臺灣博碩士論文加值系統

研究背景: 腦中風已成為高齡化社會中常見的慢性疾病之一，雖因醫學進步致死率降低，但後續仍有長期照顧上的負擔。多數中風倖存個案有肌肉力量下降、痙攣、動作與功能表現不佳等肢體上的後遺症，需要透過復健治療協助恢復原本狀態。近年振動治療也被用來改善中風個案的肌力、痙攣以及功能且有耗時較短、不易增加心血管負擔等優點，並在肌力、痙攣以及肢體動作功能的復原有不錯的成效。但目前相關研究多著重於下肢以及全身振動相關探討，對於上肢以及不同模式的振動介入因素，較無統合分析與實務成效探討。
目的:本研究透過系統性回顧與統合分析，探討中風個案在振動治療介入後上肢的肌力、痙攣、動作與功能復原之成效。
方法: 本研究以使用系統性文獻回顧方式，蒐集2011年1月起至2021年5月底為止年份區間內的中、英文研究文章，整合振動治療介入對於腦中風個案之肌力、痙攣及上肢動作與功能等相關評估結果的隨機對照實驗。使用PubMed、MEDLINE、Embase、CINAHL、Cochrane library、ProQuest、Wed of science、華藝中文電子期刊、中國知識資源總庫等共9個資料庫，進行搜尋與文獻檢索。後續採用PEDros評讀文獻品質評讀，並以RevMan 5.4.1軟體之隨機效應模式進行統合分析，再以漏斗圖判定是否有出版偏差。
結果: 本次統合分析共收錄16篇文獻。結果顯示振動治療對於中風個案上肢的肌力提升無明顯介入成效(SMD=0.23, 95%CI[-0.48,0.93], Z=0.63, p=0.53)，至於痙攣降低 (SMD=-0.49, 95%CI[-0.90,-0.08], Z=2.32, p=0.02)、上肢動作恢復(SMD=0.69, 95%CI[0.17,1.21], Z=2.58, p=0.010)與功能增益(SMD=1.88, 95%CI[0.10,3.67], Z=2.07, p=0.04)則有明顯的改善成效。結論:根據本研究結果，顯示振動治療介入對於中風個案之上肢肌力提升無顯著效益，但對於痙攣降低、動作與功能恢復則有明顯效果。此等研究發現，有助於後續臨床人員使用振動治療作為復健訓練項目，改善中風患者偏癱上肢痙攣、動作與功能恢復。

Purpose: Stroke has become one of the most common chronic diseases in aging societies. With the advancing medical science, the fatality rate of stroke has decreased. However, the long-term health care costs are still a burden. Most stroke survivors experience various sequelae, including reduced muscle strength, spasticity, and poor motor functional performance, which require rehabilitation to regain these abilities. The traditional rehabilitation techniques are observed insufficient in improving muscle strength and spasticity. In recent years, vibration therapy has been used to improve muscle strength, spasticity, and functional performance, providing a good recovery of these sequelae in stroke patients. Recent studies predominantly focused on lower limb and whole-body vibration, lacking integrated analysis and practical effect discussion on the upper extremity and different factors that affect vibration intervention. This study aimed to discuss the effectiveness of vibration therapy on muscle strength, spasticity, motor and function in the upper extremity through a systematic review and meta-analysis.
Method: This study reviewed Chinese and English research articles published from Jan 2011 to May 2021 systematically. Integrated randomized controlled trials related to the effectiveness of vibration therapy intervention on muscle strength, spasticity, and upper extremity motor and function of stroke patients were included. A total of nine databases, including PubMed, MEDLINE, Embase, CINAHL, Cochrane Library, ProQuest, Web of science, Airiti Library, and CNKI were used for searching and retrieving the literature. Subsequently, PEDros was used to evaluate the quality of the articles. The random-effects model of RevMan 5.4.1 was used to conduct the meta-analysis, and a funnel plot was used to evaluate the publication bias.
Scientific results and contribution: Sixteen articles were included in this meta-analysis. The results demonstrated that vibration therapy had no obvious intervention effect in improving the upper limb muscle strength in stroke patients (SMD=0.23, 95%CI [-0.48–0.93], Z=0.63, p=0.53); however, it demonstrated intervention effects in improving the spasticity (SMD=-0.49, 95%CI [-0.90–-0.08], Z=2.32, p=0.02), motor (SMD=0.69, 95%CI [0.17–1.21], Z=2.58, p=0.010), and function (SMD=1.88, 95%CI [0.10–3.67], Z=2.07, p=0.04). This study provided a reference for the recovery of vibration therapy intervention on the upper extremity muscle strength, spasticity, motor and function in stroke patients, which is helpful for the clinical staff to use vibration therapy as an interventional method and provides suggestions for future related research directions and design.

目錄
致謝 I
論文摘要 II
Abstract IV
圖目錄 VIII
表目錄 X
第一章 緒論 1
第一節 研究背景及重要性 1
第二節 研究目的 4
第三節 研究問題 5
第四節 名詞定義 6
第二章 文獻查證 9
第一節 腦中風與生活功能之影響 9
第二節 腦中風復原的影響因子及復健治療現況 10
第三節 振動治療之機制與影響因子 12
第四節 振動治療的治療成效 17
第五節 系統性文獻回顧與統合分析 19
第三章 研究方法 21
第一節 研究設計 21
第二節 界定文獻納入與排除條件 21
第三節 文獻搜尋 22
第四節 文獻選擇與選用 23
第五節 研究倫理考量 28
第四章 分析與結果 29
第一節 文獻檢索流程 29
第二節 樣本基本資料與特性 31
第三節 文獻品質評測與分析 38
第四節 對肌力改善效果之整體分析 40
第五節 對痙攣改善效果量之整體分析 44
第六節 對上肢動作與功能改善之整體分析 50
第七節 出版偏差檢定 61
第五章 討論 65
第一節 肌力提升成效討論 65
第二節 痙攣改善成效討論 70
第三節 上肢動作與功能成效討論 75
第六章 結論與建議 82
第一節 研究重要結論 82
第二節 臨床應用 82
第三節 研究限制 82
參考文獻 85
中文文獻 85
英文文獻 88
附錄 120
附錄一 PEDros 兩位人員分別評讀結果 120

圖目錄
圖一、振動介入對高低階中樞與周邊肌肉生理系統影響機制圖 14
圖二、資料庫文獻搜索流程圖 30
圖三、振動治療對中風個案上肢肌力綜合效果量 40
圖四、振動治療對中風個案上肢肌力效果量--年齡次群組效果圖 41
圖五、振動治療對中風個案上肢肌力效果量--罹病月數次群組效果圖 42
圖六、振動治療對中風個案上肢肌力效果量--振動頻率次群組效果圖 43
圖七、振動治療對中風個案上肢肌力效果量--振動模式次群組效果圖 44
圖八、振動治療對中風個案上肢痙攣改善綜合效果量 45
圖九、振動治療對中風個案上肢痙攣改善效果量--年齡次群組圖 46
圖十、振動治療對中風個案上肢痙攣改善效果量--罹病月數效果圖 47
圖十一、振動治療對中風個案上肢痙攣改善效果量--振動頻率次群組效果圖 48
圖十二、振動治療對中風個案上肢痙攣改善效果量--振動模式次群組效果圖 49
圖十三、振動治療對中風個案上肢痙攣改善效果量--手腕A、肩膀B次群組效果圖 50
圖十四、振動治療對中風個案上肢動作綜合效果量 51
圖十五、振動治療對中風個案上肢功能綜合效果量 52
圖十六、振動治療對中風個案上肢動作效果量-年齡次群組效果圖 53
圖十七、振動治療對中風個案上肢動作效果量-罹病月數次群組效果圖 54
圖十八、振動治療對中風個案上肢動作效果量-振動頻率次群組效果圖 55
圖十九、振動治療對中風個案上肢動作效果量-振動類別次群組效果圖 56
圖二十、振動治療對中風個案上肢功能效果量-年齡次群組效果圖 57
圖二十一、振動治療對中風個案上肢功能效果量-罹病月數次群組效果圖 58
圖二十二、振動治療對中風個案上肢功能效果量-振動頻率次群組效果圖 59
圖二十三、振動治療對中風個案上肢功能效果量-振動模式次群組效果圖 60
圖二十四、振動治療介入中風肌力提升的出版偏差 62
圖二十五、振動治療介入中風痙攣改善的出版偏差 63
圖二十六、振動治療介入中風上肢動作的出版偏差 64
圖二十七、振動治療介入中風上肢功能的出版偏差 64
圖二十八、振動治療對中風個案上肢痙攣改善效果--高頻組重新切分組效果圖 74

表目錄
表一、PICOS 形成之臨床問題 5
表二、統合分析文獻一覽表 33
表三、研究特徵表 37
表四、文獻評讀結果 39
表五、研究結果彙整表 60

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英文文獻
Ahmed Burq, H. S. I., Karimi, H., Ahmad, A., Gilani, S. A., & Hanif, A. (2021). Effect of whole-body vibration on obstacle clearance and stair negotiation time in chronic stroke patients; A randomized controlled trial. J Bodyw Mov Ther, 27, 698-704. https://doi.org/10.1016/j.jbmt.2021.05.012
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Alam, M. M., Khan, A. A., & Farooq, M. (2018). Effect of whole-body vibration on neuromuscular performance: A literature review. Work, 59(4), 571-583. https://doi.org/10.3233/wor-182699
Alashram, A. R., Padua, E., & Annino, G. (2019). Effects of Whole-Body Vibration on Motor Impairments in Patients With Neurological Disorders: A Systematic Review. American journal of physical medicine & rehabilitation, 98(12), 1084-1098. https://doi.org/10.1097/PHM.0000000000001252
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