基于COSMIN指南的失智症老年人综合评估工具的系统评价

The comprehensive assessment tools for senile dementia:a systematic review based on COSMIN methodology

目的系统评价失智症老年人综合评估工具的方法学质量和测量学属性,为临床选择最佳评估工具提供依据。方法检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Embase、Web of Science、Cochrane Library、CINAHL、ProQuest、Ovid及Scopus数据库,收集评价失智症老年人综合评估工具测量学属性的研究,检索时限均为建库至2024年1月4日。由2名研究者独立进行文献筛选和提取信息,采用达成共识遴选健康测量工具标准(COSMIN)指南对纳入的评估工具进行评价,形成最终推荐意见。结果共纳入14篇文献,包含9个失智症老年人综合评估工具。其中,阿尔茨海默病患者照护需求评估量表具有中等及以上证据证明其内容效度和内部一致性为"充分",故为A类强推荐。其余8个评估工具均为B类推荐。结论现存的失智症老年人综合评估工具中,阿尔茨海默病患者照护需求评估量表具有良好的信效度,该量表共4个维度,16个条目。但该量表在跨文化效度/测量等同性、稳定性、测量误差、假设检验、校标效度、反应度的测量学特性方面存在不确定和未提及。未来需要更多的证据将其进一步全面验证完善,为筛选出更有效、更全面、更高质量的失智症老年人综合评估工具提供基础。

Objective To assess the methodological and measurement quality of comprehensive assessment tools for evaluating senile dementia,in order to provide evidence-based guidance for clinical selection of the best assessment tool.Methods Manually searched CNKI,Wanfang Database,VIP Database,SinoMed,PubMed,Embase,Web of Science,Cochrane Library,CINAHL,ProQuest,Ovid and Scopus databases to collect and evaluate comprehensive assessment tool measurements forsenile dementia.For research on academic attributes,the search time limit was from the establishment of the database to January 4th,2024.Two researchers independently screened the literature and extracted information,used the COSMIN guidelines to evaluate the included assessment tools,and formed final recommendations.Results A total of 14 articles were included,including 9 comprehensive assessment tools for the elderly with dementia.Among them,the Care Needs Assessment Scale for Alzheimer′s Disease Patients had moderate and above evidence proving that its content validity and internal consistency were"sufficient",so it was a category A strong recommendation.The remaining 8 evaluation tools were all category B recommendations.Conclusions Among the existing comprehensive assessment tools for the elderly with dementia,the Care Needs Assessment Scale for Alzheimer′s Disease Patients has good reliability and validity.This scale has 4 dimensions and 16 items.However,there are uncertainties and unmentioned measurement properties of the scale in terms of cross-cultural validity/measurement equivalence,stability,measurement error,hypothesis testing,calibration validity,and responsiveness.More evidence is needed in the future to further comprehensively validate and improve it,providing a basis for selecting a more effective,comprehensive and high-quality comprehensive assessment tool for the elderly with dementia.