Background Early rehabilitation after stroke is essential to help reduce disability. Purpose To summarize evidence on the benefits and harms of nonpharmacologic and pharmacologic treatments for motor deficits and mood disorders in adults who have had stroke. Data Sources English-language searches of multiple electronic databases from April 2009 through July 2018; targeted searches to December 2018 for studies of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors. Study Selection 19 systematic reviews and 37 randomized controlled trials addressing therapies for motor deficits or mood disorders in adults with stroke. Data Extraction One investigator abstracted the data, and quality and GRADE assessment were checked by a second investigator. Data Synthesis Most interventions (for example, SSRIs, mental practice, mirror therapy) did not improve motor function. High-quality evidence did not support use of fluoxetine to improve motor function. Moderate-quality evidence supported use of cardiorespiratory training to improve maximum walking speed and repetitive task training or transcranial direct current stimulation to improve activities of daily living (ADLs). Low-quality evidence supported use of robotic arm training to improve ADLs. Low-quality evidence indicated that antidepressants may reduce depression, whereas the frequency and severity of antidepressant-related adverse effects was unclear. Low-quality evidence suggested that cognitive behavioral therapy and exercise, including mind-body exercise, may reduce symptoms of depression and anxiety. Limitation Studies were of poor quality, interventions and comparators were heterogeneous, and evidence on harms was scarce. Conclusion Cardiorespiratory training, repetitive task training, and transcranial direct current stimulation may improve ADLs in adults with stroke. Cognitive behavioral therapy, exercise, and SSRIs may reduce symptoms of poststroke depression, but use of SSRIs to prevent depression or improve motor function was not supported. Primary Funding Source U.S. Department of Veterans Affairs, Veterans Health Administration.

中文翻译：

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脑卒中后运动障碍和情绪障碍的治疗：2019年美国退伍军人事务部和美国国防部《脑卒中康复指南》的系统评价。

背景技术中风后的早期康复对于帮助减少残疾至关重要。目的总结非药物和药物治疗对患有中风的成年人的运动缺陷和情绪障碍的利弊的证据。数据源：从2009年4月至2018年7月，对多个电子数据库进行英语搜索；到2018年12月进行针对性搜索，以研究选择性5-羟色胺再摄取抑制剂（SSRI）或5-羟色胺-去甲肾上腺素再摄取抑制剂。研究选择19项系统评价和37项随机对照试验，针对中风成人的运动功能障碍或情绪障碍进行了治疗。数据提取一位调查员提取了数据，第二名调查员检查了质量和GRADE评估。数据综合大多数干预措施（例如SSRI，心理练习，镜疗法）并没有改善运动功能。高质量的证据不支持使用氟西汀改善运动功能。中等质量的证据支持使用心肺训练来提高最大步行速度以及重复性任务训练或经颅直流电刺激来改善日常生活活动（ADL）。低质量的证据支持使用机械臂训练来改善ADL。低质量的证据表明抗抑郁药可以减轻抑郁症，而抗抑郁药相关不良反应的发生频率和严重程度尚不清楚。低质量的证据表明，认知行为疗法和锻炼（包括身心锻炼）可能会减轻抑郁和焦虑症的症状。局限性研究质量低劣，干预措施和比较者异质，危害的证据很少。结论心肺训练，重复性任务训练和经颅直流电刺激可改善中风成人的ADL。认知行为疗法，运动和SSRI可能会减轻中风后抑郁的症状，但不支持使用SSRI预防抑郁或改善运动功能。主要资金来源美国退伍军人事务部，退伍军人健康管理局。