心脏康复依从性评估工具测量学属性的系统评价

The cardiac rehabilitation adherence assessment tools:a systematic review of psychometric properties

目的对心脏康复依从性评估工具进行系统评价,以期为临床医护人员选择合适的评估工具提供依据。方法检索美国心肺康复协会网站、英国国家卫生与临床优化研究所网站、PubMed、CINAHL、PsycINFO、Embase、Web of Science、中国知网、万方数据库、维普数据库及中国生物医学文献数据库公开发表的心血管疾病患者心脏康复依从性评估工具的研究,检索时限为建库至2022年12月3日。由2名研究人员独立筛选文献,提取数据,按照基于共识的健康测量工具遴选标准要求,对纳入研究进行方法学质量和测量学属性评价,依据改良版定量系统评价证据分级方法进行证据质量评级后形成推荐意见。结果共纳入12项研究,涉及7个心脏康复依从性评估工具,7个评估工具均未报告跨文化效度/测量不变性、测量误差及反应度;心脏康复依从性评估工具由于有高质量的证据证明其内部一致性的不充分,为C类,不推荐。其余6个评估工具因内容效度的不确定或内部一致性的不充分,证据质量为中、低等,均为B类,推荐。结论与其他6个评估工具相比,心脏康复障碍量表的测量学属性得到了较为全面的评价,具有较好的信效度,可暂时被推荐使用,但仍需更多高质量证据来进一步探究心血管疾病患者心脏康复依从性的评估工具。

Objective To evaluate the systematic review of the cardiac rehabilitation adherence assessment tools,so as to provide references for the selection of appropriate research tools.Methods We searched the American Association of Cardiovascular and Pulmonary Rehabilitation website,the National Institute for Health and Care Excellence website,PubMed,CINAHL,PsycINFO,Embase,Web of Science,CNKI,Wanfang database,VIP database and Chinese Biomedical Literature database for published studies on cardiac rehabilitation adherence assessment tools for patients with cardiovascular disease,and the search time limit is from the establishment of the databases to December 3,2022.2 researchers independently screened the literature,extracted data,and evaluated the methodological quality and the psychometric properties of the included studies according to the consensus-based standards for the selection of health measurement instruments,and the modified grading of recommendations assessment,development of evaluation was used to classify the grade of evidence and recommendations of the tools.Results A total of 12 studies were included,involving 7 cardiac rehabilitation adherence assessment tools.None of the 7 assessment tools reported cross-cultural validity or measurement invariance,measurement error or respon-siveness;the Cardiac Rehabilitation Adherence Tool is Category C and not recommended due to high quality evidence of inadequate internal consistency.The remaining 6 assessment tools are of moderate or low quality of evidence due to uncertainty of content validity or inadequate internal consistency,and all are category B and recommended.Conclusion Compared with the other 6 assessment tools,the Cardiac Rehabilitation Barriers Scale was evaluated more comprehensively for its psychometric properties with good reliability and validity,and it can be provisionally recommended for use.However,more high-quality evidence is still needed to further explore assessment tools for cardiac rehabilitation adherence in patients with cardiovascular disease.