Systematic review and meta-analysis of isokinetic muscle training to improve lower limb function in post-stroke patients_West China Medical Journal

Authors：

ZHU Yinghui ¹ ,  ZHENG Jiejiao ^1,2

1. School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P. R. China;
2. Department of Rehabilitation Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, P. R. China;

Corresponding author：

ZHENG Jiejiao, Email: zjjcss@163.com

Keywords：

Stroke; isokinetic muscle training; knee peak torque; walking function; meta-analysis

DOI：

10.7507/1002-0179.202108290

Video：

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Objective To systematically review the rehabilitation effect of isokinetic muscle training on knee muscle strength, functional walking ability and dynamic balance in post-stroke patients. Methods PubMed, Ovid Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chongqing VIP, and Wanfang databases were searched online for randomized controlled trials on isokinetic muscle training of lower limbs in post-stroke patients. The retrieval time was from inception to October, 2022. Endnote X9 software was used to manage the literature. Cochrane Manual 5.1.0 was used for quality assessment, and RevMan 5.4 software was used for meta-analysis. Results A total of 20 randomized controlled trials were included in the study, with the intervention group using isokinetic muscle training of the lower extremities or combined with conventional rehabilitation training and the control group using conventional rehabilitation training and/or other intervention, with a total of 1448 study subjects. Meta-analysis results showed that the differences in knee flexion peak torque [mean difference (MD)=5.85 N·m, 95% confidence interval (CI) (4.84, 6.85) N·m, P<0.00001], knee extension peak torque [MD=9.09 N·m, 95%CI (4.83, 13.36) N·m, P<0.0001], Time Up Go test [MD=–4.70 s, 95%CI (–6.68, –2.72) s, P<0.00001], 10-meter walking test [MD=–4.71 s, 95%CI (–9.12, –0.31) s, P=0.04], Fugl-Meyer Lower Extremity Motor Function Assessment score [MD=6.61, 95%CI (3.52, 9.70), P<0.0001], and Berg Balance Scale score [MD=5.61, 95%CI (0.91, 10.31), P=0.02] were statistically significant. Conclusion Isokinetic training may improve knee strength and functional walking ability in post-stroke patients, but there is still no strong evidence of improvement in motor function and balance.

Citation： ZHU Yinghui, ZHENG Jiejiao. Systematic review and meta-analysis of isokinetic muscle training to improve lower limb function in post-stroke patients. West China Medical Journal, 2022, 37(11): 1651-1660. doi: 10.7507/1002-0179.202108290 Copy

1.	Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet, 2014, 383(9913): 245-254.
2.	Sheffler LR, Chae J. Hemiparetic gait. Phys Med Rehabil Clin N Am, 2015, 26(4): 611-623.
3.	Wei TS, Liu PT, Chang LW, et al. Gait asymmetry, ankle spasticity, and depression as independent predictors of falls in ambulatory stroke patients. PLoS One, 2017, 12(5): e0177136.
4.	Kim CM, Eng JJ. The relationship of lower-extremity muscle torque to locomotor performance in people with stroke. Phys Ther, 2003, 83(1): 49-57.
5.	Wist S, Clivaz J, Sattelmayer M. Muscle strengthening for hemiparesis after stroke: a meta-analysis. Ann Phys Rehabil Med, 2016, 59(2): 114-124.
6.	Veldema J, Jansen P. Resistance training in stroke rehabilitation: systematic review and meta-analysis. Clin Rehabil, 2020, 34(9): 1173-1197.
7.	Sharp SA, Brouwer BJ. Isokinetic strength training of the hemiparetic knee: effects on function and spasticity. Arch Phys Med Rehabil, 1997, 78(11): 1231-1236.
8.	Khan F, Anjamparuthikal H, Chevidikunnan MF. The comparison between isokinetic knee muscles strength in the ipsilateral and contralateral limbs and correlating with function of patients with stroke. J Neurosci Rural Pract, 2019, 10(4): 683-689.
9.	张浩天, 次仁卓玛, 赵清华, 等. 等速肌力训练对脑卒中偏瘫患者下肢步行能力康复影响的 Meta 分析. 重庆医学, 2021, 50(13): 2274-2282.
10.	吴长鸿, 刘斌. 第四届全国脑血管病学术会议. 中华医学信息导报, 1996(6): 4.
11.	Gharib NM, Mohamed RA. Isokinetic strength training in patients with stroke: effects on muscle strength, gait and functional mobility. Int J Physiother Res, 2017, 5(2): 1976-1986.
12.	Büyükvural Şen S, Özbudak Demir S, Ekiz T, et al. Effects of the bilateral isokinetic strengthening training on functional parameters, gait, and the quality of life in patients with stroke. Int J Clin Exp Med, 2015, 8(9): 16871-16879.
13.	Chen CL, Chang KJ, Wu PY, et al. Comparison of the effects between isokinetic and isotonic strength training in subacute stroke patients. J Stroke Cerebrovasc Dis, 2015, 24(6): 1317-1323.
14.	毋楠楠. 早期等速肌力训练对脑卒中偏瘫患者肌力与平衡功能的影响. 实用医药杂志, 2020, 37(11): 1001-1003.
15.	李淑杰, 徐彦辉, 陈科丹. 对脑卒中后偏瘫患者进行等速肌力训练对其患肢运动功能的影响. 当代医药论丛, 2020, 18(10): 113-114.
16.	王晓敏. 等速肌力训练对脑梗死偏瘫功能恢复的影响及左右步幅差、步速与机体平衡能力、步行能力相关性分析. 护理实践与研究, 2020, 17(6): 50-52.
17.	袁少印, 齐抢. 等速肌力训练对脑卒中偏瘫患者下肢肌张力及步行能力影响. 社区医学杂志, 2019, 17(24): 1561-1564.
18.	李纲, 张志强, 张立新. 等速肌力训练用于脑卒中偏瘫患者的下肢运动功能康复的疗效观察. 中国康复医学杂志, 2019, 34(5): 588-590.
19.	彭杰, 郑琨. 等速肌力训练对纠正脑卒中患者膝过伸的疗效观察. 中国康复, 2019, 34(1): 34-36.
20.	马刚. 在脑卒中偏瘫患者肌体功能康复使用等速肌力训练的临床治疗效果探讨. 现代诊断与治疗, 2018, 29(3): 479-481.
21.	周元, 陈秀明. 膝关节等速肌力训练对脑卒中偏瘫患者步行能力的影响. 深圳中西医结合杂志, 2018, 28(8): 99-100.
22.	钟裕, 刘娟, 卢青英. 等速肌力训练模式干预在老年脑卒中偏瘫步行功能康复中的作用探讨. 基层医学论坛, 2018, 22(4): 457-459.
23.	张学慧, 邵静雯, 孙丹, 等. 下肢闭链等速肌力训练对脑卒中患者下肢肌肉功能及步行能力的影响. 中国康复医学杂志, 2018, 33(6): 693-697.
24.	谢文锦. 等速肌力训练用于老年脑卒中后下肢功能恢复. 世界最新医学信息文摘, 2018, 18(44): 83-84.
25.	李水琴, 欧妍. 等速运动锻炼对老年脑卒中偏瘫患者下肢肌力学及步行能力的影响. 中国老年学杂志, 2017, 37(18): 4613-4614.
26.	姜璧珺, 虞文魁, 陈瑶, 等. 膝关节等速肌力训练对慢性脑卒中偏瘫患者移动能力的影响. 中国实用神经疾病杂志, 2016, 19(9): 29-30.
27.	杨华中, 吴莹莹, 周永生, 等. 等速肌力训练对脑卒中偏瘫患者下肢功能恢复的影响. 中国康复, 2015, 30(2): 94-97.
28.	徐燕. 等速肌力训练在脑卒中的应用. 中国实用医药, 2015(14): 287-288.
29.	萧伟成, 吴伊敏, 黄营湘, 等. 等速肌力训练对脑梗死偏瘫者步行恢复的影响. 包头医学院学报, 2015, 31(9): 58-59.
30.	侯立皓, 许光旭, 张桂林. 等速肌力训练用于老年脑卒中后下肢功能恢复. 实用老年医学, 2009, 23(4): 299-300.
31.	潘顺丹, 阮传亮. 脑卒中后姿势控制障碍的康复研究进展. 神经损伤与功能重建, 2020, 15(9): 522-527.
32.	de Carvalho Froufe Andrade AC, Caserotti P, de Carvalho CM, et al. Reliability of concentric, eccentric and isometric knee extension and flexion when using the REV9000 isokinetic dynamometer. J Hum Kinet, 2013, 37: 47-53.
33.	Neptune RR, Sasaki K, Kautz SA. The effect of walking speed on muscle function and mechanical energetics. Gait Posture, 2008, 28(1): 135-143.
34.	Bijleveld-Uitman M, van de Port I, Kwakkel G. Is gait speed or walking distance a better predictor for community walking after stroke?. J Rehabil Med, 2013, 45(6): 535-540.
35.	Kwakkel G. Impact of intensity of practice after stroke: issues for consideration. Disabil Rehabil, 2006, 28(13/14): 823-830.
36.	Barroso FO, Torricelli D, Molina-Rueda F, et al. Combining muscle synergies and biomechanical analysis to assess gait in stroke patients. J Biomech, 2017, 63: 98-103.
37.	Lund C, Dalgas U, Grønborg TK, et al. Balance and walking performance are improved after resistance and aerobic training in persons with chronic stroke. Disabil Rehabil, 2018, 40(20): 2408-2415.
38.	Bower K, Thilarajah S, Pua YH, et al. Dynamic balance and instrumented gait variables are independent predictors of falls following stroke. J Neuroeng Rehabil, 2019, 16(1): 3.

1. Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet, 2014, 383(9913): 245-254.
2. Sheffler LR, Chae J. Hemiparetic gait. Phys Med Rehabil Clin N Am, 2015, 26(4): 611-623.
3. Wei TS, Liu PT, Chang LW, et al. Gait asymmetry, ankle spasticity, and depression as independent predictors of falls in ambulatory stroke patients. PLoS One, 2017, 12(5): e0177136.
4. Kim CM, Eng JJ. The relationship of lower-extremity muscle torque to locomotor performance in people with stroke. Phys Ther, 2003, 83(1): 49-57.
5. Wist S, Clivaz J, Sattelmayer M. Muscle strengthening for hemiparesis after stroke: a meta-analysis. Ann Phys Rehabil Med, 2016, 59(2): 114-124.
6. Veldema J, Jansen P. Resistance training in stroke rehabilitation: systematic review and meta-analysis. Clin Rehabil, 2020, 34(9): 1173-1197.
7. Sharp SA, Brouwer BJ. Isokinetic strength training of the hemiparetic knee: effects on function and spasticity. Arch Phys Med Rehabil, 1997, 78(11): 1231-1236.
8. Khan F, Anjamparuthikal H, Chevidikunnan MF. The comparison between isokinetic knee muscles strength in the ipsilateral and contralateral limbs and correlating with function of patients with stroke. J Neurosci Rural Pract, 2019, 10(4): 683-689.
9. 张浩天, 次仁卓玛, 赵清华, 等. 等速肌力训练对脑卒中偏瘫患者下肢步行能力康复影响的 Meta 分析. 重庆医学, 2021, 50(13): 2274-2282.
10. 吴长鸿, 刘斌. 第四届全国脑血管病学术会议. 中华医学信息导报, 1996(6): 4.
11. Gharib NM, Mohamed RA. Isokinetic strength training in patients with stroke: effects on muscle strength, gait and functional mobility. Int J Physiother Res, 2017, 5(2): 1976-1986.
12. Büyükvural Şen S, Özbudak Demir S, Ekiz T, et al. Effects of the bilateral isokinetic strengthening training on functional parameters, gait, and the quality of life in patients with stroke. Int J Clin Exp Med, 2015, 8(9): 16871-16879.
13. Chen CL, Chang KJ, Wu PY, et al. Comparison of the effects between isokinetic and isotonic strength training in subacute stroke patients. J Stroke Cerebrovasc Dis, 2015, 24(6): 1317-1323.
14. 毋楠楠. 早期等速肌力训练对脑卒中偏瘫患者肌力与平衡功能的影响. 实用医药杂志, 2020, 37(11): 1001-1003.
15. 李淑杰, 徐彦辉, 陈科丹. 对脑卒中后偏瘫患者进行等速肌力训练对其患肢运动功能的影响. 当代医药论丛, 2020, 18(10): 113-114.
16. 王晓敏. 等速肌力训练对脑梗死偏瘫功能恢复的影响及左右步幅差、步速与机体平衡能力、步行能力相关性分析. 护理实践与研究, 2020, 17(6): 50-52.
17. 袁少印, 齐抢. 等速肌力训练对脑卒中偏瘫患者下肢肌张力及步行能力影响. 社区医学杂志, 2019, 17(24): 1561-1564.
18. 李纲, 张志强, 张立新. 等速肌力训练用于脑卒中偏瘫患者的下肢运动功能康复的疗效观察. 中国康复医学杂志, 2019, 34(5): 588-590.
19. 彭杰, 郑琨. 等速肌力训练对纠正脑卒中患者膝过伸的疗效观察. 中国康复, 2019, 34(1): 34-36.
20. 马刚. 在脑卒中偏瘫患者肌体功能康复使用等速肌力训练的临床治疗效果探讨. 现代诊断与治疗, 2018, 29(3): 479-481.
21. 周元, 陈秀明. 膝关节等速肌力训练对脑卒中偏瘫患者步行能力的影响. 深圳中西医结合杂志, 2018, 28(8): 99-100.
22. 钟裕, 刘娟, 卢青英. 等速肌力训练模式干预在老年脑卒中偏瘫步行功能康复中的作用探讨. 基层医学论坛, 2018, 22(4): 457-459.
23. 张学慧, 邵静雯, 孙丹, 等. 下肢闭链等速肌力训练对脑卒中患者下肢肌肉功能及步行能力的影响. 中国康复医学杂志, 2018, 33(6): 693-697.
24. 谢文锦. 等速肌力训练用于老年脑卒中后下肢功能恢复. 世界最新医学信息文摘, 2018, 18(44): 83-84.
25. 李水琴, 欧妍. 等速运动锻炼对老年脑卒中偏瘫患者下肢肌力学及步行能力的影响. 中国老年学杂志, 2017, 37(18): 4613-4614.
26. 姜璧珺, 虞文魁, 陈瑶, 等. 膝关节等速肌力训练对慢性脑卒中偏瘫患者移动能力的影响. 中国实用神经疾病杂志, 2016, 19(9): 29-30.
27. 杨华中, 吴莹莹, 周永生, 等. 等速肌力训练对脑卒中偏瘫患者下肢功能恢复的影响. 中国康复, 2015, 30(2): 94-97.
28. 徐燕. 等速肌力训练在脑卒中的应用. 中国实用医药, 2015(14): 287-288.
29. 萧伟成, 吴伊敏, 黄营湘, 等. 等速肌力训练对脑梗死偏瘫者步行恢复的影响. 包头医学院学报, 2015, 31(9): 58-59.
30. 侯立皓, 许光旭, 张桂林. 等速肌力训练用于老年脑卒中后下肢功能恢复. 实用老年医学, 2009, 23(4): 299-300.
31. 潘顺丹, 阮传亮. 脑卒中后姿势控制障碍的康复研究进展. 神经损伤与功能重建, 2020, 15(9): 522-527.
32. de Carvalho Froufe Andrade AC, Caserotti P, de Carvalho CM, et al. Reliability of concentric, eccentric and isometric knee extension and flexion when using the REV9000 isokinetic dynamometer. J Hum Kinet, 2013, 37: 47-53.
33. Neptune RR, Sasaki K, Kautz SA. The effect of walking speed on muscle function and mechanical energetics. Gait Posture, 2008, 28(1): 135-143.
34. Bijleveld-Uitman M, van de Port I, Kwakkel G. Is gait speed or walking distance a better predictor for community walking after stroke?. J Rehabil Med, 2013, 45(6): 535-540.
35. Kwakkel G. Impact of intensity of practice after stroke: issues for consideration. Disabil Rehabil, 2006, 28(13/14): 823-830.
36. Barroso FO, Torricelli D, Molina-Rueda F, et al. Combining muscle synergies and biomechanical analysis to assess gait in stroke patients. J Biomech, 2017, 63: 98-103.
37. Lund C, Dalgas U, Grønborg TK, et al. Balance and walking performance are improved after resistance and aerobic training in persons with chronic stroke. Disabil Rehabil, 2018, 40(20): 2408-2415.
38. Bower K, Thilarajah S, Pua YH, et al. Dynamic balance and instrumented gait variables are independent predictors of falls following stroke. J Neuroeng Rehabil, 2019, 16(1): 3.

West China Medical Journal

Systematic review and meta-analysis of isokinetic muscle training to improve lower limb function in post-stroke patients

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