非药物干预对轻度认知功能障碍病人作用的证据总结与评价(二)
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摘要
[目的]对与轻度认知功能障碍(MCI)病人认知干预有关的指南或系统评价进行证据总结与评价,为制订MCI病人相关指南推荐意见提供参考性建议。[方法]计算机检索加拿大安大略注册护士协会(RNAO)官网、美国神经病协会(AAN)官网、英国国家卫生与临床优化研究所(NICE)官网、苏格兰院际指南网(SIGN)、Cochrane Library、PubMed、CINAHL、Web of science、中国知网、维普、万方数据库,检索时间2014年1月—2018年4月,采用AMSTAR 2工具评价纳入研究的方法学质量,必要时应用GRADE方法学对结局指标进行证据分级,采用AGREEⅡ标准评价指南质量。[结果]最终纳入1篇指南、4篇系统评价,主要缺陷为缺乏前期设计方案及未说明相关利益冲突两方面。按照GRADE系统对两篇系统评价的4项证据体进行证据质量评价,其证据体质量为低质量1项和极低质量3项。[结论]纳入研究质量参差不齐。受纳入研究数量及质量限制,尚需开展更多高质量临床研究加以验证。
Objective:To summarize and evaluate the evidences for guidelines or systematic reviews related to cognitive intervention of mild cognitive impairment(MCI) patients and provide reference for formulating recommendations of guidelines for MCI patients.Methods:Databases including the official website of Registered Nurses Association of Ontario(RNAO),American Academy of Neurology(AAN), National Institute for Health and Clinical Excellence(NICE) and Scottish Intercollegiate Guideline Network(SIGN),Cochrane Library,PubMed,CINAHL,Web of science,CNKI,VIP,Wanfang Database were searched by computer from January 2014 to April 2018.AMSTAR 2 was used to evaluate the methodological quality of the incorporated research,GRADE methodology was used to classify the outcome indicators and AGREE Ⅱ standard was used to evaluate the quality of the guidelines.Results:One guideline and four systematic reviews were included.The main shortcomings were lack of former design plan and lack of explanation of relevant conflicts in interest.Four evidences in two systematic reviews were taken for evidence quality evaluation according to the GRADE system.There was one with low quality and another three with very low quality.Conclusions:The quality of the included studies was uneven.The research was limited by the number and quality of the included studies so it needs to be verified by more high-quality clinical studies.
Objective:To summarize and evaluate the evidences for guidelines or systematic reviews related to cognitive intervention of mild cognitive impairment(MCI) patients and provide reference for formulating recommendations of guidelines for MCI patients.Methods:Databases including the official website of Registered Nurses Association of Ontario(RNAO),American Academy of Neurology(AAN), National Institute for Health and Clinical Excellence(NICE) and Scottish Intercollegiate Guideline Network(SIGN),Cochrane Library,PubMed,CINAHL,Web of science,CNKI,VIP,Wanfang Database were searched by computer from January 2014 to April 2018.AMSTAR 2 was used to evaluate the methodological quality of the incorporated research,GRADE methodology was used to classify the outcome indicators and AGREE Ⅱ standard was used to evaluate the quality of the guidelines.Results:One guideline and four systematic reviews were included.The main shortcomings were lack of former design plan and lack of explanation of relevant conflicts in interest.Four evidences in two systematic reviews were taken for evidence quality evaluation according to the GRADE system.There was one with low quality and another three with very low quality.Conclusions:The quality of the included studies was uneven.The research was limited by the number and quality of the included studies so it needs to be verified by more high-quality clinical studies.
引文
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[12] 赵乐,牛丹,陈以华,等.计算机认知训练对认知功能障碍患者干预效果的Meta分析[J].齐鲁护理杂志,2017,23(17):43-47.
[13] CHANDLER M J,PARKS A C,MARSISKE M,et al.Everyday impact of cognitive interventions in mild cognitive impairment:a systematic review and Meta-analysis[J].Neuropsychology Review,2016,26(3):225-251.
[14] HILL N T,MOWSZOWSKI L,NAISMITH S L,et al.Computerized cognitive training in older adults with mild cognitive impairment or dementia:a systematic review and Meta-analysis[J].American Journal of Psychiatry,2016,174(4):329-340.
[15] 中国老年医学学会认知障碍分会,认知障碍患者照料及管理专家共识撰写组.中国认知障碍患者照料管理专家共识[J].中华老年医学杂志,2016,35(10):1051-1060.
[16] PETERSEN R C,LOPEZ O,ARMSTRONG M J,et al.Practice guideline update summary:mild cognitive impairment:report of the guideline development,dissemination and implementation subcommittee of the American Academy of Neurology[J].Neurology,2018,90(3):126-135.
[17] 赵景茹,吕佩源.2017年AAN轻度认知功能障碍实践指南解读[J].中国全科医学,2018,21(12):1387-1391.
[18] 周英凤,胡雁,张晓菊,等.PICC输液技术有效性及安全性评估的系统评价再评价[J].护理学杂志,2016,31(7):90-94.
[2] 孙晓晖,邢秋燕,李雪洁.综合认知训练对养老院轻度认知功能障碍老人认知功能的影响[J].现代医药卫生,2018,34(4):526-528.
[3] CLARE L,WOODS R T.Cognitive training and cognitive rehabilitation for people with early-stage Alzheimer′s disease:a review[J].Neuropsychological Rehabilitation,2004,14(4):385-401.
[4] 朱宏霞,张彩华.老年轻度认知功能障碍的影响因素及护理干预研究进展[J].护理研究,2009,23(9C):2447-2449.
[5] 李紫梦,刘彦慧,王云云,等.非药物干预对轻度认知功能障碍病人作用的证据总结与评价(一)[J].循证护理,2019,5(3):193-202.
[6] SHES B J,REEVES B C,WELLS G,et al.AMSTAR 2:a critical appraisal tool for systematic reviews that include randomized or non-randomized studies of health care interventions,or both[J].BMJ,2017,358:j4008.
[7] ATKINS D,BEST D,BRISS P A,et al.Grading quality of evidence and strength of recommendations[J].BMJ,2004,328 (7454):1490.
[8] SCHüNEMANN H,BROZEK J,OXMAN A,et al.GRADE handbook for grading quality of evidence and strength of recommendation[EB/OL].[2019-04].http://www.cc-ims.net/grade pro.
[9] 韦当,王聪尧,肖晓娟,等.指南研究与评价(AGREE Ⅱ)工具实例解读[J].中国循证儿科杂志,2013,8(4):316-319.
[10] DANS A L,DANS L F.Appraising a tool for guideline appraisal (the AGREE Ⅱ instrument) [J].Journal of Clinical Epidemiology,2010,63(12):1281-1282.
[11] YANG H L,CHAN P T,CHANG P C,et al.Memory-focused interventions for people with cognitive disorders:a systematic review and meta-analysis of randomized controlled studies[J].International Journal of Nursing Studies,2018,78(1):44-51.
[12] 赵乐,牛丹,陈以华,等.计算机认知训练对认知功能障碍患者干预效果的Meta分析[J].齐鲁护理杂志,2017,23(17):43-47.
[13] CHANDLER M J,PARKS A C,MARSISKE M,et al.Everyday impact of cognitive interventions in mild cognitive impairment:a systematic review and Meta-analysis[J].Neuropsychology Review,2016,26(3):225-251.
[14] HILL N T,MOWSZOWSKI L,NAISMITH S L,et al.Computerized cognitive training in older adults with mild cognitive impairment or dementia:a systematic review and Meta-analysis[J].American Journal of Psychiatry,2016,174(4):329-340.
[15] 中国老年医学学会认知障碍分会,认知障碍患者照料及管理专家共识撰写组.中国认知障碍患者照料管理专家共识[J].中华老年医学杂志,2016,35(10):1051-1060.
[16] PETERSEN R C,LOPEZ O,ARMSTRONG M J,et al.Practice guideline update summary:mild cognitive impairment:report of the guideline development,dissemination and implementation subcommittee of the American Academy of Neurology[J].Neurology,2018,90(3):126-135.
[17] 赵景茹,吕佩源.2017年AAN轻度认知功能障碍实践指南解读[J].中国全科医学,2018,21(12):1387-1391.
[18] 周英凤,胡雁,张晓菊,等.PICC输液技术有效性及安全性评估的系统评价再评价[J].护理学杂志,2016,31(7):90-94.