国内社区护理干预对老年骨质疏松症病人临床结局影响的系统评价

Effects of community nursing intervention for patients with senile osteoporosis in China:A systematic review and meta-analysis

[目的]客观评价国内社区护理干预对老年骨质疏松症病人临床结局的影响。[方法]电子检索万方、中文期刊全文数据库、中国生物医学文献数据库和中国知网中有关社区护理干预对老年骨质疏松症病人临床结局影响的随机对照试验(RCTs),同时追溯纳入文献及相关综述的参考文献。两名评价者独立检索、筛查文献,提取数据、评价纳入文献的方法学质量后,进行交叉核对,任何争议通过共识原则解决。采用Cochrane协作网提供的RevMan 5.3软件进行Meta分析,GRADEprofiler 3.6软件对证据质量进行评级。[结果]共纳入7个RCTs,包括914例研究对象。Meta分析结果显示,社区护理干预能降低病人的骨折发生率[OR=0.26,95%CI(0.15,0.45),P=0.00],针对BMD社区护理干预并未显示特殊优势[MD=0.04,95%CI(-0.02,0.10),P=0.16]。定性分析表明,社区护理干预能改善病人生活质量及骨质疏松性疼痛症状。GRADE结果显示,证据总体质量等级极低。[结论]社区护理干预能有效减少老年骨质疏松症病人的骨折发生率,改善病人生活质量和骨性疼痛,然而由于纳入研究存在较大异质性,且整体质量不足,开展设计严谨的多中心、大样本RCTs进一步验证相关结局实为必要。

Objective：The aim of the present study is to systematically assess the potential of community nursing intervention for patients with senile osteoporosis. Methods：To search of WanFang,Chinese Periodical Full -text Database, China Biomedical Literatures Database and China National Knowledge Infrastructure were performed for relevant RCTs regarding effects of community nursing intervention for patients with senile osteoporosis. And the references of eligible literatures and reviews were also manually screened. Relevant studies were searched, screened. Data were extracted. Methodological quality of included studies were assessed and all proces- ses underwent cross -checked by two independent reviewers. Any divergences resolved based on consensus. And then a rneta - analysis was performed by using RevMan 5.3 software and the assessing for the level of evidence was conducted via GRADEprofiler 3.6. Results： Total 7 RCTs,involving 914 participants were included into the present systematic review and meta-analysis. The pooled results showed that community nursing intervention was associated with the reduction of the fracture rate for patients with senile osteoporosis [OR=0.26,95% CI （0.15,0.45） ,P=0.00]. It had no obvious advantage for change of bone mineral density （BMD）[MD-= 0. 04, 95 %CI （-0.02 ,O. 10）, P=0. 16]. Qualitative analysis identified that community nursing intervention had the potential of improving the quality of life （QOL） and osteoporosis- related pain. Results from GRADE suggested that the level of evidence was very low. Conclusion：Community nursing intervention can effectively decrease the fracture rate,improve the quality of life and pain for osteoporosis patients. However, due to the heterogeneity and low quality of included studies,it is imperative to plan rigorous - designed RCTs, with multicenter and large sample size,to establish relevant outcomes ulteriorly.