1.65, 95%CI (0.84, 2.45), P<0.001] and decreased VAS score [SMD=-0.63, 95%CI (-1.10, -0.16), P=0.008] during chronic rehabilitation period (≥two weeks after surgery). There was no statistically significant effect of MIT on knee ROM and VAS in the acute rehabilitation period (24h after operation)(P>0.05). ConclusionsCurrent evidence shows that MIT combined with routine physical rehabilitation can significantly improve quadriceps muscle strength, knee ROM, and relieve pain in patients after TKA. However, the effect of MIT on knee ROM and pain is affected by the rehabilitation stage.