老年女性尿失禁非药物干预的最佳证据总结及实践建议

Summary of best evidence and practice recommendations for nonpharmacological interventions of urinary incontinence in elderly women

目的整合老年女性尿失禁非药物干预的最佳证据,并形成实践建议。方法本研究为系统综述,以“老年女性”“尿失禁”“膀胱训练”“盆底肌训练”“elderly woman”“urinary incontinence”“enuresis”“leakage of urine”等为检索词,根据6S证据资源金字塔模型循序逐层检索BMJ最佳临床实践、UpToDate、世界卫生组织、国际指南协作网、英国国家卫生与保健优化研究所、中华医学会、苏格兰院际指南网、加拿大安大略注册护士协会网、Cochrane图书馆、JBI循证卫生保健中心数据库、新西兰指南工作组、波兰妇产科医师学会、PubMed、Embase、Medline、Web of Science、中国生物医学文献服务系统、中国知网、万方等数据库中的所有证据,包括循证知识库资源、临床实践指南、专家共识、系统综述等。检索时间为2017年1月1日至2022年5月1日,数据整理时间为2022年5月2至25日。由2名研究者根据AGREEⅡ和JBI循证卫生保健中心的评价工具独立进行文献质量评价和资料提取,使用JBI循证卫生保健中心的证据预分级系统和证据推荐级别系统对证据等级进行划分,在JBI的证据结构指导下结合研究组讨论及专家意见确定证据推荐强度并进行最佳证据的提取和汇总,形成实践建议。结果共纳入文献9篇,其中指南7篇、系统评价2篇;指南6篇质量等级为A,1篇质量等级为B;系统评价2篇质量等级均为A,84%(27/32)的条目评价结果为“是”。证据总结汇总“整体建议、尿失禁类型与程度评估、生活方式改变、行为疗法、促发因素防范、特殊人群干预”6个维度34条最佳证据,针对筛查、评估、特殊症状、生活方式及行为疗法梳理了流程图,形成了实践建议。结论老年女性尿失禁非药物干预文献总体质量较高,证据级别较高;尽早辨识尿失禁类型并评估严重程度,改变生活方式,避免诱发因素,采取行为疗法,是尿失禁非药物治疗的关键。

Objective To integrate the best evidence of non-drug intervention of urinary incontinence in elderly women and to formulate practical recommendations.Methods In this systematic review study,using“elderly woman”,“urinary incontinence”,“bladder training”,“pelvic floor muscle training”,“enuresis”,“leakage of urine”as the key words,the 6S evidence resource pyramid model was used to search in British Medical Journal best practice,Uptodate,World Health Organization,Guidelines International Network,National Institute for Health and Care Excellence,Chinese Medical Association,Scottish Intercollegiate Guideline Network,Registered Nurses Association of Ontario,Cochrane Library,The Joanna Briggs Institute(JBI),New Zealand Guidelines Group,Polish Society of Gynecologists and Obstetricians,PubMed,Embase,Medline,Web of Science,SinoMed,China National Knowledge Infrastructure,WanFang Data,etc.The evidence retrieved included evidence-based knowledge base resources,clinical practice guidelines,expert consensus,systematic review,etc.Data were retrieved from January 1,2017 to May 1,2022,and collated from May 2,2022 to May 25,2022.Two researchers independently evaluated the quality of literature and extracted data using the AGREEⅡand JBI evidence-based health care center assessment tools.The JBI evidence-based health care center′s evidence pre-rating system and evidence recommendation rating system were applied to rank the evidence;and under the guidance of the evidence structure of JBI,the strength of evidence recommendation was determined and the best evidence was extracted and summarized in combination with the study group discussion and expert opinion.Results A total of 9 articles were retrieved,including 7 guidelines and 2 systematic reviews;and 6 guidelines were classified as Grade A and 1 as grade B;both 2 systematic reviews were rated as Grade A;84%(27/32)of the items were evaluated as“Yes”.Evidence were summarized as 34 pieces of best evidence from 6 dimensions,including“overall recommendation,evaluation of type and degree of urinary incontinence,lifestyle change,behavioral therapy,prevention of precipitating factors,intervention in special population”;the flow chart of screening,evaluation,special symptoms,life style and behavior therapy was combed,and the practical suggestions were formed.Conclusions The overall quality of the literature on non-drug intervention of urinary incontinence in elderly women is high,and the level of evidence is high.Early identification of urinary incontinence types and assessment of disease severity,lifestyle changes,avoidance of predisposing factors and behavioral therapy are the key to non-drug treatment of urinary incontinence in those patients.