儿童和青少年脑性瘫痪临床实践指南选题的范围综述

Topics of Clinical Practice Guideline for Children and Adolescents with cerebral palsy:Scoping review

背景儿童和青少年脑瘫的康复期望高质量的临床实践指南,指导康复实践者通过科学合理的评估与干预,改善儿童和青少年脑瘫的健康状态。目的支持、改进和完善指南核心专家组提出的儿童和青少年脑性瘫痪临床实践指南(CANDLE)选题架构层次。设计范围综述。方法检索英文数据库(谷歌学术搜索)和中文数据库(中国知网、万方和维普);灰色文献检索谷歌和百度网站;检索起止日期为2010年1月1日至2022年5月2日。纳入儿童和青少年脑瘫知识合成类文献(指南、共识、系统评价、范围综述)。根据谷歌学术搜索网站默认的智能排序依次筛选,阅读题目和摘要初筛直至连续50篇均无符合纳入标准的文献为止;筛选保留文献下载全文再筛;再筛保留文献的参考文献与保留文献查重,不重复文献行题目和摘要筛选。自制文献数据提取表,提取文献一般特征;范围综述界定问题:《国际功能、残疾和健康分类-儿童青少年》(ICF-CY)运用状况,功能是如何被表述的,儿童脑瘫康复的评估、发育、交互等如何被总结归纳的;6名数据提取员采用定性和定量的方法总结结果,CANDLE核心专家成员通过讨论回答范围综述界定的问题。主要结局指标指南选题总体框架层次。结果372篇文献纳入本文范围综述,指南、共识、系统评价和范围综述均呈现随年份逐步增多趋势,英文范围综述2010至2018年7篇,~2022年42篇。英文文献研究者最关注干预技术、评估技术和功能状态,中文文献中干预技术占比66.7%。181篇英文干预技术文献中,涉及37种技术。整体架构采用了ICF-CY或ICF理念4篇,部分采用了为78篇。47篇共识和指南中,9篇共识和7部指南以功能为切入,与运动和姿势相关的功能切入点包括:肌张力、移动、手部活动、继发肌肉骨骼障碍、日常生活活动能力和休闲活动。104篇(31%)文献单独论述评估方法,采用基于共识的健康测量工具遴选标准(COSMIN)方法20篇。9篇(3%)单独阐述发育特性对功能的影响。41篇(12.1%)通过相关性、影响因素等方法分析了各种功能之间以及与背景性因素的交互作用。结论范围综述支持、改进和完善了CANDLE总体架构,修正为以功能为切入点建立8个维度,以ICF-CY定位、评估、发育、交互性、干预5要素表现维度,在要素下产生选题。

Background Rehabilitation of children and adolescents with cerebral palsy(CP)needs high-quality clinical practice guidelines to provide effective assessment and intervention to improve the health condition of children and adolescents with CP.Objective To improve and perfect the topic structure of Clinical Practice Guidelines for Children and Adolescents with Cerebral Palsy(CANDLE).Design A Scoping review Methods We searched English literature in Google Scholar and Chinese literature in CNKI,WangFang and VIP from January 1,2010 to May 2,2022 to get literature about children and adolescents with CP including guidelines,expert consensus,systematic review,and scoping review.Grey literature was searched in Google and BAIDU.According to intelligent sorting of Google scholar,researchers preliminarily screened literature by reading titles and abstracts until consecutive 50 articles of failed to match the inclusion criteria.The included literature was rescreened by reading full texts.References of the included literature after the second screening were compared with the final list of the included studies to find differences.Those unduplicated ones were screened by reading titles and abstracts.Researchers extracted data about questions proposed by the scoping review to a self-made Excel sheet.The sheet consists of items of the application condition of The International Classification of Functioning,Disability and Health for Children and Youth(ICF-CY),function assessment,development,intervention,and functional influencing factor of children and adolescents with CP.The consistency of extracted data by 6 researchers was requested to be over 80%.Qualitative and quantitative methods were used to analyze data,and the core member of the CANDLE team answered the questions proposed by the scoping review.Main outcome measures Questions proposed by the scoping review.Results A total of 372 articles were enrolled in this scoping review.There has been a gradual increase in the number of guidelines,expert consensus,systematic reviews and scoping reviews in the past years.We got 7 English scoping reviews from 2010 to 2018,and 42 from 2018 to 2022.The majority of English literature focuses on intervention techniques,assessment techniques,and function status.Intervention techniques in Chinese literature accounted for 66.7%.There were 37 kinds of intervention techniques in 181 English articles.Four articles adopted ICF-CY or ICF concept,and 78 articles partially used ICF concept in their structure.A total of 47 guidelines and expert consensus were enrolled.Among them,9 expert consensus and 7 guidelines used function as a starting point.In 6 comprehensive guidelines,contents about function related to posture and motor were shown by muscular tension,mobility,hand activity,secondary musculoskeletal,daily living and leisure activities.There were 104 articles(31%)discussing the assessment method separately within 20 articles using COSMIN.Nine articles(3%)independently elaborated the effect of development characteristics on function.A total of 41 articles(12.1%)analyzed the interaction between function and background factors through the methods of correlation and influencing factors.Conclusion The overall structure of CANDLE was initially formed through this scoping review.Eight domains were established with function as the core,each of which is shown through five elements(ICF-CY as the framework,assessment,development,interaction,and intervention).Questions of interest within the scope are built on the elements.