改善膝骨关节炎非手术患者运动治疗依从性的最佳证据总结

Evidence summary of improving adherence to exercise therapy in non-surgical patients with knee osteoarthritis

目的 总结改善膝骨关节炎非手术患者运动治疗依从性的最佳证据,以期为医护人员、管理者、患者及照顾者提供循证依据和参考。方法 计算机检索国际指南协作网、英国国家临床医学研究所、苏格兰校际指南网、加拿大安大略注册护士协会、美国指南网、美国风湿病学会、国际骨关节炎研究学会、土耳其抗风湿病联盟、欧洲骨质疏松和骨关节炎临床及经济学协会、欧洲灰色文献信息系统、Cochrane Library、PubMed、Joanna Briggs Library、医脉通、中国知网、万方数据库中对改善膝骨关节炎非手术患者治疗性运动依从性的文献。检索时限为2017年1月1日—2022年4月20日。由经过循证培训的2名研究人员对所纳入的文献进行质量评价,最终并对符合质量评价标准的文献进行证据提取。结果 共纳入12篇文献,包括指南5篇,系统评价4篇,专家共识3篇,涵盖多学科团队协作、制定个性化运动计划、外部支持、干预措施、健康教育和随访管理等6个方面。总结改善KOA非手术患者运动治疗依从性的最佳证据共18条,其中A级推荐8条,B级推荐10条。结论 临床医护人员在应用证据时,应充分评估并结合患者个体情况制定运动计划、加强多学科交流写作、充分利用外部支持资源并做好健康教育和全程随访管理,综合考量并选择最佳证据实施,可以改善KOA非手术患者运动治疗的依从性。

Objective To summarize the best evidence for improving adherence to exercise therapy in nonsurgical patients with knee osteoarthritis(KOA), so as to provide an evidence-based basis and reference for healthcare professionals, managers, patients, and caregivers. Methods Guidelines International Network, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, Registered Nurses Association of Ontario,National Guideline Clearinghouse, American College of Rheumatology, Osteoarthritis Research Society International,Turkish League Against Rheumatism, European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, System for Information on Grey Literature in Europe, Cochrane Library, PubMed, Joanna Briggs Library,www.guide.medlive.cn, China National Knowledge Infrastructure, and WanFang Data were searched by computer for literature about improving exercise therapy compliance in non-surgical patients with KOA. The retrieval time limit was from January 1, 2017 to April 20, 2022. The quality of the included literature was evaluated by 2 researchers with evidencebased training, and ultimately evidence was extracted from the literature that met the quality evaluation criteria. Results A total of 12 publications were included, including 5 guidelines, 4 systematic reviews, and 3 expert consensuses, covering6 aspects of multidisciplinary teamwork, development of individualized exercise plans, external support, interventions, health education, and follow-up management. A total of 18 best evidences for improving exercise therapy compliance in non-surgical patients with KOA were summarized, with 8 A-level recommendations and 10 B-level recommendations.Conclusions When applying the evidence, clinical staff should fully assess and develop exercise plans with individual patients, strengthen multidisciplinary communication and writing, make full use of external support resources and do health education and full follow-up management. Through comprehensive consideration and selection of the best evidence for implementation, the compliance of KOA non-surgical patients with exercise therapy can be improved.