بومی سازی راهنمای عملکرد بالینی کاردرمانی در عملکرد اندام فوقانی بیماران سکته مغزی با روش مرور ادغام یافته و نظر خبرگان

نوع مقاله: مقاله مروری

نویسندگان

1 1. کارشناس ارشد کاردرمانی و آموزش پزشکی، عضو گروه کاردرمانی، دانشکده علوم توانبخشی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

2 2. کارشناس کاردرمانی. دانشکده علوم توانبخشی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

3 3. فلوی انتقال دانش در توانبخشی قلبی دانشگاه فناوری سیدنی استرالیا. دانشیار ، دکترای تخصصی مدیریت آموزش عالی دانشگاه علوم بهزیستی و توانبخشی ، تهران، ایران

4 4. دکترای کادرمانی، عضو هیئت علمی گروه کاردرمانی، دانشکده علوم توانبخشی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

5 5. دانشیار گروه کاردرمانی، دانشگاه علوم بهزیستی و توانبخشی ، تهران، ایران

چکیده

مقدمه و اهداف
سکته مغزی مهمترین عامل ناتوانی در بزرگسالان محسوب می شودو ناتوانی عملکردی اندام فوقانی ناشی از آن، از مهمترین اختلالات  است که فرد را در انجام فعالیت های روزمره زندگی ناتوان می سازد. مداخلات توانبخشی در قالب راهنمای عملکردی می تواند منجر به عملکرد یکپارچه درمانگران گردد و پروسه بهبودی بعد از سکته را افزایش و ناتوانی عملکردی را کاهش دهد. هدف از این مطالعه مرور ادغام یافته و بومی سازی راهنمای عملکردی مداخلات کاردرمانی در توانبخشی عملکرد اندام فوقانی بیماران سکته مغزی بر مبنای شواهد موجود و نظر خبرگان است.
مواد و روش ها
این مطالعه از نوع مطالعات ترکیبی و دو مرحله ای است. در مرحله اول یک بررسی ادغام یافته سیستماتیک انجام شدو کلیه مقالات خارجی و داخلی ده سال اخیر در توانبخشی دست و راهنماهای عملکردی با کلید واژه های راهنمای عملکرد بالینی، سکته مغزی،  مداخلات کاردرمانی و عملکرد اندام فوقانی، استخراج و نتایج آنها ثبت گردید. در مرحله دوم به روش کیفی نتایج استخراج شده در پانل خبرگان  که مشتمل بر 10 نفر از کاردرمانگران حرفه ای در حوزه سکته مغزی بودند، مطرح و مورد بررسی قرارگرفت و نتایج نهایی در قالب کتابچه ای ارائه شد.
یافته ها
در بررسی انجام شده 268 مقاله در زمینه سکته مغزی و عملکرد اندام فوقانی و 11 راهنمای عملکرد بالینی یافت شد، ابتدا خلاصه مقالات، سپس متن کامل 70 مقاله مرتبط با مداخلات در بهبود عملکرد دست بیماران سکته مغزی که شرایط ورود به مطالعه را داشته اند مورد بررسی قرار گرفت. مداخلات وسایل کمکی رباتیک، محدودیت درمانی اجباری، استفاده از اسپلینت، آینه درمانی، بازآموزی حسی، تمرین ذهنی، تکلیف محور، تمرینات مقاومتی، تمرینات دو طرفه و تحریکات الکتریکی در اندام فوقانی بیماران سکته مغزی در این مقالات بررسی شدند.
نتیجه گیری
بررسی انجام شده نشان داد هیچ نوع راهنمای عملکرد بالینی مکتوب و مستند در این زمینه تا کنون منتشر نشده است؛ و نتایج حاصل از بررسی مقالات و نظر خبرگان تاکید بر مداخلاتی داشت که بیشترین کاربرد را در کاردرمانی دارند . این مداخلات عبارتند از محدودیت درمانی اجباری، وسایل کمکی رباتیک، آینه درمانی، بازآموزی حسی، تمرین ذهنی و رویکرد تکلیف محور. نتایج حاصل در زمینه مداخلات کاردرمانی در بهبود عملکرد اندام فوقانی بیماران سکته مغزی درقالب کتابچه راهنمای عملکردی کاردرمانی ارائه شد.

کلیدواژه‌ها


عنوان مقاله [English]

Localization of occupational therapy clinical practice guideline to improve the upper extremity function in patients with stroke: an integrative review and expert panel

نویسندگان [English]

  • Zahra Shafiee 1
  • Mahrokh Ghahari 2
  • Mohammad Ali Hosseini 3
  • Mahdi Rezaee 4
  • Mehdi Rassafiani 5
1 1. MSc of occupational therapy& Medical education, Department of Occupational Therapy. Faculty of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 2. BSc of Occupational Therapy, Department of occupational therapy. Faculty of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 3. Postdoctoral Fellow of Knowledge Transfer in Cardiac Rehabilitation Head of Rehabilitation Management Group University of Social Welfare and Rehabilitation Sciences Tehran/Iran
4 4. PhD of Occupational Therapy, Department of Occupational Therapy. Faculty of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5 5. Associated Professor of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences Tehran/Iran
چکیده [English]

Background and Aim: Stroke is a major cause of disability in adults and functional disability of upper limb. It is the most important difficulty that makes the person unable to perform activities of daily living. Rehabilitation interventions in the guidelines format can result in integrated therapists’ performance and increases the process of recovery and decrease the level of functional disability after stroke. The purpose of this study was to make an integrative review and localization of occupational therapy practice guideline in rehabilitation of upper limb function in stroke patients according to available evidences and experts’ opinions.
Materials and Methods: This study is a combination of two steps. In the first phase, the integrated review was done in all domestic and foreign published articles and practical guidelines of the previous ten years. The key words of Clinical practice guide, stroke, occupational therapy interventions and of upper limb function were used and the found articles were extracted. In the second phase, the quality of the results were analyzed and discussed in the expert panel that included of 10 occupational therapists in CVA area. Then final results were presented in a booklet format.
Results: In this study 268 articles in the field of stroke and upper limb function and 11 clinical practice guidelines were found. Initially, abstracts and then 70 full texts of articles relating to hand function interventions in stroke patients which had inclusion criteria were investigated. Robotic aids interventions, induced constraint movement therapy, splinting, mirror therapy, sensory training, mental training, task- oriented approach, resistive exercises, bilateral exercises and electrical stimulation of the upper extremities in stroke patients were enrolled in these articles.
Conclusion: The results of the study and the experts werefocused on induced constraint movement therapy, robotic assistive devices, mirror therapy, sensory re-education, mental practice and task-based approach in the rehabilitation of hand function in stroke patients.Results were presented in the field of occupational therapy in improving upper extremity function of stroke patients in booklet format.

کلیدواژه‌ها [English]

  • Cerebral Vascular Accident
  • clinical practice guideline
  • occupational therapy interventions and upper limb function
  1. WHO. The World Health Report 2003 [www.who.int/whr/2003/en/overview.en.pdf].#
  2. Legg L, Drummond A, Leonardi-Bee J, Gladman J, Corr S, Donkervoort M, et al. Occupational therapy for patients with problems in personal activities of daily living after stroke: systematic review of randomised trials. Bmj. 2007;335(7626):922##
  3. Langhorne P, Coupar F, Pollock A. Motor recovery after stroke: a systematic review. Lancet neurology. 2009;8(8):741.##
  4. Morris JH, van Wijck F, Joice S, Ogston SA, Cole I, MacWalter RS. A comparison of bilateral and unilateral upper-limb task training in early poststroke rehabilitation: a randomized controlled trial. Archives Pmr. 2008;89(7):1237.##
  5. Kwan J. Care pathways for acute stroke care and stroke rehabilitation: from theory to evidence. Jocn. 2007;14(3):189-200##
  6. National health and medical research council(NHMRC).A guide to the development, implementation and evaluation of clinical practice guideline.Aus 1998. Available from:  http://www.ausinfo.gov.au/general/gen_hottobuy.htm ##
  7. Duncan PW, Zorowitz R, Bates B, Choi JY, Glasberg JJ, Graham GD, et al. Management of adult stroke rehabilitation care a clinical practice guideline. Stroke. 2005;36(9):e100-e43.##
  8. CPG. Stroke rehabilitation guide : supporting London Commissioners to commission quality services in 2010/11. Healthcare for London2010/11. Available from: www.healthcareforlondon.nhs.uk.##
  9. Eng J, Harris, J., . GRASP. Graded Repetitive Arm Supplementary Program, Guideline& Manual. A home work based program to improvement and hand function in people living with stroke.  GRASP books(level 1,2&3) 2009.##
  10. Kutner NG, Zhang R, Butler AJ, Wolf SL, Alberts JL. Quality-of-life change associated with robotic-assisted therapy to improve hand motor function in patients with subacute stroke: a randomized clinical trial. Physical therapy. 2010;90(4):493-504.##
  11. McCall M, McEwen, S., Colantonio, A., Streiner, D., & Dawson, D. R. . Modified constraint-induced movement therapy for elderly clients with subacute stroke. AJOT. 2011;65:409–18.##
  12. Kwakkel G. Effects of Robot-Assisted Therapy on Upper Limb Recovery After Stroke: A Systematic Review. Neurorehabil Neural Repair. 2oo8(22):111–21.##
  13. Fasoli SE, Krebs HI, Stein J, Frontera WR, Hughes R, Hogan N. Robotic therapy for chronic motor impairments after stroke: Follow-up results. Archives of PMR. 2004;85(7):1106-11.##
  14. Hsieh Y-w, Wu C-y, Liao W-w, Lin K-c, Wu K-y, Lee C-y. Effects of Treatment Intensity in Upper Limb Robot-Assisted Therapy for Chronic Stroke A Pilot Randomized Controlled Trial. Neurorehabilitation and Neural Repair. 2011;25(6):503-11.##
  15. Amini m. investigate of short term effect of immobilizer splint on the hand ROM. Spasticity and function in hemiplegic paitent. Tananbakhshi novin. 2009(3,4) in persion.##
  16. Heydari M. to compare effect of static & dynamic splint on the hand functional movement in hemiplegic patient. Journal of Ghom medical callage. 2009;4:84-53 in persion.##
  17. Pizzi A, Carlucci G, Falsini C, Verdesca S, Grippo A. Application of a volar static splint in poststroke spasticity of the upper limb. Archives of Pmr 2005;86(9):1855-9.##
  18. Tootoonchi A. Effect of wrist adjustable splint in spasticity reduction in stroke patient upper limb. Sientific Journal of Gorgan medical callege 2009;37 in persion.##
  19. Yavuzer G, Selles R, Sezer N, Sütbeyaz S, Bussmann JB, Köseoğlu F, et al. Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Archives of Pmr. 2008;89(3):393-8.##
  20. Michielsen MEaS.& et al. Motor Recovery and Cortical Reorganization After Mirror Therapy in Chronic Stroke Patients A Phase II Randomized Controlled TrialNeurorehabilitation and Neural Repair. 2011;25(3):223-33.##
  21. Rothgangel AS, Braun SM, Beurskens AJ, Seitz RJ, Wade DT. The clinical aspects of mirror therapy in rehabilitation: a systematic review of the literature. IJIR. 2011;34(1):1-13.##
  22. Dohle C, Püllen J, Nakaten A, Küst J, Rietz C, Karbe H. Mirror therapy promotes recovery from severe hemiparesis: a randomized controlled trial. Neurorehabilitation and Neural Repair. 2009;23(3):209-17##
  23. Ezendam D, Bongers RM, Jannink MJ. Systematic review of the effectiveness of mirror therapy in upper extremity function. Disability & Rehabilitation. 2009;31(26):2135-49.##
  24. Hayner K, Gibson, G., & Giles, G. M. . Comparison of constraint-induced movement therapy and bilateral treatment of equal intensity in people with chronic upper-extremity dysfunction after cerebrovascularaccident. . AJOT. 2010;64:528–39.##
  25. Grotta JC. Constraint-Induced Movement Therapy. Stroke. 2004;35:2699-701.##
  26. Abdolvahab M. Effects of progressive resistive exercise on isometric strength of shoulder extensor and abductor muscle in adult hemiplegic. . Modern Rehabilitation. 2010;3(3,4). in persion.##
  27. Askim T. Outcomes 12 months after a constraint induced movement therapy program were maintained for an additional year. AJPh. 2008;54(2): 141 ##
  28. Bonaiuti D, Rebasti L, Sioli P. The constraint induced movement therapy: a systematic review of randomised controlled trials on the adult stroke patients. Europa Medicophysica. 2007;43(2):139.##
  29. Winstein C. Methods for a multisite randomized trial to investigate the effect of constraint-induced movement therapy in improving upper extremity function among adults recovering from a cerebrovascular stroke. Neurorehabil Neural Repair NNP. 2003;17:137-52.##
  30. Wu C-y, Chen C-l, Tang SF, Lin K-c, Huang Y-y. Kinematic and clinical analyses of upper-extremity movements after constraint-induced movement therapy in patients with stroke: a randomized controlled trial. Archives of Pmr. 2007;88(8):964-70##
  31. Rowe VT, Blanton, S., & Wolf, S. L. Long-term follow-up after constraint-induced therapy: A case report of a chronic stroke survivor. AJOT. 2009;63:317–22.##
  32. Page SJ, Sisto S, Levine P, McGrath RE. Efficacy of modified constraint-induced movement therapy in chronic stroke: a single-blinded randomized controlled trial. Archives of Pmr. 2004;85(1):14-8.##
  33. McCall M, McEwen, S., Colantonio, A., Streiner, D., & Dawson, D. R. . Modified constraint-induced movement therapy for elderly clients with subacute stroke. AJOT. 2011;65:409–18.##
  34. Hakkennes S, Keating, JL. Constraint-induced movement therapy following stroke: a systematic review of randomised controlled trials. Topics in Stroke Rehabilitation. 2012;19(4):287-93.##
  35. Levy CE, Nichols DS, Schmalbrock PM, Keller P, Chakeres DW. Functional MRI evidence of cortical reorganization in upper-limb stroke hemiplegia treated with constraint-induced movement therapy. AJPM&R. 2001;80(1):4-12.##
  36. Wolf S. Revisiting Constraint- Induced movement therapy: Are we too smitten with the mitten? Is all non- use “learned” and other quandaries? Is all non-use “learned”and other quandaries? . Physical therapy. 2007;87(9):1-12.##
  37. Hejazi shirmard M. Effects of sensory retraining on recovery of the hemiplegic upper limb in stroke patients (A Single-System Design) 2012 . Tavanbakhshi Novin,  in persion.##
  38. Doyle S, Bennett S, Fasoli SE, McKenna KT. Interventions for sensory impairment in the upper limb after stroke. Cochrane Database of Systematic Reviews. 2010;6.##
  39. Schabrun SM, Hillier S. Evidence for the retraining of sensation after stroke: a systematic review. Clinical rehabilitation. 2009;23(1):27-39##
  40. Verbunt JA, Seelen HA, Ramos FP, Michielsen BH, Wetzelaer WL, Moennekens M. Mental practice-based rehabilitation training to improve arm function and daily activity performance in stroke patients: a randomized clinical trial. BMC neurology. 2008;8(1):7.##
  41. Barclay-Goddard R, Stevenson T, Thalman L, Poluha W. Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke. Stroke. 2011;42(11):e574-e5.##
  42. Müller K, Bütefisch C, Seitz RJ, Hömberg V. Mental practice improves hand function after hemiparetic stroke. Restorative neurology and neuroscience. 2007;25(5):501-11.##
  43. Ietswaart M, Johnston M, Dijkerman HC, Scott CL, Joice SA, Hamilton S, et al. Recovery of hand function through mental practice: A study protocol. BMC neurology. 2006;6(1):39.##
  44. Rensink M, Schuurmans M, Lindeman E, Hafsteinsdottir T. Task‐oriented training in rehabilitation after stroke: systematic review. Journal of advanced nursing. 2009;65(4):737-54.##
  45. Morris JH, van Wijck F, Joice S, Ogston SA, Cole I, MacWalter RS. A comparison of bilateral and unilateral upper-limb task training in early poststroke rehabilitation: a randomized controlled trial. Archives of Pmr. 2008;89(7):1237-45.##
  46. Blennerhassett J, Dite W. Additional task-related practice improves mobility and upper limb function early after stroke: a randomised controlled trial. Aust J Physiother. 2004;50(4):219-24.##
  47. Mandal A. Effect of occupational therapy task oriented approach on recovery of upper- extremity motor function and activities of daily living in stroke patients.The IJOT. 2009;6-1(2).##
  48. French B, Leathley M, Sutton C, McAdam J, Thomas L, Forster A, et al. A systematic review of repetitive functional task practice with modelling of resource use, costs and effectiveness. Health Technol Assess. 2008 Jul;12(30):iii, ix-x, 1-117. ##
  49. Hossiennifar M. The effects of functional and strengthening exercises on improvement of upper extremity function in patients with hemiparesis following stroke. . Tabib e shargh 2008;3:163-73.in persion.##
  50. Harris JE, Eng JJ. Strength Training Improves Upper-Limb Function in Individuals With Stroke A Meta-Analysis. Stroke. 2010;41(1):136-40.##
  51. Stewart, K C., et al, Bilateral movement training and stroke rehabilitation: A systematic review and meta-analysis, Journal of the Neurological Sciences, 2006; 1-2(244): 89-95##
  52. Luft, AR. &et al, Repetitive Bilateral Arm Training and Motor Cortex Activation in Chronic Stroke, JAMA: the JAMA, 2004; 299(15):1853-1861##
  53. Whitall, J., Repetitive Bilateral Arm Training with Rhythmic Auditory Cueing Improves Motor Function in Chronic Hemiparetic Stroke.Journal of stroke, 2000(31): 2390-2395##
  54. Knutson, J.S., Harley, M.Y.Hisel, T.Z., Chae, J., Improving hand function in stroke survivors: a pilot study of contralaterally controlled functional electric stimulation in chronic hemiplegia, Archives of physical medicine and rehabilitation, 2007; 88(4): 513-520##
  55. Alon G, Levitt AF, McCarthy PA. Functional electrical stimulation enhancement of upper extremity functional recovery during stroke rehabilitation: a pilot study. Neurorehabil Neural Repair2007; 21:207–215##
  56. Hardy, K., Suever, K. & et al, Combined bracing, electrical stimulation, and functional practice for chronic, upper-extremity spasticity, the AJOT, 2010; 64(5): 720-726##
  57. Hedman, LD.et al, Neuromuscular electrical stimulation during task-oriented exercise improves arm function for an individual with proximal arm dysfunction after stroke, Ajpm&R, 2007;86(7): 592-59##