A Comparative Study On The Effects Of Rehabilitation Methods Based On The Cerebral Plasticity Theory On The Recovery Of Upper Limb Function Following Stroke

ObjectiveA Bayesian network meta-analysis was used to evaluate and compare the effects of different rehabilitation methods based on the theory of cerebral plasticity on the recovery of upper limb function after stroke in order to provide the evidence-based evidences for the choice of rehabilitation nursing schemes in similar cases.MethodsThe contents of this study plan was submitted to PROSPERO and registration number was applied.Literature retrieval strategies had been formulated.Literature retrieval involved PubMed,China Journal Full-text Database(CNKI),Wanfang Database,China Biomedical Literature Database(CBM)and Weipu Chinese Journal Full-text Database(VIP).The relevant literature published at home and abroad until November 2018 on the effects of rehabilitation methods based on the cerebral plasticity theory on the recovery of upper limb function following stroke was collected,and the criteria for inclusion and exclusion was formulated.Literature management was carried out by EndNote X8.2.Studies were selected and data was extracted in each study.The selected literature was evaluated by the bias risk assessment tool in the Review Manager 5.3 software provided by the Cochrane.STATA15.0 software was used to show the network relationship between the studies and to analyze the bias of publication,WinBUGS1.4.3 was used to evaluate convergence.Node splitting method of GeMTC software and Z test of STATA15.0 software were combined to evaluate consistency and inconsistency.WinBUGS1.4.3 and GeMTC software were used for Bayesian network meta-analysis and the treatment hierarchy was summarised and reported as surface under the cumulative ranking curve.Results(1)A total of 59 articles were included,involving 2254 patients with upper limb dysfunction following stroke.(2)The Markov chains constructed in this study had little fluctuation.The autocorrelation functions were close to 0.The potential scale reduction factors were 1.The convergence degree of Markov chain was satisfactory,and the model could predict data effectively.(3)There was a closed loop in the network diagram.The node splitting method showed that there was consistency(P>0.05),and the Z test showed that there was no inconsistency(P>0.05).Therefore,the study had the conditions to sort the rehabilitation methods.(4)Mirror visual feedback had significantly higher scores for upper limb function in Fugl-Meyer Assessment of the Upper Extremity than conventional therapy.And the probability chart of Fugl-Meyer Assessment of the Upper Extremity scoring ranking showed that mirror visual feedback also had the highest probability of becoming the best scheme with a surface under the cumulative ranking curve of 0.36.The effect size of conventional rehabilitation therapy was significantly lower than that of mirror visual feedback[WMD=-14.40,95%CrI(-24.32,-6.01)].(5)Compared with conventional rehabilitation therapy,the intervention methods involved had no significant change in Box and Block Test scores.There was no statistical significance.The probability chart of Box and Block Test scores scoring ranking showsed that virtual reality technology combined with bilateral arm training had the highest probability of becoming the best scheme with a surface under the cumulative ranking curve of 0.76.(6)Mirror visual feedback had significantly higher scores for upper limb function in Wolf Motor Function Test than conventional therapy,The probability chart of Wolf Motor Function Test scoring ranking showed that mirror visual feedback had the highest probability of becoming the best scheme with a surface under the cumulative ranking curve of 0.59.The effect size of conventional rehabilitation therapy was significantly lower than that of mirror visual feedback[WMD=-12.80,95%CrI(-23.69,-239)].(7)Mirror visual feedback had significantly higher scores for upper limb function in Action Research Arm Test than conventional therapy.The probability chart of Action Research Arm Test scoring ranking showed that mirror visual feedback had the highest probability of becoming the best scheme with a surface under the cumulative ranking curve of 0.79.The effect size of conventional rehabilitation therapy was significantly lower than that of mirror visual feedback[WMD=-16.30,95%CrI(-32.89,-0.08)].(8)The registration number of this study in PROSPERO is CRD42018104816.Conclusion(1)Mirror visual feedback was the most likely to be the best intervention method for the recovery of upper limb function after stroke using Fugl-Meyer Assessment of the Upper Extremity,Wolf Motor Function Test and Action Research Arm Test to evaluate the effects of rehabilitation methods based on the theory of cerebral plasticity.That was,mirror visual feedback could improve the function of the joints of the upper limb,the function of flexion and extension of the upper limb,the ability of coordination,the degree of motion,the stability and coordination of the joint,the ability of task-oriented movement,the ability of grasping and holding,kneading and coarse motor function were superior to other intervention methods involved in this study.(2)Virtual reality technology combined with bilateral arm training had an advantage in evaluating the rehabilitation of upper limb function after stroke based on the theory of brain plasticity by Box and Block Test.That was,virtual reality technology combined with bilateral arm training had a tendency to improve the overall hand flexibility of stroke patients,which was better than the other intervention methods involved in this study.But more evidences were needed to prove that it was the best way to improve overall hand flexibility.(3)Mirror visual feedback was effective,simple,safe,low cost and suitable for families.Virtual reality technology combined with bilateral arm training could improve the work efficiency of specialized nursing staff and avoid the boring and single rehabilitation nursing mode.