Background

Post-stroke, patients exhibit considerable variations in gait patterns. One of the variations that can be present in post-stroke gait is knee hyperextension in the stance phase.

Research question

What is the current evidence for the effectiveness of the treatment of knee hyperextension in post-stroke gait?

Methods

MEDLINE, EMBASE, PEDro, CINAHL, and the Cochrane library were searched for relevant controlled trials. Two researchers independently extracted the data and assessed the methological quality. A best evidence synthesis was conducted to summarize the results.

Results

Eight controlled trials (5 RCTs, 3 CCTs) were included. Three types of interventions were identified: proprioceptive training, orthotic treatment, and functional electrostimulation (FES). In the included studies, the time since the stroke occurrence varied from the (sub)acute phase to the chronic phase. Only short-term effects were investigated. The adjustment from a form of proprioceptive training to physiotherapy training programs seems to be effective (moderate evidence) for treating knee hyperextension in gait, as applied in the subacute phase post-stroke. Neither evidence for effects on gait speed nor gait symmetry were found as a result of proprioceptive training. Orthoses that cover the knee have some effects (limited evidence) on knee hyperextension and gait speed. No evidence was found for FES.

Significance

This is the first systematic literature review on the effectiveness of interventions on knee hyperextension in post-stroke gait. We found promising results (moderate evidence) for some “proprioceptive approaches” as an add-on therapy to physiotherapy training programs for treating knee hyperextension during the subacute phase post-stroke, in the short-term. Therefore, initially, clinicians should implement a training program with a proprioceptive approach in order to restore knee control in these patients. Because only studies reporting short-term results were found, more high-quality RCTs and CCTs are needed that also study mid- and long-term effects.

中文翻译：

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卒中后步态膝关节过伸的治疗。系统评价

背景

中风后，患者的步态模式表现出相当大的变化。中风后步态中可能出现的变化之一是站立阶段的膝关节过度伸展。

研究问题

目前有哪些证据表明治疗中风后步态中膝关节过伸的有效性？

方法

检索了 MEDLINE、EMBASE、PEDro、CINAHL 和 Cochrane 图书馆的相关对照试验。两名研究人员独立提取数据并评估方法学质量。进行了最佳证据综合以总结结果。

结果

纳入了八项对照试验（5 项 RCT，3 项 CCT）。确定了三种类型的干预措施：本体感受训练、矫形治疗和功能性电刺激 (FES)。在纳入的研究中，卒中发生的时间从（亚）急性期到慢性期不等。只研究了短期影响。从本体感觉训练到物理治疗训练计划的调整似乎对治疗步态中的膝关节过度伸展是有效的（中等证据），如应用于中风后的亚急性期。由于本体感受训练，没有发现对步态速度和步态对称性有影响的证据。覆盖膝盖的矫形器对膝盖过度伸展和步态速度有一些影响（证据有限）。没有发现 FES 的证据。

意义

这是第一篇关于中风后步态膝关节过度伸展干预措施有效性的系统文献综述。我们发现一些“本体感受方法”作为物理治疗训练计划的附加疗法，在短期内治疗中风后亚急性期膝关节过度伸展，取得了有希望的结果（中等证据）。因此，最初，临床医生应实施采用本体感觉方法的训练计划，以恢复这些患者的膝关节控制。因为只发现了报告短期结果的研究，所以需要更多高质量的 RCT 和 CCT，同时研究中期和长期影响。