循证医学在康复临床中的应用

Application of evidence based medicine in rehabilitation clinic

在康复医学领域如何开展循证医学?循证医学证据的分级,实践循证医学的步骤,以及怎样才能够通过临床医师参与和利用Cochrane协作网、阅读和应用循证医学文献来寻找到目前最好的证据,以解决患者的实际问题;循证医学应用于心肺疾患、神经系统疾患、骨关节疾患等已取得较好的经济效益和社会效益;而目前的部分系统评价所收集的原始文献尚不充分,大部分缺乏大型、多中心随机对照试验的支持,有的系统评价无法得出对临床有帮助的结论。文章综述了康复科主要相关疾病的循证医学研究概况,为临床康复医师如何实践循证医学和进行康复医学科研提供参考。

The history of Evidence based medicine(EBM) is short, but it has been developed rapidly.A Canadian scholar, David Sackett, published an EBM article formally in 1992 and gave the concept of EBM at first. The Cochrane center, named as famous deceased British epidemiologist and physician, that is Archie Cochrane who was the beginner of the EBM, was set up in Oxford University in1992. The first EBM annual meeting was hold in Oxford in 1993 and Cochrane collaboration was set up at the same time.13 branches of Cochrane center has been established in 13 countries now. We started to prepare the construction of China Cochrane center in the 1st affiliated hospital of West China University of Medicine Sciences (WCUMS) in 1995. The application of preparing the construction of China Cochrane center was sent to Health Ministry of P.R.C formally by he 1st affiliated hospital of West China University of Medicine Sciences in Feb 1997.China Cochrane center was accept and registered by international Cochrane Collaboration and became the first Asian Cochrane center .EBM and it's research methods provides a new way to solve the global problems such as rapidly increasing of medical cost and high cost without best medical service .EBM developed rapidly recently and was used to many clinical disciplines. They crossed each other and developed many frontier branches of science, such as evidence based neuroscience, evidence based obstetrics and gynecology and evidence based pediatrics. The association between EBM and rehabilitation is not so much. Author tried to introduce the application of EBM in physiatry to physiatricians. This article explained the importance of developing EBM in Physical Medicine and Rehabilitation, and introduced the classification of evidences and steps of practicing EBM. Author thinks that clinical physicians should look for the best evidences to solve patients' practical problems by participating and taking advantage of Cochrane collaboration and reading and using EBM literatures. It shows good economic and social effect after EBM has been used in heat and pulmonary disease, nerve system disease and bone and joint disease. Nowadays, the original literatures of part of system reviews are not enough. Many system reviews not involves large, multiple center randomized control trials. There are not any helpful conclusions in some system reviews. Author summarized research outline of EBM about the diseases in rehabilitation section. It will help physiatrician practice