学龄期恶性肿瘤患儿运动康复的最佳证据总结

doi:10.3761/j.issn.0254-1769.2023.04.014

摘要/Abstract

摘要：

目的检索、评价及总结学龄期恶性肿瘤患儿运动康复的相关证据，为医护人员指导患儿及其家庭开展运动康复提供参考。方法计算机系统检索国内外数据库、相关指南网站及专业学会网站中关于学龄期恶性肿瘤患儿运动康复的临床决策、推荐实践、指南、证据总结、专家共识及系统评价。检索时限为2017年2月—2022年2月。由2名研究者独立进行文献质量评价、证据提取及整合。结果最终纳入13篇文献，其中指南3篇、证据总结3篇、推荐实践1篇、专家共识1篇、系统评价5篇。从运动目的、运动对象、运动评估、运动方案和运动管理5个方面共总结21条最佳证据。结论该研究总结了学龄期恶性肿瘤患儿运动康复的最佳证据，建议医护人员应用证据时充分考虑临床情境，结合患儿及其家庭的需求和偏好，制订更为详细的个性化运动康复方案。

关键词: 肿瘤, 儿童, 学龄期, 运动疗法, 循证护理学

Abstract:

Objective To retrieve，evaluate and summarize the current evidence related to exercise rehabilitation in school-age children with malignant tumors，and provide references for clinical healthcare workers to guide children and their families to practice the plan for exercise rehabilitation. Methods The researchers conducted a systematical search in national and international databases，relevant guideline websites and professional society websites for related clinical decisions，recommended practices，guidelines，evidence summaries，expert consensuses，and systematic reviews for exercise rehabilitation in school-age children with malignancies since February 2017 to February 2022. The quality evaluation，extraction，and integration for evidence were conducted independently by 2 researchers，respectively. Results A total of 13 studies，including 3 guidelines，3 JBI evidence summaries，1 recommended practice，1 expert consensus and 5 systematic reviews，were included. There were 21 pieces of best evidence with 5 dimensions，including the purposes，participants，assessment，detailed programs，and management for exercise rehabilitation being summarized. Conclusion The study summarizes the best evidence of exercise rehabilitation in school-age children with malignant tumors. It is recommended for health professionals to fully consider the clinical situations to develop more detailed personalized exercise rehabilitation program based on the needs and preferences of school-age children with malignant tumors and their families.

Key words: Neoplasm, Children, School-Age, Exercise Therapy, Evidence-Based Nursing

徐欣怡, 唐莉, 余雅婷, 陈晓容, 毛孝容, 闵丽华. 学龄期恶性肿瘤患儿运动康复的最佳证据总结[J]. 中华护理杂志, 2023, 58(4): 477-484.

XU Xinyi, TANG Li, YU Yating, CHEN Xiaorong, MAO Xiaorong, MIN Lihua. The best evidence summary for exercise rehabilitation in school-age children with malignant tumors[J]. Chinese Journal of Nursing, 2023, 58(4): 477-484.

图/表 5

表1 PubMed检索策略

Table 1 Search strategy in PubMed

图1 文献筛选流程图

Figure 1 Flow chart of literature screening

表2 纳入文献的一般特征（n=13）

Table 2 Characteristics of included studies（n=13）

表3 纳入指南的质量评价结果（n=3）

Table 3 Quality evaluation of guidelines（n=3）

表4 学龄期恶性肿瘤患儿运动康复的最佳证据总结

Table 4 Summary of the best evidence for exercise rehabilitation in school-age children with malignant tumors

参考文献 34

[1]	World Health Organization. Childhood cancer[DB/OL].(2021-12-13)[2022-05-10]. https://www.who.int/news-room/fact-sheets/detail/cancer-in-children.
[2]	Fadel SA, Boschi-Pinto C, Yu SC, et al. Trends in cause-specific mortality among children aged 5-14 years from 2005 to 2016 in India,China,Brazil,and Mexico:an analysis of nationally representative mortality studies[J]. Lancet, 2019, 393(10176):1119-1127. DOI URL
[3]	Morales JS, Valenzuela PL, Rincón-Castanedo C, et al. Is health status impaired in childhood cancer survivors:a systematic review and Meta-analysis[J]. Crit Rev Oncol Hematol, 2019, 142: 94-118. DOI PMID
[4]	Hooke MC, Rodgers C, Taylor O, et al. Physical activity,the child-hood cancer symptom cluster-leukemia,and cognitive function:a longitudinal mediation analysis[J]. Cancer Nurs, 2018, 41(6):434-440. DOI PMID
[5]	Morales JS, Valenzuela PL, Velázquez-Díaz D, et al. Exercise and childhood cancer:a historical review[J]. Cancers(Basel), 2021, 14(1):82.
[6]	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):1991-1994.
	Zhu Z, Hu Y, Xing WJ, et al. The composition of different types of evidence based problems[J]. J Nurses Train, 2017, 32(21):1991-1994.
[7]	Brouwers MC, Browman GP, Burgers JS, et al. Appraisal of gui-delines for research & evaluation Ⅱ[EB/OL]. (2017-12)[2022-05-10]. http://www.agreetrust.org.
[8]	林楠, 诸纪华, 徐红贞, 等. 早产儿体位管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(4):486-492. DOI
	Lin N, Zhu JH, Xu HZ, et al. Best evidence summary of positioning management for preterm infants[J]. Chin J Nurs, 2022, 57(4):486-492. DOI
[9]	顾莺, 张慧文, 周英凤, 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具:系统评价的方法学质量评价[J]. 护士进修杂志, 2018, 33(8):701-703.
	Gu Y, Zhang HW, Zhou YF, et al. JBI evidence-based health center’s quality assessment tool for different types of research:the quality evaluation of diagnostic and economic evaluation[J]. J Nurses Train, 2018, 33(8):701-703.
[10]	胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018:77.
	Hu Y, Hao YF. Evidence-based nursing[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2018:77.
[11]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence rank system(2014 edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[12]	Coombs A, Schilperoort H, Sargent B. The effect of exercise and motor interventions on physical activity and motor outcomes during and after medical intervention for children and adolescents with acute lymphoblastic leukemia:a systematic review[J]. Crit Rev Oncol Hematol, 2020, 152:103004. DOI URL
[13]	Cheung AT, Li WHC, Ho LLK, et al. Physical activity for pediatric cancer survivors:a systematic review of randomized controlled trials[J]. J Cancer Surviv, 2021, 15(6):876-889. DOI PMID
[14]	Ishaque S. Cancer patients(pediatric):occupational therapy[EB/OL].(2021-04-06)[2022-05-10]. https://ovidsp.dc2.ovid.com/ovid-b/ovidweb.cgi&S=HFEAFPFHPMEBIIACJPNJKGDGGAHCAA00&Link+Set=S.sh.18%7c1%7csl_190.
[15]	Slade S. Childhood cancer:exercise[EB/OL].(2021-04-07)[2022-05-10]. https://ovidsp.dc2.ovid.com/ovid-b/ovidweb.cgi&S=LFKM-FPOHPGEBIICLJPNJEFDGFKCLAA00&Link+Set=S.sh.18%7c1%7csl_190.
[16]	沈晓雯, 郑小芬, 董宁, 等. 有氧运动结合抗阻运动对恶性肿瘤患儿干预效果的Meta分析[J]. 中华护理杂志, 2021, 56(12):1846-1851. DOI
	Shen XW, Zheng XF, Dong N, et al. The effect of aerobic combined resistance exercise in children with malignant tumor:a Meta-analysis[J]. Chin J Nurs, 2021, 56(12):1846-1851.
[17]	Rossi F, Ricci F, Botti S, et al. The Italian consensus conference on the role of rehabilitation for children and adolescents with leukemia,central nervous system,and bone tumors,part 1:review of the conference and presentation of consensus statements on rehabilitative evaluation of motor aspects[J]. Pediatr Blood Cancer, 2020, 67(12):e28681.
[18]	GPOH. S2k guideline:promotion of exercise and exercise therapy in pediatric oncology[EB/OL].(2021-10)[2022-05-10]. https://www.awmf.org/leitlinien/detail/ll/025-036.html.
[19]	Wurz A, McLaughlin E, Lategan C, et al. The international pediatric oncology exercise guidelines(iPOEG)[J]. Transl Behav Med, 2021, 11(10):1915-1922. DOI URL
[20]	Robinson PD, Oberoi S, Tomlinson D, et al. Management of fatigue in children and adolescents with cancer and in paediatric recipients of haemopoietic stem-cell transplants:a clinical practice guideline[J]. Lancet Child Adolesc Health, 2018, 2(5):371-378. DOI PMID
[21]	Aginga C. Faigue in children with cancer:non-pharmacological interventions[EB/OL].(2021-06-09)[2022-05-10]. https://ovidsp.dc2.ovid.com/ovid-b/ovidweb.cgi?&S=LDGBFPCIGNEBIIOMI-PNJGHPFCLFNAA00&Link+Set=S.sh.18%7c1%7csl_190.
[22]	JBI. Childhood cancer(unfitness):physical exercise training intervention[EB/OL].(2021-07-01)[2022-05-10]. https://ovidsp.dc2.ovid.com/ovid-b/ovidweb.cgi?&S=PKLAFPGHHNEBIIMFJPNJBFIHKELKAA00&Link+Set=S.sh.18%7c1%7csl_190.
[23]	Santos SDS, Moussalle LD, Heinzmann-Filho JP. Effects of phy-sical exercise during hospitalization in children and adolescents with cancer:a systematic review[J]. Rev Paul Pediatr, 2020, 39:e2019313. DOI URL
[24]	Morales JS, Valenzuela PL, Rincón-Castanedo C, et al. Exercise training in childhood cancer:a systematic review and Meta-analysis of randomized controlled trials[J]. Cancer Treat Rev, 2018, 70:154-167. DOI PMID
[25]	Braam KI, van der Torre P, Takken T, et al. Physical exercise training interventions for children and young adults during and after treatment for childhood cancer[J]. Cochrane Data-base Syst Rev, 2016, 3(3):CD008796.
[26]	Grimshaw SL, Taylor NF, Shields N. The feasibility of physical activity interventions during the intense treatment phase for children and adolescents with cancer:a systematic review[J]. Pediatr Blood Cancer, 2016, 63(9):1586-1593. DOI PMID
[27]	Chang CW, Mu PF, Jou ST, et al. The effectiveness of non-pharmacological interventions on fatigue in children and adolescents with cancer:a systematic review[J]. JBI Libr Syst Rev, 2012, 10(10):574-614.
[28]	Li HC, Chung OK, Ho KY, et al. Effectiveness of an integrated adventure-based training and health education program in promoting regular physical activity among childhood cancer survivors[J]. Psychooncology, 2013, 22(11):2601-2610. DOI PMID
[29]	Li WHC, Ho KY, Lam KKW, et al. Adventure-based training to promote physical activity and reduce fatigue among childhood cancer survivors:a randomized controlled trial[J]. Int J Nurs Stud, 2018, 83:65-74. DOI URL
[30]	ahin S, Akel BS, Huri M, et al. Investigation of the effect of task-orientated rehabilitation program on motor skills of children with childhood cancer:a randomized-controlled trial[J]. Int J Rehabil Res, 2020, 43(2):167-174. DOI URL
[31]	Stout NL, Silver JK, Raj VS, et al. Toward a national initiative in cancer rehabilitation:recommendations from a subject matter expert group[J]. Arch Phys Med Rehabil, 2016, 97(11):2006-2015. DOI URL
[32]	Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour[J]. Br J Sports Med, 2020, 54(24):1451-1462. DOI URL
[33]	戚少丹, 顾莺, 胡静, 等. 危重症患儿早期循序渐进运动方案的构建及应用[J]. 中华护理杂志, 2022, 57(14):1702-1708. DOI
	Qi SD, Gu Y, Hu J, et al. Construction and preliminary application of early progressive exercise program for critically ill children[J]. Chin J Nurs, 2022, 57(14):1702-1708. DOI
[34]	潘小容, 莫霖, 刘倩, 等. 家庭正向行为支持方案的构建及应用研究[J]. 中华护理杂志, 2021, 56(11):1618-1626. DOI
	Pan XR, Mo L, Liu Q, et al. Construction and application of family-positive behavior support programme for preschool children with malignant tumors[J]. Chin J Nurs, 2021, 56(11):1618-1626. DOI