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.	張浩天, 次仁卓瑪, 趙清華, 等. 等速肌力訓練對腦卒中偏癱患者下肢步行能力康復影響的 Meta 分析. 重慶醫學, 2021, 50(13): 2274-2282.
10.	吳長鴻, 劉斌. 第四屆全國腦血管病學術會議. 中華醫學信息導報, 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 ?en S, ?zbudak 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. 早期等速肌力訓練對腦卒中偏癱患者肌力與平衡功能的影響. 實用醫藥雜志, 2020, 37(11): 1001-1003.
15.	李淑杰, 徐彥輝, 陳科丹. 對腦卒中后偏癱患者進行等速肌力訓練對其患肢運動功能的影響. 當代醫藥論叢, 2020, 18(10): 113-114.
16.	王曉敏. 等速肌力訓練對腦梗死偏癱功能恢復的影響及左右步幅差、步速與機體平衡能力、步行能力相關性分析. 護理實踐與研究, 2020, 17(6): 50-52.
17.	袁少印, 齊搶. 等速肌力訓練對腦卒中偏癱患者下肢肌張力及步行能力影響. 社區醫學雜志, 2019, 17(24): 1561-1564.
18.	李綱, 張志強, 張立新. 等速肌力訓練用于腦卒中偏癱患者的下肢運動功能康復的療效觀察. 中國康復醫學雜志, 2019, 34(5): 588-590.
19.	彭杰, 鄭琨. 等速肌力訓練對糾正腦卒中患者膝過伸的療效觀察. 中國康復, 2019, 34(1): 34-36.
20.	馬剛. 在腦卒中偏癱患者肌體功能康復使用等速肌力訓練的臨床治療效果探討. 現代診斷與治療, 2018, 29(3): 479-481.
21.	周元, 陳秀明. 膝關節等速肌力訓練對腦卒中偏癱患者步行能力的影響. 深圳中西醫結合雜志, 2018, 28(8): 99-100.
22.	鐘裕, 劉娟, 盧青英. 等速肌力訓練模式干預在老年腦卒中偏癱步行功能康復中的作用探討. 基層醫學論壇, 2018, 22(4): 457-459.
23.	張學慧, 邵靜雯, 孫丹, 等. 下肢閉鏈等速肌力訓練對腦卒中患者下肢肌肉功能及步行能力的影響. 中國康復醫學雜志, 2018, 33(6): 693-697.
24.	謝文錦. 等速肌力訓練用于老年腦卒中后下肢功能恢復. 世界最新醫學信息文摘, 2018, 18(44): 83-84.
25.	李水琴, 歐妍. 等速運動鍛煉對老年腦卒中偏癱患者下肢肌力學及步行能力的影響. 中國老年學雜志, 2017, 37(18): 4613-4614.
26.	姜璧珺, 虞文魁, 陳瑤, 等. 膝關節等速肌力訓練對慢性腦卒中偏癱患者移動能力的影響. 中國實用神經疾病雜志, 2016, 19(9): 29-30.
27.	楊華中, 吳瑩瑩, 周永生, 等. 等速肌力訓練對腦卒中偏癱患者下肢功能恢復的影響. 中國康復, 2015, 30(2): 94-97.
28.	徐燕. 等速肌力訓練在腦卒中的應用. 中國實用醫藥, 2015(14): 287-288.
29.	蕭偉成, 吳伊敏, 黃營湘, 等. 等速肌力訓練對腦梗死偏癱者步行恢復的影響. 包頭醫學院學報, 2015, 31(9): 58-59.
30.	侯立皓, 許光旭, 張桂林. 等速肌力訓練用于老年腦卒中后下肢功能恢復. 實用老年醫學, 2009, 23(4): 299-300.
31.	潘順丹, 阮傳亮. 腦卒中后姿勢控制障礙的康復研究進展. 神經損傷與功能重建, 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, Gr?nborg 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. 張浩天, 次仁卓瑪, 趙清華, 等. 等速肌力訓練對腦卒中偏癱患者下肢步行能力康復影響的 Meta 分析. 重慶醫學, 2021, 50(13): 2274-2282.
10. 吳長鴻, 劉斌. 第四屆全國腦血管病學術會議. 中華醫學信息導報, 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 ?en S, ?zbudak 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. 早期等速肌力訓練對腦卒中偏癱患者肌力與平衡功能的影響. 實用醫藥雜志, 2020, 37(11): 1001-1003.
15. 李淑杰, 徐彥輝, 陳科丹. 對腦卒中后偏癱患者進行等速肌力訓練對其患肢運動功能的影響. 當代醫藥論叢, 2020, 18(10): 113-114.
16. 王曉敏. 等速肌力訓練對腦梗死偏癱功能恢復的影響及左右步幅差、步速與機體平衡能力、步行能力相關性分析. 護理實踐與研究, 2020, 17(6): 50-52.
17. 袁少印, 齊搶. 等速肌力訓練對腦卒中偏癱患者下肢肌張力及步行能力影響. 社區醫學雜志, 2019, 17(24): 1561-1564.
18. 李綱, 張志強, 張立新. 等速肌力訓練用于腦卒中偏癱患者的下肢運動功能康復的療效觀察. 中國康復醫學雜志, 2019, 34(5): 588-590.
19. 彭杰, 鄭琨. 等速肌力訓練對糾正腦卒中患者膝過伸的療效觀察. 中國康復, 2019, 34(1): 34-36.
20. 馬剛. 在腦卒中偏癱患者肌體功能康復使用等速肌力訓練的臨床治療效果探討. 現代診斷與治療, 2018, 29(3): 479-481.
21. 周元, 陳秀明. 膝關節等速肌力訓練對腦卒中偏癱患者步行能力的影響. 深圳中西醫結合雜志, 2018, 28(8): 99-100.
22. 鐘裕, 劉娟, 盧青英. 等速肌力訓練模式干預在老年腦卒中偏癱步行功能康復中的作用探討. 基層醫學論壇, 2018, 22(4): 457-459.
23. 張學慧, 邵靜雯, 孫丹, 等. 下肢閉鏈等速肌力訓練對腦卒中患者下肢肌肉功能及步行能力的影響. 中國康復醫學雜志, 2018, 33(6): 693-697.
24. 謝文錦. 等速肌力訓練用于老年腦卒中后下肢功能恢復. 世界最新醫學信息文摘, 2018, 18(44): 83-84.
25. 李水琴, 歐妍. 等速運動鍛煉對老年腦卒中偏癱患者下肢肌力學及步行能力的影響. 中國老年學雜志, 2017, 37(18): 4613-4614.
26. 姜璧珺, 虞文魁, 陳瑤, 等. 膝關節等速肌力訓練對慢性腦卒中偏癱患者移動能力的影響. 中國實用神經疾病雜志, 2016, 19(9): 29-30.
27. 楊華中, 吳瑩瑩, 周永生, 等. 等速肌力訓練對腦卒中偏癱患者下肢功能恢復的影響. 中國康復, 2015, 30(2): 94-97.
28. 徐燕. 等速肌力訓練在腦卒中的應用. 中國實用醫藥, 2015(14): 287-288.
29. 蕭偉成, 吳伊敏, 黃營湘, 等. 等速肌力訓練對腦梗死偏癱者步行恢復的影響. 包頭醫學院學報, 2015, 31(9): 58-59.
30. 侯立皓, 許光旭, 張桂林. 等速肌力訓練用于老年腦卒中后下肢功能恢復. 實用老年醫學, 2009, 23(4): 299-300.
31. 潘順丹, 阮傳亮. 腦卒中后姿勢控制障礙的康復研究進展. 神經損傷與功能重建, 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, Gr?nborg 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

Abstract Full text Figures/Tables Video References Cited by

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