만성 뇌졸중 편마비 환자의 균형 및 하지 기능에 운동 중재가 미치는 영향: 체계적 문헌고찰 및 메타분석
Effects of Exercise Intervention on Balance and Lower Limb Function in Patients with Chronic Stroke Hemiplegia: A Systematic Review and Meta-Analysis
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만성뇌졸중편마비환자대상의운동중재는균형과보행기능을개선하고나아가삶의질과 일상생활수행능력향상에도밀접한관련이있다고알려져있다. 따라서본연구는만성뇌졸중 편마비환자를대상으로적용한운동중재가균형및하지기능에미치는영향에관해보고한국내 문헌을체계적으로수집하고메타분석하였다. 본연구의분석대상문헌으로수집된연구는총 5편으로, PRISMA 가이드라인을따라문헌을수집하였다. 문헌의질평가는Risk of Bias 도구를 사용하였고, 효과크기는R 4.5.1 ver. 프로그램을사용하였다. 체계적문헌고찰결과, 연구문헌의 중재 기간 및 빈도는 8-12주, 주 3-4회였으며 모든 문헌에서 측정 항목의 긍정적인 개선을 보고하였다. 비뚤림위험평가결과, 일부문헌에서무작위배정순서생성및배정순서은폐가 불충분하였고, 연구대상자의탈락으로인한불충분한결과보고문헌이존재하였다. 메타분석 결과, 운동중재는만성뇌졸중편마비환자의균형및하지근력지표에대해유의한전체효과 크기를가졌으나(ES = 0.78, 95% CI = 0.02; 1.54), 일부하위요인에서는유의하지않은신뢰구간이 발견되었다. 보행지표의경우모든문헌이일관된개선효과를보고하였으며, 유의한전체효과 크기를보고하였다(ES = -1.89, 95% CI = -2.45; -1.33). 깔때기도표도출과trim and fill 보정을통한 출판편향검정결과, 균형및하지근력지표에서는잠재적출판편향의위험이발견되었고, 보정후 3개의문헌이추가되었다. 보행지표의경우깔때기도표의비대칭성과잠재적출판편향의위험성 모두 발견되지 않았다. 본 연구의 결과는 만성 뇌졸중 편마비 환자에게 운동 중재가 미치는 독립적인영향을보고함으로써운동중재의임상적의의를강화하고급성및아급성뇌졸중환자, 인지기능저하환자등대상자의특성별효과적인운동프로그램을개발하는데에기여할것이다.
Abstract
Exercise interventions for chronic stroke patients are known to improve gait function and are closely associated with activities of daily living. Therefore, this study systematically collected and meta-analyzed domestic literature reporting the effects of exercise interventions applied to chronic stroke patients with hemiplegia on balance and lower limb function. A total of five studies were collected as the analysis subjects for this research, following the PRISMA guidelines for literature collection. Quality assessment of the literature was performed using the Risk of Bias tool, and effect size was calculated using the R 4.5.1 ver. program. The systematic review revealed that the intervention duration and frequency in the studies ranged from 8 to 12 weeks and 3 to 4 times per week, respectively. All studies reported positive improvements in the measured outcomes. Risk of bias assessment revealed that some studies had inadequate random sequence generation and allocation concealment, and there were studies with insufficient outcome reporting due to participant dropouts. The meta-analysis revealed that exercise intervention had a significant overall effect size on balance and lower limb strength indicators in chronic stroke hemiplegic patients (ES = 0.78, 95% CI : 0.02; 1.54), although non-significant confidence intervals were found for some sub-factors. For gait indicators, all studies reported consistent improvement effects and significant overall effect sizes (ES = -1.89, 95% CI = -2.45; -1.33). Results from funnel plot analysis and trim-and-fill adjustment for publication bias indicated a potential risk of publication bias in balance and lower limb strength indicators. After adjustment, three additional studies were identified. No asymmetry in the funnel plot or potential risk of publication bias was detected for the gait indicators. The findings of this study strengthen the clinical significance of exercise intervention by reporting its independent effect on chronic stroke hemiplegic patients. They will contribute to developing effective exercise programs tailored to specific patient characteristics, such as acute and subacute stroke patients and those with cognitive impairment.