脑卒中偏瘫患者早期康复的最佳证据总结

Best evidence summary of early rehabilitation for stroke patients with hemiplegia

目的检索、评价并总结脑卒中偏瘫患者早期康复的最佳证据,为构建临床早期康复方案提供参考依据。方法通过计算机检索Cochrane图书馆、JBI循证卫生保健国际合作中心图书馆、加拿大安大略注册护士协会、美国指南网、英国指南网、国际指南协作网、国家指南资源中心以及PubMed、中国知网、中国生物医学数据库建库至2021年12月涉及脑卒中偏瘫患者早期康复的所有文献,包括临床实践指南、最佳实践信息册、推荐实践及系统评价。首先,通过PIPOST(population,intervention,professional,outcome,setting,type of evidence)问题开发工具作为文献的纳排标准;其次,对纳入的指南、系统评价、随机对照试验由2名经过培训的研究员根据不同文献类型按照《临床指南研究与评价系统》(AGREEⅡ)、AMSTAR(assessment of multiple systematic reviews)评价工具、澳大利亚JBI循证实践中心相应的评价标准“背靠背”对以上文献进行评价。结果根据评价结果,纳入符合推荐标准文献共14篇;其中,临床指南7篇,4篇为A级推荐,3篇为B级推荐;系统评价4篇,评价结果依次为:9a2b、8a3b、9a2b、8a3b;随机对照试验3篇,评价结果依次为:11a2b、11a1b1c、11a1b1c;经评价汇总,形成了脑卒中偏瘫患者早期康复30条推荐证据,涵盖了早期康复评估工具、组织化管理、训练强度与频率等7个维度。结论脑卒中偏瘫患者的早期康复对预防残疾尤为重要。临床实践应根据循证证据建立早期康复的评估方案、实施标准及评价体系。

Objective To search,evaluate and summarize the best evidence of early rehabilitation for stroke patients with hemiplegia,providing reference for the construction of clinical early rehabilitation program.Methods The Cochrane Library,JBI Center for International Cooperation in Evidence-Based Health Care Library,Ontario Association of Registered Nurses,USA Guidenet,UK Guidenet,International Guidenet,National Guidenet Resource Center,PubMed,CNKI and Chinese Biomedical database were searched by computer until December 2021 All literature on early patient rehabilitation,including clinical practice guidelines,best practice information kits,recommended practices,and systematic reviews.First of all,PIPOST(population,intervention,professional,outcome,setting,type of evidence)problem development tool was used as the indexing standard for literature.Secondly,Randomized Controlled trials for included guidelines,systematic reviews,randomized controlled trials were conducted by 2 trained investigators based on different literature types according to Appraisal of Guidelines for Research and Evaluation(AGREEⅡ),AMSTAR(assessment of multiple systematic trials reviews)evaluation tool and the corresponding evaluation criteria of the JBI Evidence-based Practice Center in Australia"back to back"evaluation of the above literature.Results According to the evaluation results,a total of 14 literatures meeting the recommended criteria were included.Among them,there were 7 clinical guidelines,4 were recommended as grade A and 3 were recommended as grade B.There were 4 systematic reviews,and the evaluation results were 9a2b,8a3b,9a2b,8a3b.There were 3 randomized controlled trials,and the evaluation results were 11a2b,11a1b1c,11a1b1c.After evaluation and summary,30 recommended evidences for early rehabilitation of stroke patients with hemiplegia were formed,covering 7 dimensions such as early rehabilitation assessment tools,organized management,training intensity and frequency.Conclusion It is critical for Early rehabilitation of stroke patients with hemiplegia to prevent disability.Clinical practice should be established the evaluation plan,implementation standard and evaluation system of early rehabilitation based on best evidence.the opening degree.