全膝关节置换术后患者居家康复锻炼方案的构建

Development of a home-based rehabilitation program for patients receiving total knee arthroplasty

目的构建全膝关节置换术后患者居家康复锻炼方案,促进患者术后居家管理。方法以知识行动框架指导方案构建,系统检索全膝关节置换术后居家康复锻炼的相关文献并评价质量,提取及汇总最佳证据形成锻炼意见;采用德尔菲法进行2轮咨询,确定居家康复锻炼内容;通过患者、实践者、管理者访谈,分析实施证据的促进因素和阻碍因素;采用专家小组会议制定居家康复锻炼内容实施的行动策略。结果共纳入23篇文献,筛选24条锻炼意见并细化为术后2~26周的居家康复锻炼内容;确定3个促进因素与4个阻碍因素;最终形成全膝关节置换术后患者居家康复锻炼方案,并制定康复锻炼评估与实践流程图。结论全膝关节置换术后患者居家康复锻炼方案的制定遵循实施科学的知识行动框架,纳入最佳证据,结合专业人员判断、患者意愿及可用资源,可为患者进行居家康复锻炼提供规范系统的干预指引。

Objective To develop a home-based rehabilitation program for patients receiving total knee arthroplasty(TKA)and to promote home management.Methods Guided by the Knowledge-to-Action framework,the development of home-based rehabilitation protocol involved such steps:first step,systematic literature review and quality assessment of relevant studies on home-based rehabilitation after TKA were performed;second step,the best evidence was extracted and summarized to generate rehabilitation contents;third step,two rounds of expert consultation were conducted using the Delphi method to determine the most appropriate rehabilitation contents;fourth step,qualitative interviews with patients,practitioners,and managers,were conducted to better understand facilitators and barriers of evidence implementation;and the last step,action strategies were formulated by an expert panel.Results A total of 23 articles were included,Twenty four items of rehabilitation contents were selected for home-based rehabilitation and a detailed protocol across postoperative weeks 2-26 was formulated.Three facilitators and four bar-riers were identified.A home-based rehabilitation program and a flowchart for the assessment and implementation of the program were developed.Conclusion Following the Knowledge-to-Action framework,the home-based rehabilitation program,which incorporates the best evidence and considers professional judgments,patient preferences,and available resources,can offer standardized and systematic intervention guidelines for patients engaging in home-based rehabilitation exercises.