轮椅技能训练对下肢运动功能障碍患者日常轮椅使用水平和生存质量改善效果的系统评价和Meta分析
摘要
目的:通过系统评价和Meta分析的方法比较规范化的轮椅技能训练与常规护理/康复在改善患者日常轮椅使用水平和生存质量方面的疗效。方法:计算机检索PubMed、EMbase、Web of Science、EBSCO、Google Scholar和中国知网等数据库中关于轮椅技能训练对下肢运动功能障碍患者康复疗效的随机对照试验(RCT),检索时间均从建库至2016年1月,分别采用Cochrane协作网中RCT的偏倚风险评价标准和RevMan 5.3软件进行方法学质量评价和Meta分析。结果:共纳入8个RCT,314例患者。Meta分析结果表明,经过3天—8周的干预后轮椅技能训练组患者日常轮椅使用水平显著高于常规护理/康复组[SMD=1.04, 95%CI (0.39, 1.68), P=0.002],但关于轮椅使用自信心、轮椅参与度、使用满意度、生存质量和日常生活活动能力等指标,由于缺乏充足的RCT,尚不能进行Meta分析。结论:3天—8周的轮椅技能训练能够显著提高下肢运动功能障碍患者日常轮椅使用水平,但鉴于其较高的临床异质性和GRADE系统推荐分级,我们可以谨慎推荐应用在临床康复、社区康复和家庭康复中,提高康复治疗师临床指导能力,提升患者日常生活独立性。
引文
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[15]Routhier F, Kirby RL, Demers L, et al. Efficacy and retention of the French-Canadian version of the wheelchair skills training program for manual wheelchair users:a randomized controlled trial[J]. Arch Phys Med Rehabil, 2012,93(6):940—948.
[16]Sakakibara BM, Miller WC, Souza M, et al. Wheelchair skills training to improve confidence with using a manual wheelchair among older adults:a pilot study[J]. Arch Phys Med Rehabil, 2013, 94(6):1031—1037.
[17]王杨,李奎成,邓小倩.规范化轮椅技能训练对截瘫患者的康复疗效[J].中国康复,2013,(05):351—353.
[18]郭佳宝,杨雨洁,岳雨珊,等.机器人辅助训练改善脑卒中患者下肢功能障碍的系统评价[J].中国康复理论与实践,2013,(08):701—709.
[19]Fliess-Douer O, Vanlandewijck YC, Lubel Manor G, et al.A systematic review of wheelchair skills tests for manual wheelchair users with a spinal cord injury:towards a standardized outcome measure[J]. Clin Rehabil, 2010, 24(10):867—886.
[20]Kilkens OJ, Post MW, Dallmeijer AJ, et al. Wheelchair skills tests:a systematic review[J]. Clin Rehabil, 2003, 17(4):418—430.
[2]周罗治非.浅谈轮椅的研究现状及其在神经损伤中的康复应用[J].按摩与康复医学,2014,5(2):208—211.
[3]Ripat JD, Woodgate RL. The role of assistive technology in self-perceived participation[J]. Int J Rehabil Res, 2012, 35(2):170—177.
[4]Scherer MJ, Sax C, Vanbiervliet A, et al. Predictors of assistive technology use:the importance of personal and psychosocial factors[J]. Disabil Rehabil, 2005, 27(21):1321—1331.
[5]Scherer M, Jutai J, Fuhrer M, et al. A framework for modelling the selection of assistive technology devices(ATDs)[J]. Disabil Rehabil Assist Technol, 2007, 2(1):1—8.
[6]Toro ML, Eke C, Pearlman J. The impact of the World Health Organization 8-steps in wheelchair service provision in wheelchair users in a less resourced setting:a cohort study in Indonesia[J]. BMC Health Serv Res, 2016, 16(1):26.
[7]Best KL, Kirby RL, Smith C, et al. Wheelchair skills training for community-based manual wheelchair users:a randomized controlled trial[J]. Arch Phys Med Rehabil, 2005, 86(12):2316—2323.
[8]Kirby RL, Miller WC, Routhier F, et al. Effectiveness of a wheelchair skills training program for powered wheelchair users:A randomized controlled trial[J]. Arch Phys Med Rehabil, 2015, 96(11):2017—2026.
[9]杨克虎.系统评价指导手册[M].北京:人民卫生出版社,2010.149—163.
[10]刘鸣.系统评价、Meta-分析设计与实施方法[M].北京:人民卫生出版社,2011.69—127.
[11]Howard Balshem, Mark Helfanda, Holger J. GRADE指南:Ⅲ.证据质量分级[J].中国循证医学杂志,2011,11(04):451—455.
[12]Best KL, Miller WC, Huston G, et al. Pilot study of a peer-led wheelchair training program to improve self-efficacy using a manual wheelchair:A randomized controlled trial[J]. Arch Phys Med Rehabil, 2016, 97(1):37—44.
[13]MacPhee AH, Kirby RL, Coolen AL, et al. Wheelchair skills training program:A randomized clinical trial of wheelchair users undergoing initial rehabilitation[J]. Arch Phys Med Rehabil, 2004, 85(1):41—50.
[14]Oztürk A, Ucsular FD. Effectiveness of a wheelchair skills training programme for community-living users of manual wheelchairs in Turkey:a randomized controlled trial[J].Clin Rehabil, 2011, 25(5):416—424.
[15]Routhier F, Kirby RL, Demers L, et al. Efficacy and retention of the French-Canadian version of the wheelchair skills training program for manual wheelchair users:a randomized controlled trial[J]. Arch Phys Med Rehabil, 2012,93(6):940—948.
[16]Sakakibara BM, Miller WC, Souza M, et al. Wheelchair skills training to improve confidence with using a manual wheelchair among older adults:a pilot study[J]. Arch Phys Med Rehabil, 2013, 94(6):1031—1037.
[17]王杨,李奎成,邓小倩.规范化轮椅技能训练对截瘫患者的康复疗效[J].中国康复,2013,(05):351—353.
[18]郭佳宝,杨雨洁,岳雨珊,等.机器人辅助训练改善脑卒中患者下肢功能障碍的系统评价[J].中国康复理论与实践,2013,(08):701—709.
[19]Fliess-Douer O, Vanlandewijck YC, Lubel Manor G, et al.A systematic review of wheelchair skills tests for manual wheelchair users with a spinal cord injury:towards a standardized outcome measure[J]. Clin Rehabil, 2010, 24(10):867—886.
[20]Kilkens OJ, Post MW, Dallmeijer AJ, et al. Wheelchair skills tests:a systematic review[J]. Clin Rehabil, 2003, 17(4):418—430.