血流限制训练在神经康复中的有效性：系统综述和荟萃分析

摘要(中文译文)

肌无力是神经系统疾病后常见的功能障碍，然而针对这一问题所采用的传统高负荷训练对这些患者往往不切实际或不安全。血流限制（BFR）训练已成为一种可行的方法，能够在使用显著较低机械负荷的情况下，引发与高负荷训练相当的生理适应。本研究旨在总结BFR训练在神经系统疾病中的临床应用，并评估其在改善肌力和功能结局方面的有效性与安全性。本系统综述和荟萃分析遵循PRISMA指南。检索了PubMed、Embase、PEDro、Cochrane、CINAHL、CNKI中比较BFR与多种对照干预的干预性研究。主要结局为肌力和功能结局。同时进行了敏感性分析、亚组分析和荟萃回归。共纳入37项研究，涉及963名参与者，包括脑卒中（n=639）、帕金森病（n=18）、多发性硬化（n=128）、脊髓损伤（n=170）、脑性瘫痪（n=1）、周围神经损伤（n=2）和横贯性脊髓炎（n=1）患者。我们的结果显示，加用BFR可显著增加肌力，效应量为0.752（95% CI 0.49-1.02）。在平衡、Fugl-Meyer下肢评定和改良Barthel指数方面也观察到显著改善。亚组分析显示，发病时间是BFR对临床结局有效性的一项关键因素。此外，BFR训练在神经康复中总体表现出安全性。这些发现支持BFR训练在神经康复中改善肌力和功能结局的有效性，且未出现任何显著不良事件。然而，仍需进一步开展高质量研究以验证BFR的疗效并完善其在神经系统疾病患者中的训练方案。

Abstract

Muscle weakness is a common impairment following neurological disorders, yet traditional high-load training aimed at addressing this is often impractical or unsafe for these patients. Blood flow restriction (BFR) training has emerged as a viable method, capable of eliciting physiological adaptations comparable to high-load training while using significantly lower mechanical loads. This study aimed to summarize the clinical applications of BFR training for neurological disorders and assess its effectiveness and safety in improving muscle strength and functional outcomes. The systematic review and meta-analysis followed PRISMA guidelines. PubMed, Embase, PEDro, Cochrane, CINAHL, CNKI were searched for intervention studies comparing BFR with diverse control interventions. The primary outcomes were muscle strength and functional outcomes. Sensitivity analyses, subgroup analysis and meta-regression were also performed. Thirty-seven studies involving 963 participants were included, with individuals having stroke (n = 639), Parkinson's disease (n = 18), multiple sclerosis (n = 128), spinal cord injury (n = 170), cerebral palsy (n = 1), peripheral nerve injury (n = 2), and transverse myelitis (n = 1). Our results revealed that the addition of BFR significantly increased muscle strength, with effect sizes of 0.752 (95% CI 0.49-1.02). Significant improvements were also observed in balance, Fugl-Meyer Lower Extremity assessment, and Modified Barthel Index. Subgroup analyses revealed that onset time was a crucial factor for the effectiveness of BFR on clinical outcomes. Furthermore, BFR training demonstrated overall safety in neurological rehabilitation. These findings support the effectiveness of BFR training in improving muscle strength and functional outcomes in neurological rehabilitation, without any significant adverse events. However, further high-quality research is needed to validate the efficacy of BFR and refine its training protocols for individuals with neurological disorders.

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