老年全髋关节置换术患者早期运动疗法的最佳证据总结

Best evidence summary of early exercise therapy for elderly patients undergoing total hip arthroplasty

目的:全髋关节置换术(total hip arthroplasty,THA)是治疗患者髋部疾病和恢复髋部功能的常用方法,THA术后早期康复可以优化手术结果。运动疗法是康复策略的重要组成部分,本文旨在通过整合老年THA患者早期运动疗法的相关证据,为临床护理人员制订科学、规范的早期运动康复护理方案提供理论依据。方法:遵循“6S”证据模型,系统检索国际指南协作网、美国国立指南网、苏格兰校际指南网络、英国国家健康和保健医学研究所网站、中国临床指南文库、医脉通指南网、Pubmed、Embase、Web of Science、卫生保健及护理学数据库(Cumulative Index to Nursing and Allied Health Literature,CINAHL)、澳大利亚乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)循证卫生保健中心数据库、Cochrane、中国生物医学文献数据库、中国知网、万方数据库、维普数据库等临床决策支持系统、指南网站及数据库中关于老年THA早期运动康复护理实践相关文献,根据纳入和排除标准进行筛选、质量评价和证据提取。检索时间为建库至2022年6月。并通过获取文献的参考文献进行补充检索。结果:共纳入文献15篇,指南文献4篇,专家共识5篇,系统评价3篇,干预性研究2篇,临床决策1篇;共提取证据18条,包括早期运动计划、早期运动评估、早期运动实施、早期运动评价、早期运动教育。结论:本文所纳入证据为后期制订早期运动康复护理方案提供了循证依据。但在临床实际转化应用中,还应该综合考虑患者意愿、临床环境、成本和可行性等方面,再制订适合中国国情的老年THA患者早期运动康复护理方案。

Objective:Total hip arthroplasty(THA)is a common method for treating hip diseases and restoring hip function.Early rehabilitation after THA can optimize surgical outcomes.Exercise therapy is an important component of rehabilitation strategies.This study aims to integrate relevant evidence on early exercise therapy for elderly THA patients to provide a theoretical basis for clinical nursing staff to develop scientific and standardized early exercise rehabilitation nursing plans.Methods:Following the 6S evidence model,a systematic search was conducted in the International Guidelines Collaboration Network,American National Guidelines Clearinghouse,Scottish Intercollegiate Guidelines Network,British National Institute for Health and Care Excellence,Chinese Clinical Guidelines Library,Yimaitong Guidelines Network,Pubmed,Embase,Web of Science,cumulative index to nursing&allied health literature(CINAHL),Australian Joanna Briggs Research Institute(JBI)Evidence-based Healthcare Center Database,Cochrane,Chinese Biomedical Literature Database,China National Knowledge Infrastructure(CNKI)Database,Wanfang Database,and VIP Database.The search aimed to find literature related to early exercise rehabilitation nursing practice of elderly THA patients.The inclusion and exclusion criteria were used for screening,quality evaluation,and evidence extraction.The search period was from the establishment of the database to June 2022.Additional searches were conducted through the references of retrieved literature.Results:A total of 15 documents were included,consisting of 4 guidelines,5 expert consensus documents,3 systematic reviews,2 interventional studies,and 1 clinical decision-making document.A total of 18 pieces of evidence were extracted,covering early exercise plans,early exercise assessment,early exercise implementation,early exercise evaluation,and early exercise education.Conclusion:The evidence included in this study provides an evidence-based basis for developing early exercise rehabilitation nursing plans.However,in clinical practice,it is necessary to consider patient preferences,clinical environment,cost,and feasibility to develop early exercise rehabilitation nursing plans suitable for elderly THA patients in China.