Efectividad de la terapia de movimiento inducido por restricción modificada sobre la función motora de la extremidad superior parética en adultos secuelados de accidente cerebrovascular en etapa aguda-subaguda : una revisión sistemática
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2023
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es
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Universidad Andrés Bello
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Licencia CC
Licencia CC
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Antecedentes: La terapia de movimiento inducida por restricción modificada (mCIMT) ha demostrado ser efectiva para mejorar la función de la extremidad superior en las distintas etapas de la rehabilitación del accidente cerebrovascular (ACV). Sin embargo, las revisiones y metaanálisis disponibles han incluido todas las etapas de la rehabilitación, por lo que es relevante analizar y sintetizar la literatura relacionada a etapas agudas y subagudas de rehabilitación del ACV. Objetivo general: Determinar la efectividad de la mCIMT sobre la función motora de la extremidad superior parética en adultos secuelados de ACV en etapa aguda y subaguda de rehabilitación, en base a una revisión de la literatura. Métodos: Se realizó la búsqueda en las bases de datos MEDLINE/Pubmed, Scopus, PEDro y Web of Science. Los criterios de inclusión fueron ensayos controlados aleatorizados en adultos secuelados de ACV con paresia de la extremidad superior, tratados con mCIMT para mejorar la función de la extremidad superior en etapas agudas o subagudas de la rehabilitación. Se valoró la calidad metodológica de los estudios mediante la escala PEDro y se utilizaron los criterios de la declaración PRISMA para la redacción del informe. Los resultados fueron analizados mediante una síntesis cualitativa. Resultados: Obtuvimos datos de 13 artículos, donde el 69% de los pacientes cursaron un evento isquémico y en nueve estudios los pacientes (61.8%) en promedio se encontraban en fase subaguda de la rehabilitación, la dosificación de la mCIMT fue ampliamente variable, en diez artículos (76.9%) la frecuencia de intervención fue 5 sesiones por semana, la terapia convencional (TC) de los grupos control fue ampliamente variable, de los cuatro artículos que aplicaron mCIMT en fase aguda del ACV, todos presentan cambios significativos intergrupales a favor de mCIMT en comparación con la TC (1–4). De los nueve artículos realizados en la fase subaguda, cuatro presentaron cambios significativos entre grupos a favor de la mCIMT con respecto a TC (3–6), tres mostraron un efecto positivo dentro de ambos grupos(7–9), y cuatro demostraron diferencia mínima clínicamente importante (MCID) (5–7,10) en el grupo mCIMT. Conclusión: Existe evidencia que sugiere que la terapia de mCIMT es efectiva para mejorar la función motora de las extremidades superiores en pacientes con ACV en etapa aguda y subaguda. Se requiere que futuros ensayos estudien los efectos de la mCIMT a largo plazo, como también los mecanismos neurofisiológicos subyacentes a la mejoría de la función de la extremidad superior.
Background. Modified constraint-induced movement therapy (mCIMT) has been shown to be effective in improving upper extremity function at different stages of stroke rehabilitation. However, the available reviews and meta-analyses have included all stages of rehabilitation, so it is relevant to analyze and synthesize the literature related to acute and subacute stages of stroke rehabilitation. Objetive. To determine the effectiveness of mCIMT on the motor function of the paretic upper extremity in adults after stroke in the acute and subacute stages of rehabilitation, based on a review of the literature. Methods. The search was carried out in the MEDLINE/Pubmed, Scopus, PEDro and Web of Science databases. Inclusion criteria were randomized controlled trials in adults after stroke with upper extremity paresis, treated with mCIMT to improve upper extremity function in acute or subacute stages of rehabilitation. The methodological quality of the studies was assessed using the PEDro scale and the criteria of the PRISMA statement were used to write the report. The results were analyzed through a qualitative synthesis. Results. We obtained data from 13 articles, where 69% of the patients had an ischemic event and in nine studies (61.8%) the patients on average were in the subacute phase of rehabilitation, the dosage of mCIMT was widely variable, in ten articles (76.9%) the frequency of intervention was 5 sessions per week, the conventional therapy (CT) of the control groups was widely variable, of the four articles that applied mCIMT in the acute phase of stroke, all present significant intergroup changes in favor of mCIMT compared to CT (17,27–29). Of the nine articles carried out in the subacute phase, four presented significant changes between groups in favor of mCIMT with respect to CT (18,27,28,30), three showed a positive effect within both groups (19,32,34), and four demonstrated minimal clinically important difference (MCID) (18,19,26,30) in the mCIMT group. Conclusion. There is evidence to suggest that mCIMT therapy is effective in improving upper extremity motor function in patients with acute and subacute stroke. Future trials are required to study the long-term effects of mCIMT, as well as the neurophysiological mechanisms underlying the improvement in upper extremity function.
Background. Modified constraint-induced movement therapy (mCIMT) has been shown to be effective in improving upper extremity function at different stages of stroke rehabilitation. However, the available reviews and meta-analyses have included all stages of rehabilitation, so it is relevant to analyze and synthesize the literature related to acute and subacute stages of stroke rehabilitation. Objetive. To determine the effectiveness of mCIMT on the motor function of the paretic upper extremity in adults after stroke in the acute and subacute stages of rehabilitation, based on a review of the literature. Methods. The search was carried out in the MEDLINE/Pubmed, Scopus, PEDro and Web of Science databases. Inclusion criteria were randomized controlled trials in adults after stroke with upper extremity paresis, treated with mCIMT to improve upper extremity function in acute or subacute stages of rehabilitation. The methodological quality of the studies was assessed using the PEDro scale and the criteria of the PRISMA statement were used to write the report. The results were analyzed through a qualitative synthesis. Results. We obtained data from 13 articles, where 69% of the patients had an ischemic event and in nine studies (61.8%) the patients on average were in the subacute phase of rehabilitation, the dosage of mCIMT was widely variable, in ten articles (76.9%) the frequency of intervention was 5 sessions per week, the conventional therapy (CT) of the control groups was widely variable, of the four articles that applied mCIMT in the acute phase of stroke, all present significant intergroup changes in favor of mCIMT compared to CT (17,27–29). Of the nine articles carried out in the subacute phase, four presented significant changes between groups in favor of mCIMT with respect to CT (18,27,28,30), three showed a positive effect within both groups (19,32,34), and four demonstrated minimal clinically important difference (MCID) (18,19,26,30) in the mCIMT group. Conclusion. There is evidence to suggest that mCIMT therapy is effective in improving upper extremity motor function in patients with acute and subacute stroke. Future trials are required to study the long-term effects of mCIMT, as well as the neurophysiological mechanisms underlying the improvement in upper extremity function.
Notas
Tesina de (Magíster en Neurorrehabiliación)
Palabras clave
Accidente Cerebrovascular, Terapia, Extremidad Superior