脑卒中运动功能障碍患者自我管理的最佳证据总结

Summary of Best Evidence for Self-Management of Patients with Motor Dysfunction after Stroke

背景自我管理可满足脑卒中患者及其家人的长期康复需求,但目前相关证据内容缺乏,临床尚无科学、规范的自我管理方案。目的评价和总结脑卒中运动功能障碍患者自我管理的最佳证据。方法系统检索PubMed、Cochrane Library、Web of Science、Embase、CINAHL、中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库、美国心脏协会/美国卒中协会(AHA/ASA)、世界卒中组织(WSO)、中国卒中协会、国际指南协作网(GIN)、苏格兰学院间指南网(SIGN)、美国国立指南库(NGC)、医脉通,获取脑卒中运动功能障碍患者自我管理的相关研究证据,文献类型主要包括指南、专家共识、系统评价、类实验性研究及随机对照研究。检索时限为建库至2022年7月。由两名研究人员独立采用2017版临床指南研究与评价工具(AGREEⅡ)及JBI循证卫生保健中心制定的2016版文献评价标准对检索到的文献进行质量评价,提取证据并对证据进行质量分级,总结脑卒中运动功能障碍患者自我管理的最佳证据。结果共纳入36篇文献,其中指南9篇,专家共识4篇,系统评价5篇,类实验性研究5篇,随机对照研究13篇,汇总为组织管理、评估、运动指导、健康教育、社会心理支持及监测与随访6个方面,共34条最佳证据。结论本研究汇总的脑卒中运动功能障碍患者自我管理的证据包含组织管理、评估、运动指导、健康教育、社会心理支持及监测与随访6个方面,医护人员应结合实际临床情境,根据患者个体情况和需求选择最佳证据,为患者提供个性化自我管理干预,改善患者运动功能和自我管理能力,促进疾病康复。

Background Self-management meets the long-term rehabilitation needs of stroke patients and their families.However,there is a lack of relevant evidence,and there is no scientific and standardized self-management program in clinical practice.Objective To evaluate and summarize the best evidence of self-management in patients with motor dysfunction after stroke.Methods PubMed,Cochrane Library,Web of Science,Embase,CINAHL,CNKI,Wanfang Data,VIP,Chinese Biomedical Literature Database(CBM),American Heart Association/American Stroke Association(AHA/ASA),World Stroke Organization(WSO),Chinese Stroke Association(CSA),Guidelines International Network(GIN),Scottish Intercollegiate Guidelines Network(SIGN),National Guideline Clearinghouse(NGC),and Yimaitong were searched for relevant research evidence on self-management of patients with motor dysfunction after stroke from inception to July 2022,including guidelines,expert consensuses,systematic reviews,quasi-experimental studies,and randomized controlled studies.Two researchers independently evaluated the quality of the retrieved literature by using the 2017 version of the Appraisal of Guidelines for Research and Evaluation(AGREEⅡ)and the 2016 version of the literature evaluation criteria developed by the Joanna Briggs Institute(JBI)Evidence-based Health Care Center,extracted evidence and graded the quality of the evidence to summarize the best evidence of self-management in patients with motor dysfunction after stroke.Results A total of 36 studies were involved,including 9 guidelines,4 expert consensuses,5 systematic reviews,5 quasi-experimental studies,and 13 randomized controlled studies,which were summarized in 6 aspects of organization and management,assessment,exercise instruction,health education,psychological support,monitoring and follow-up,and 34 pieces of best evidence.Conclusion The evidence of self-management in patients with motor dysfunction after stroke summarized in this study contains 6 aspects:organization and management,assessment,exercise instruction,health education,psychological support,monitoring and follow-up.Healthcare workers should select the best evidence based on the individual situation and needs of patients in the context of clinical practice,and provide personalized self-management interventions for patients,so as to improve their motor function and self-management ability,promoting the recovery of disease.