脑卒中患者远程康复运动管理有效性及安全性的系统评价再评价

doi:10.3761/j.issn.0254-1769.2022.12.006

摘要/Abstract

摘要：

目的检索、再评价脑卒中患者远程康复运动管理的系统评价,为临床医护人员临床决策及康复运动干预策略的持续改进提供借鉴。方法计算机检索Cochrane Library、Embase、PubMed、Web of Science、CINAHL、澳大利亚乔安娜布里格斯研究所（Joanna Briggs Institute,JBI）循证卫生保健中心数据库以及万方数据库、中国知网、维普数据库和中国生物医学文献数据库,查找关于脑卒中患者运动功能远程康复管理相关的系统评价/Meta分析/荟萃分析,检索时限为建库至2021年9月19日。2名经过循证知识系统培训的研究人员应用系统评价方法学质量评价工具（Assessment of Mutiple Systematic Reviews,AMSTAR）对文献进行方法学质量评价后,采用推荐分级的评估、制订与评价（Grades of Recommendations Assessment,Development and Evaluation,GRADE）系统进行证据汇总与分级。结果初检文献124篇,纳入文献14篇,AMSTAR质量评价结果显示,中等质量文献有5篇,其余9篇为高等质量,纳入文献的整体方法学质量较高。采用GRADE系统对14篇系统评价的67条主要结局指标的证据质量评价结果显示,22条证据为中等质量,29条证据为低等质量,16条证据为极低质量。结论该研究纳入的系统评价方法学质量较高,但其结局指标证据质量较低。远程康复运动管理有利于改善患者的运动功能、生活自理能力及生活质量,可提高患者的满意度与参与度,但远程运动管理干预方式的研究设计及结局指标的客观性仍需改进。

关键词: 脑卒中, 远程康复, 运动管理, 系统评价再评价, 循证护理学

Abstract:

Objective To search and evaluate the systematic review of telerehabilitation management in stroke patients,providing references for clinical decision making and continuous improvement of rehabilitation exercise intervention strategies. Methods Systematic reviews/meta-analysis of telerehabilitation management of motor function in stroke patients was searched in Cochrane Library,Embase,PubMed,Web of Science,CINAHL,Joanna Briggs Institute（JBI）,China National Knowledge Infrastructure,China Science and Technology Journal Database,Wanfang Database,and Chinese Biomedicine Literature Database. The search time limit was from the inception of the database until September 19,2021. 2 researchers trained in evidence-based knowledge system applied AMSTAR （Assessment of Mutiple Systematic Reviews） to evaluate the methodological quality of the literature. GRADEE （Grades of Recommendations Assessment,Development and Evaluation） system was used for evidence summary and grading. Results There were 124 preliminary studies in this study,of which 14 were included. AMSTAR quality evaluation results showed that there were 5 studies of medium quality,and the rest were all of high quality,indicating that the overall research methodology of the included literature was of high quality. According to the evidence quality evaluation results of GRADE system for 67 main outcome indicators of 14 articles,22 pieces of evidence were medium,29 pieces of evidence were low,and 16 pieces of evidence were extremely low. Conclusion The methodological quality of systematic evaluation included in this study is high,but the evidence quality of outcome indicators is low. Telerehabilitation exercise management is beneficial to improve patients’ motor function,self-care ability and quality of life,and improve patients’ satisfaction and participation. However,the design,operation and evaluation of the outcome index of telerehabilitation management still need to be improved.

Key words: Stroke, Telerehabilitation, Exercise Management, Overview of Systematic Review, Evidence-Based Nursing

朱金凤, 张远星, 王芳, 狄恒丹, 袁萍, 陈湘玉, 陈璐. 脑卒中患者远程康复运动管理有效性及安全性的系统评价再评价[J]. 中华护理杂志, 2022, 57(12): 1447-1455.

ZHU Jinfeng, ZHANG Yuanxing, WANG Fang, DI Hengdan, YUAN Ping, CHEN Xiangyu, CHEN Lu. The effectiveness and safety of telerehabilitation management in stroke patients：an overview of systematic reviews[J]. Chinese Journal of Nursing, 2022, 57(12): 1447-1455.

图/表 4

图1 文献检索流程图

Figure 1 Flow diagram of literature search and study selection

表1 纳入文献的基本特征（n=14）

Table 1 Characteristics of included studies（n=14）

表2 纳入文献的AMSTAR质量评价结果（n=14）

Table 2 Quality assessment of studies using AMSTAR（n=14）

表3 纳入文献结局指标的GRADE证据质量分级（n=14）

Table 3 GRADE evidence quality of outcomes included in the literature（n=14）

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