脑卒中运动功能障碍患者康复管理的最佳证据总结

Summary of best evidence for rehabilitation management of patients with motor dysfunction after stroke

目的:脑卒中运动功能障碍患者康复工作的开展至关重要,然而目前缺少脑卒中患者在康复病房、社区以及家庭康复管理的相关证据总结。本研究旨在汇总脑卒中运动功能障碍患者康复管理的相关证据,为临床和社区医护人员开展康复干预提供参考依据。方法:系统检索BMJ Best Practice、UpToDate、美国国立指南库、美国心脏协会/美国卒中协会、加拿大医学会、英国国家卫生与临床优化研究所、美国退伍军人事务部/国防部、加拿大安大略注册护士协会、JBI循证卫生保健中心数据库、The Cochrane Library、PubMed、Web of Science、Embase、CINAHL、中国知网、万方数据库、维普数据库、中国生物医学文献系统中关于脑卒中运动功能障碍患者康复管理的所有文献,包括临床决策、指南、专家共识、推荐实践、系统评价、证据总结,检索时限为建库至2023年10月。由2名研究者独立对文献进行质量评价。结果:共纳入21篇文献,包括11篇指南、2篇专家共识和8篇系统评价。通过对纳入文献的证据进行提取与整合,从康复管理模式、康复机构、康复团队、康复介入时机、康复评估、康复项目、康复时间和频率、康复强度和康复支持9个领域中汇总45条证据,涵盖了脑卒中患者早期、亚急性期和慢性期全病程的三级康复管理的相关内容。结论:本研究汇总的脑卒中运动功能障碍患者康复管理的最佳证据较为全面,证据质量较高,对临床和社区医护人员开展康复干预具有重要指导意义。建议应用证据时,综合考虑脑卒中患者当前病情、运动功能受损情况、环境因素和患者的意愿,然后选择最适合的康复方案,并根据每位患者的具体需求和喜好调整训练的种类和强度。

Objective:The rehabilitation work for patients with motor dysfunction after stroke is crucial.However,there is currently a lack of summarized evidence regarding the rehabilitation management of stroke patients in rehabilitation wards,communities,and at home.This study aims to compile relevant evidence on the rehabilitation management of patients with motor dysfunction after stroke,providing a reference for clinical and community health professionals to carry out rehabilitation interventions.Methods:A systematic search was conducted in BMJ Best Practice,UpToDate,National Guidebook Clearinghouse,American Heart Association/American Stroke Association,Canadian Medical Association,National Institute for Health and Clinical Excellence,United States Department of Veterans Affairs/Department of Defense,Registered Nurses Association of Ontario,JBI Evidence-Based Healthcare Center Database,The Cochrane Library,PubMed,Web of Science,Embase,CINAHL,CNKI,Wanfang Database,SinoMed,and other databases for all literature on the rehabilitation management of patients with motor dysfunction after stroke.This included clinical decision-making,guidelines,expert consensuses,recommended practices,systematic reviews,and evidence summaries,with the search period spanning from the establishment of each database to October 2023.Two researchers independently evaluated the quality of the literature.Results:A total of twenty-one documents were included,consisting of 11 guidelines,2 expert consensus,and 8 systematic reviews.Evidence was extracted and integrated from the included literature,summarizing forty-five pieces of evidence across nine areas:rehabilitation management model,rehabilitation institutions,rehabilitation teams,timing of rehabilitation interventions,rehabilitation assessment,rehabilitation programs,rehabilitation duration and frequency,rehabilitation intensity,and rehabilitation support These covered comprehensive rehabilitation management content for stroke patients in the early,subacute,and chronic phases.Conclusion:The best evidence summarized in this study for the rehabilitation management of patients with motor dysfunction after stroke is comprehensive and of high quality.It provides important guidance for clinical and community healthcare professionals in carrying out rehabilitation interventions.When applying the evidence,it is recommended to consider the current condition of the stroke patient,the extent of motor dysfunction,environmental factors,and the patient’s preferences.Then,select the most appropriate rehabilitation plan,and adjust the type and intensity of training according to each patient’s specific needs and preferences.