乳腺癌相关淋巴水肿患者运动疗法的最佳证据总结

Summary of best evidence for exercise therapy in patients with breast cancer related lymphedema

目的对乳腺癌相关淋巴水肿患者的运动疗法相关证据进行检索、评价和总结,为临床实践提供依据。方法根据"6S"证据资源金字塔模型由上至下循序逐层检索BMJ Best Practice、UpToDate、国际指南协作网、英国国家卫生与临床优化研究所、苏格兰院际指南网、美国国立指南库、美国国家综合癌症网、国际淋巴水肿学会网站、国际淋巴水肿协会网站、医脉通、Cochrane Library、中国生物医学文献数据库、PubMed、Web of Science、中国知网、万方数据库中关于乳腺癌相关淋巴水肿患者运动疗法的所有证据,包括临床实践指南、专家共识、最佳实践信息册、Meta分析、系统评价等证据,检索时限为2000年1月—2021年10月。由2名研究者对纳入文献进行质量评价、证据提取和汇总。结果共纳入28篇文献,其中最佳临床实践1篇,临床决策1篇,临床指南7篇,专家共识3篇,系统评价16篇。共提取40条最佳证据,包括运动保障、运动须知、运动类型、运动强度、运动时间、运动频率和随访与健康宣教7个方面。结论运动疗法对乳腺癌相关淋巴水肿患者非常重要。医护人员在应用证据的过程中,应结合实际情况,组建专业医疗团队,充分考虑患者的身心状况及运动习惯,动态化地根据患者的健康状况和偏好调整和制订个性化的运动方案,从而提高运动疗法效果,改善患者的生活质量。

Objective To retrieve,evaluate and summarize the evidence on exercise therapy in patients with breast cancer related lymphedema,so as to provide basis for clinical practice.Methods According to the"6S"evidence resource pyramid model,all the evidence on exercise therapy for patients with breast cancer related lymphedema,including clinical guideline,expert consensus,best practice information book,Meta-analysis,systematic review and other evidence,were searched layer by layer from top to bottom in British Medical Journal(BMJ)Best Practice,UpToDate,Guidelines International Network,National Institute for Health and Clinical Excellence,Scottish Intercollegiate Guidelines Network,Agency for Healthcare Research and Quality,National Comprehensive Cancer Network,National Lymphedema Network,International Society of Lymphedema,Yimaitong,Cochrane Library,China Biology Medicine,PubMed,Web of Science,China National Knowledge Infrastructure,and WanFang Data.The search period was from January 2000 to October 2021.Two researchers conducted literature quality evaluation,evidence extraction and summary.Results A total of 28 articles were included,including one best clinical practice,one clinical decision-making,7 clinical guidelines,three expert consensus,and 16 systematic reviews.A total of 40 best pieces of evidence were extracted from 7 aspects,including exercise guarantee,exercise instructions,exercise form,exercise intensity,exercise time,exercise frequency,and follow-up and health education.Conclusions Exercise therapy is very important for patients with breast cancer related lymphedema.In the process of applying evidence,medical and nursing staff should combine the actual situation to form a professional medical team,fully consider the patient's physical and mental condition and exercise habits,dynamically adjust and develop personalized exercise plans based on the patient's health status and preferences,thereby improving the effectiveness of exercise therapy and patient's quality of life.