老年髋部骨折患者康复期体验与需求的Meta整合

doi:10.3761/j.issn.0254-1769.2022.19.016

摘要/Abstract

摘要：

目的系统评价有关老年髋部骨折患者康复期体验与需求的质性研究,为制订符合国内老年髋部骨折患者需求的康复期护理策略提供参考。方法计算机检索Cochrane Library、PubMed、Embase、中国知网、万方数据库等,收集建库至2021年12月关于老年髋部骨折患者康复期体验与需求的质性研究。采用2016版澳大利亚乔安娜布里格斯研究所（Joanna Briggs Institute,JBI）循证卫生保健中心质性研究质量评价标准评价文献质量,利用汇集性整合法进行结果整合。结果共纳入29项研究,提炼出3个理论模型和93个主题,归纳形成12个类别,合并为4个整合结果：创伤对老年髋部骨折患者身体状态的限制;创伤对老年髋部骨折患者心理状态的影响;康复过程中老年髋部骨折患者表现出不同的态度及应对方式;康复过程中老年髋部骨折患者的需求。结论老年髋部骨折患者处于身心双重限制的困境,医护人员应关注多样化、多维度的患者康复需求,制订以患者需求为导向的个性化康复策略。

关键词: 老年人, 髋骨折, 康复, 体验与需求, 质性研究, Meta整合, 循证护理学

Abstract:

Objective To systematically evaluate the qualitative research on the experience and feeling of elderly patients with hip fracture during rehabilitation. Methods We searched databases including the Cochrane Library,PubMed,Embase,CBM,CNKI,Wanfang,VIP. The literature of qualitative research on the experience and needs of rehabilitation for elderly patients with hip fracture from the establishment of the database to December 2021 was retrieved. The literature was evaluated using the Australian JBI Quality Evaluation Criteria for Qualitative Research in Evidence-based Health Care Centres（2016）,and the results were consolidated using an aggregative integration approach. Results A total of 29 studies were included;3 theoretical models and 93 clear research topics were extracted,and 12 new categories were formed after induction and integration,which were finally merged into 4 integrated results. Integration results 1：Limitations of trauma on physical status of elderly patients with hip fracture. Integration results 2：The effect of trauma on the psychological state of elderly patients with hip fracture. Integration results 3：The elderly patients with hip fracture showed different attitudes and coping styles during rehabilitation. Integrated results 4：The needs of elderly patients with hip fracture during rehabilitation. Conclusion The elderly patients with hip fracture have dual physical and mental limitations after surgery,and will experience a long and struggling process. Medical staff should pay attention to patients diversified and multi-dimensional rehabilitation needs and formulate individualized rehabilitation strategies based on patients’ needs.

Key words: Aged, Hip Fracture, Rehabilitation, Experience and Demand, Qualitative Research, Meta Inte-gration, Evidence-based Nursing

彭涛, 贺开麒, 雷一鹏, 李炳昆, 姚爽, 何永琴, 张玉梅. 老年髋部骨折患者康复期体验与需求的Meta整合[J]. 中华护理杂志, 2022, 57(19): 2406-2413.

PENG Tao, HE Kaiqi, LEI Yipeng, LI Bingkun, YAO Shuang, HE Yongqin, ZHANG Yumei. Rehabilitation experience and nursing demands of elderly patients with hip fracture：a meta-synthesis of qualitative research[J]. Chinese Journal of Nursing, 2022, 57(19): 2406-2413.

图/表 3

图1 文献筛选过程及结果

Figure 1 Literature screening process

表1 纳入文献的基本特征（n=29）

Table 1 The basic characteristics of the included literature（n=29）

表2 纳入文献的质量评价（n=29）

Table 2 Methodological quality evaluation of the included literature（n=29）

参考文献 41

[1]	中国老年医学学会骨与关节分会创伤骨科学术工作委员会. 老年髋部骨折诊疗专家共识(2017)[J]. 中华创伤骨科杂志, 2017, 19(11):921-927.
	Chinese Geriatric Society of Bone and Joint Branch of Orthopaedic Trauma Academic Working Committee. Experts’ concensus on diagnosis and management of geriatric hip fractures (2017)[J]. Chin J Orthop Trauma, 2017, 19(11):921-927.
[2]	Veronese N, Maggi S. Epidemiology and social costs of hip fracture[J]. Injury, 2021, 49(8):1458-1460. DOI URL
[3]	Alexiou KI, Roushias A, Varitimidis SE, et al. Quality of life and psychological consequences in elderly patients after a hip fracture:a review[J]. Clin Interv Aging, 2018, 13:143-150. DOI URL
[4]	张燕, 王婷婷, 车路, 等. 高龄髋部骨折患者早期活动管理方案的构建及应用研究[J]. 中华护理杂志, 2019, 54(11):1615-1620. DOI URL
	Zhang Y, Wang TT, Che L, et al. Construction and application of early activity management scheme for elderly patients with hip fracture full text replacement[J]. Chin J Nurs, 2019, 54(11):1615-1620. DOI URL
[5]	王可心, 范江, 李雪, 等. 老年髋部骨折患者术后功能恢复的长期强化家庭康复训练[J]. 中国组织工程研究, 2020, 24(14):2158-2163.
	Wang KX, Fan J, Li X, et al. Long-term intensive family rehabilitation training for postoperative functional recovery in elderly hip fracture patients[J]. Chin J Tissue Eng Res, 2020, 24(14):2158-2163.
[6]	孙新立, 王剑, 赵志彩, 等. 多学科协作绿色通道对老年创伤性髋部骨折手术治疗疗效及术后预后水平的影响[J]. 创伤外科杂志, 2020, 22(11):814-818.
	Sun XL, Wang J, Zhao ZC, et al. Effect of multi-disciplinary collaborative green channel on prognosis of traumatic hip fracture in the elderly[J]. J Trauma Surg, 2020, 22(11):814-818.
[7]	Institute TJB. Criticl appraisal checklist for qualitative research[EB/OL]. (2020-11-05)[2022-04-13]. http://joannabriggs.org/research/criticalappraisa-l-tools.html.
[8]	Lockwood C, Munn Z, Porritt K. Qualitative research synthesis:methodological guidance for systematic reviewers utilizing meta-aggregation[J]. Int J Evid Based Healthc, 2015, 13(3):179-187. DOI URL
[9]	何丹, 钱会娟, 周玲, 等. 老年髋部骨折行髋关节置换术后患者出院时延续护理需求的质性研究[J]. 中华现代护理杂志, 2020, 26(9):1188-1191.
	He D, Qian HJ, Zhou L, et al. Continuous nursing needs at discharge among geriatric hip fracture patients with hip arthroplasty:a qualitative research[J]. Chin J Mod Nurs, 2020, 26(9):1188-1191.
[10]	Johnson H, Forbes D, Egan MY, et al. Hip-fracture care in rural southwestern Ontario:an ethnographic study of patient transitions and physiotherapy handoffs[J]. Physiother Can, 2013, 65(3):266-275. DOI PMID
[11]	Rasmussen B, Nielsen CV, Uhrenfeldt L. Enduring life in between a sense of renewal and loss of courage:lifeworld perspectives one year after hip fracture[J]. Int J Qual Stud Health Well Being, 2021, 16(1):1934996.
[12]	Bruun-Olsen V, Bergland A, Heiberg KE. “I struggle to count my blessings”:recovery after hip fracture from the patients’ perspective[J]. BMC Geriatr, 2018, 18(1):18. DOI PMID
[13]	Rasmussen B, Nielsen CV, Uhrenfeldt L. Being active 1 1/2 years after hip fracture:a qualitative interview study of aged adults’ experiences of meaningfulness[J]. BMC Geriatr, 2020, 20(1):263. DOI PMID
[14]	Brooks L, Stolee P, Elliott J, et al. Transitional care experiences of patients with hip fracture across different health care settings[J]. Int J Integr Care, 2021, 21(2):2. DOI PMID
[15]	董芳辉, 胡三莲, 钱会娟. 老年髋部骨折患者术后居家护理及其需求的质性研究[J]. 解放军护理杂志, 2017, 34(21):24-27.
	Dong FH, Hu SL, Qian HJ. A qualitative study of home care and nursing demands of elderly patients with hip fracture after operation[J]. Nurs J Chin PLA, 2017, 34(21):24-27.
[16]	Killington M, Walker R, Crotty M. The chaotic journey:recovering from hip fracture in a nursing home[J]. Arch Gerontol Geriatr, 2016, 67:106-112. DOI URL
[17]	Vestøl I, Debesay J, Bergland A. Mobility-a bridge to sense of coherence in everyday life:older patients’ experiences of participation in an exercise program during the first 3 weeks after hip fracture surgery[J]. Qual Health Res, 2021, 31(10):1823-1832. DOI URL
[18]	Popejoy LL, Dorman Marek K, Scott-Cawiezell J. Patterns and problems associated with transitions after hip fracture in older adults[J]. J Gerontol Nurs, 2013, 39(9):43-52. DOI PMID
[19]	Sims-Gould J, Stott-Eveneshen S, Fleig L, et al. Patient perspectives on engagement in recovery after hip fracture:a qualitative study[J]. J Aging Res, 2017, 20:2171865.
[20]	McMillan L, Booth J, Currie K, et al. A grounded theory of taking control after fall-induced hip fracture[J]. Disabil Reha-bil, 2012, 34(26):2234-2241.
[21]	Glenny C, Stolee P, Sheiban LD, et al. Communicating during care transitions for older hip fracture patients:family caregiver and health care provider’s perspectives[J]. Int J Integr Care, 2013, 13:e044.
[22]	Pol M, Peek S, van Nes F, et al. Everyday life after a hip fracture:what community-living older adults perceive as most beneficial for their recovery[J]. Age Ageing, 2019, 48(3):440-447. DOI URL
[23]	Ko YJ, Lee JH, Baek SH. Discharge transition experienced by older Korean women after hip fracture surgery:a qualitative study[J]. BMC Nurs, 2021, 20(1):112. DOI URL
[24]	Griffiths F, Mason V, Boardman F, et al. Evaluating recovery following hip fracture:a qualitative interview study of what is important to patients[J]. BMJ Open, 2015, 5(1):e005406.
[25]	Rasmussen B, Nielsen CV, Uhrenfeldt L. Being active after hip fracture;older people’s lived experiences of facilitators and barriers[J]. Int J Qual Stud Health Well Being, 2018, 13(1):1554024.
[26]	梁小芹, 邵小珍, 陶颖, 等. 老年髋部骨折患者照顾者延续护理需求的质性研究[J]. 护理管理杂志, 2018, 18(2):97-101.
	Liang XQ, Shao XZ, Tao Y, et al. A qualitative study on the continuity nursing needs of elderly hip fracture patients’ caregivers[J]. J Nurs Adm, 2018, 18(2):97-101.
[27]	Toscan J, Manderson B, Santi SM, et al. “Just another fish in the pond”:the transitional care experience of a hip fracture patient[J]. Int J Integr Care, 2013, 13:e023.
[28]	Huang TT, Acton GJ. Ways to maintain independence among Taiwanese elderly adults with hip fractures:a qualitative study[J]. Geriatr Nurs, 2009, 30(1):28-35. DOI URL
[29]	Nahm ES, Resnick B, Orwig D, et al. Exploration of informal caregiving following hip fracture[J]. Geriatr Nurs, 2010, 31(4):254-262. DOI URL
[30]	Gesar B, Baath C, Hedin H, et al. Hip fracture;an interruption that has consequences four months later. A qualitative study[J]. Int J Orthop Trauma Nurs, 2017, 26:43-48.
[31]	张华果, 司文腾, 何宇迪, 等. 老年髋部骨折术后患者跌倒恐惧心理体验的质性研究[J]. 中华护理杂志, 2021, 56(4):527-533. DOI URL
	Zhang HG, Si WT, He YD, et al. Experiences of fear of falling in elderly patients following hip fracture surgery:a qualitative descriptive study[J]. Chin J Nurs, 2021, 56(4):527-533.
[32]	朱慧芳, 颜美琼, 金福妹. 老年髋部骨折术后居家病人抑郁影响因素的质性研究[J]. 护理研究, 2013, 27(36):4120-4121.
	Zhu HF, Yan MQ, Jin FM. A qualitative study on influencing factors of postoperative depression in elderly hip fracture patients at home[J]. Chin Nurs Res, 2013, 27(36):4120-4121.
[33]	Schiller C, Franke T, Belle J, et al. Words of wisdom-patient perspectives to Guide recovery for older adults after hip fracture:a qualitative study[J]. Patient Prefer Adherence, 2015, 9:57-64.
[34]	Stolee P, Elliott J, Byrne K, et al. A framework for supporting post-acute care transitions of older patients with hip fracture[J]. J Am Med Dir Assoc, 2019, 20(4):414-419. DOI PMID
[35]	McMillan L, Booth J, Currie K, et al. ‘Balancing risk’ after fall-induced hip fracture:the older person’s need for information[J]. Int J Older People Nurs, 2014, 9(4):249-257. DOI URL
[36]	Segevall C, Söderberg S, Björkman Randström K. The journey toward taking the day for granted again:the experiences of rural older people’s recovery from hip fracture surgery[J]. Or-thop Nurs, 2019, 38(6):359-366.
[37]	Phelps EE, Tutton E, Griffin X, et al. A qualitative study of patients’ experience of recovery after a distal femoral fracture[J]. Injury, 2019, 50(10):1750-1755. DOI URL
[38]	季涧琳, 陆群峰, 杨利灵, 等. 过渡期护理的概念分析[J]. 中华护理杂志, 2022, 57(3):374-379. DOI URL
	Ji JL, Lu QF, Yang LL, et al. Concept analysis of transitional care[J]. Chin J Nurs, 2022, 57(3):374-379. DOI URL
[39]	王烁, 侯婉玲, 胡蓉芳, 等. ICU患者创伤后应激障碍危险因素的Meta分析[J]. 中华护理杂志, 2016, 51(8):915-922.
	Wang S, Hou WL, Hu RF, et al. A meta-analysis of risk factors for PTSD in intensive care unit survivors[J]. Chin J Nurs, 2016, 51(8):915-922.
[40]	耿亚琴, 许勤, 刘惠贤, 等. 中文版创伤后成长量表在多发伤幸存者中应用的信效度分析[J]. 中华护理杂志, 2011, 46(10):1003-1005.
	Gen YQ, Xu q, Liu HX, Xu XL. Reliability and validity analysis of the Chinese version of the Post Traumatic Growth Scale in survivors of multiple injuries[J]. Chin J Nurs, 2011, 46(10):1003-1005.
[41]	梁小芹, 鲁雪梅, 刘均娥, 等. 共管照护模式在老年髋部骨折患者中的研究进展[J]. 中华护理杂志, 2020, 55(10):1484-1489. DOI URL
	Liang XQ, Lu XM, Liu JE, et al. Research progress on geriatric orthopedic co-management care model in geriatric hip fracture patients[J]. Chin J Nurs, 2020, 55(10):1484-1489. DOI URL