Gnass I, Bartoszek G, Thiesemann R, Meyer G
Institut für Pflegewissenschaft, Fakultät für Medizin, Universität Witten/Herdecke, Witten, Deutschland.
Z Gerontol Geriatr. 2010 Jun;43(3):147-57. doi: 10.1007/s00391-009-0089-6. Epub 2010 Jan 14.
Free movement of the limbs is a prerequisite of mobility and autonomy in old age. The prevalence of contractures in international studies has been reported to range between 15% and 70%. The wide variation might be explained by different definitions and diagnostic criteria, settings, and participants' characteristics. Contractures lead to additional nursing demands. In Germany, contracture risk assessment and prevention have been recently defined as a quality indicator of nursing home care that should be regularly monitored by expert raters of the statutory health insurance system. Therefore, it is necessary to have a clear definition of contracture. The goal of this literature review was to identify definitions of contractures used in controlled trials.
A systematic literature search of controlled trials investigating contracture as primary, secondary, or adverse outcome was conducted using the databases PubMed, CINAHL, Embase, and the Cochrane Library. The search was limited to articles published after 1985 and written in English or German language. Publications were excluded, if animals, children, or congenital contracture were investigated. Two reviewers independently screened the abstracts and extracted data from full publications. Disagreement was solved by consensus involving a third reviewer.
Initially, 544 publications were identified; 37 controlled studies fulfilled the inclusion criteria and were included. A total of 33 studies investigated contracture as primary outcome, three as secondary outcome, and one as adverse outcome. Five studies clearly defined the term contracture. However, all these definitions are different. In 31 studies, only the diagnostic criteria were mentioned and one study mentioned neither a definition nor specific diagnostic criteria.
The majority of clinical trials investigating contracture as outcome parameter do not provide a clear definition. However, the success of contracture prevention and treatment in clinical trials and practice can only be judged in the presence of a clear definition. Thus, it appears especially difficult to use contracture as a quality indicator for nursing homes.
肢体的自由活动是老年人行动能力和自主能力的前提条件。国际研究报告的挛缩患病率在15%至70%之间。这种广泛的差异可能是由不同的定义、诊断标准、研究背景和参与者特征所解释的。挛缩会导致额外的护理需求。在德国，挛缩风险评估和预防最近被定义为养老院护理的一项质量指标，应由法定健康保险系统的专家评估员定期进行监测。因此，有必要对挛缩有一个明确的定义。本综述的目的是确定在对照试验中使用的挛缩定义。
使用PubMed、CINAHL、Embase和Cochrane图书馆数据库对将挛缩作为主要、次要或不良结局进行研究的对照试验进行系统的文献检索。检索仅限于1985年以后发表的、用英语或德语撰写的文章。如果研究对象是动物、儿童或先天性挛缩，则排除相关出版物。两名评审员独立筛选摘要并从全文中提取数据。分歧通过第三名评审员参与的共识来解决。
最初，共识别出544篇出版物；37项对照研究符合纳入标准并被纳入。共有33项研究将挛缩作为主要结局进行调查，3项作为次要结局，1项作为不良结局。5项研究明确界定了挛缩这一术语。然而，所有这些定义都各不相同。在31项研究中，仅提及了诊断标准，1项研究既未提及定义也未提及具体诊断标准。
大多数将挛缩作为结局参数进行研究的临床试验都未提供明确的定义。然而，只有在有明确定义的情况下，才能判断临床试验和实践中挛缩预防和治疗的成效。因此，将挛缩用作养老院的质量指标似乎尤其困难。
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