《火针治疗带状疱疹临床实践指南》临床问题和结局指标的确定

Development of clinical questions and outcomes on Clinical Practice Guideline of Fire Needling Therapy for Herpes Zosters

目的:应用世界针灸学会联合会标准《针灸临床实践指南制定及其评估规范》提出的临床问题确定方法,形成《火针治疗带状疱疹临床实践指南》的临床问题及结局指标。方法:采用调研法与专家咨询、共识法相结合的方法,以中国针灸学会临床医生(会员)为调研对象,征集其关注的临床问题后,在专家组内开展2轮函询。第1轮专家问卷采用投票法,征集针灸专家是否同意保留干预措施相关临床问题的意见;第2轮专家问卷采用德尔菲法,征集临床问题和结局指标重要性评分。结果:临床调研共收集到153位临床医生提出的200个结构化临床问题,及13种以火针为主的联合疗法治疗经验。德尔菲问卷权威系数>0.70,备选临床问题和结局指标重要性评分变异系数分别为0.06~0.26和0.12~0.47,纳入临床问题重要性评分均值>4,结局指标重要性评分均值>6,且变异系数均≤0.25的前10个临床问题与12个结局指标(急性期与带状疱疹后神经痛期人群分别对应6个指标)。结论:本研究形成了《火针治疗带状疱疹临床实践指南》的临床问题和结局指标,为指南形成推荐意见提供研究基础。

Objective To develop the clinical questions and outcomes of Clinical Practice Guideline of Fire Needling Therapy for Herpes Zosters based on Norms of Formulation and Evaluation for the Clinical Guideline on Acupuncture and Moxibustion released by World Federation of Acupuncture and Moxibustion Societies.Methods Combined the investigation with expert consultation and consensus method,and taken clinicians(members)of Chinese Association of Acupuncture and Moxibustion as the subjects,the clinical questions concerned were collected and the two-round consultation was conducted among expert group by letter.In the first round questionnaire,using the voting method,the relevant clinical questions in intervention measures were collected;and in the second round,with the Delphi method adopted,the importance of clinical questions and outcomes in the investigation was scored.Results A total of 200 structured clinical questions proposed by 153 clinicians and the clinical experience with 13 kinds of combined therapies involved and fire needling as the key measure were collected.The authority coefficient(Cr)of the Delphi questionnaire was>0.70,and the coefficient of variation for the importance scores of alternative clinical questions and outcomes was 0.06-0.26 and 0.12-0.47,respectively.The top 10 clinical questions and 12 outcomes(6 outcomes referred to the patients either in the acute stage or the post-neuralgia stage)were included,with the importance score of clinical questions>4,the importance score of outcomes>6,and the coefficient of variation≤0.25.Conclusion The clinical questions and outcomes of Clinical Practice Guideline of Fire Needling Therapy for Herpes Zosters are formulated,which provides the research basis for the recommendation development of the guideline.