全膝关节置换术后患者居家自主康复锻炼的最佳证据总结

Summary of Best Evidence for Home-based Independent Rehabilitation Exercise After Total Knee Arthroplasty

目的检索、评价并总结初次全膝关节置换术后患者在无医务人员监督情况下进行居家自主康复锻炼的最佳证据,为临床实践提供参考。方法遵循“6S”证据模型,系统检索国内外相关指南网站、专业协会网站及PubMed、Embase、中国知网、万方、维普等数据库中关于初次全膝关节置换术后居家自主康复锻炼的相关文献,包括指南、临床决策、系统评价、证据总结、专家共识及随机对照试验,检索时限为2012年1月1日至2022年6月30日。由3名研究者独立评价文献质量,并提取证据。结果共纳入文献22篇,包括指南4篇、临床决策1篇、系统评价5篇、随机对照试验12篇。根据相关内容共总结出居家自主康复锻炼的25条证据,主要涵盖适用人群、康复目标、锻炼内容、锻炼时长及强度、锻炼原则、安全保障与效果评价7个方面。结论基于循证方法总结的初次全膝关节置换术后患者居家自主康复锻炼的最佳证据具有较好的科学性,能够为全膝关节置换术后患者康复锻炼健康教育与锻炼方案的制订提供循证依据。

Objective To retrieve,evaluate and summarize the best evidence for home-based independent rehabilitation exercise after initial total knee arthroplasty without the supervision of healthcare providers,so as to provide a reference for clinical practice.Methods Based on the"6S"evidence pyramid,articles(guidelines,clinical decisions,systematic reviews,evidence summaries,expert consensuses,randomized controlled trials,etc.)related to home-based independent rehabilitation exercise after initial total knee arthroplasty were systematically retrieved in domestic and foreign guideline websites,professional association websites,PubMed,Embase,CNKI,Wanfang Data and VIP from January 1,2012 to June 30,2022.Three investigators independently evaluated the quality of the articles and extracted relevant evidence.Results A total of 22 articles were included,including 4 guidelines,1 clinical decision,5 systematic reviews and 12 randomized controlled trials.Finally,25 pieces of evidence for home-based independent rehabilitation exercise were summarized from related contents,mainly covering 7 aspects:applicable population,rehabilitation objectives,exercise content,exercise duration and intensity,exercise principles,safety guarantee and effect evaluation.Conclusion The best evidence for home-based independent rehabilitation exercise after initial total knee arthroplasty summarized by an evidence-based method is scientific and able to provide an evidence-based basis for the formulation of health education and exercise plans for postoperative rehabilitation exercise.