Lai P, Chua S S, Chan S P
Pharmacy Department, University of Malaya and University Malaya Medical Centre, Kuala Lumpur, Malaysia.
Osteoporos Int. 2010 Oct;21(10):1637-56. doi: 10.1007/s00198-010-1199-0. Epub 2010 Apr 9.
A systematic review was conducted to evaluate evidence concerning the effect of non-drug interventions by healthcare professionals on community-dwelling postmenopausal osteoporotic women. Evidence available indicates that such interventions are effective in improving the quality of life, medication compliance, and calcium intake, but effect on other outcomes is less conclusive.
The purpose of this study is to conduct a systematic review to evaluate evidence concerning the effect of non-drug interventions by healthcare professionals on community-dwelling postmenopausal osteoporotic women.
Randomized controlled trials (RCTs) published in English between year 1990 and 2009 were identified. Types of patient outcome used as assessment included quality of life (QOL), bone mineral density (BMD), medication compliance and persistence, knowledge level, and lifestyle modification.
Twenty four RCTs met the inclusion criteria. Seven studies assessed interventions by physiotherapists, six by physicians, seven by nurses, three by multi-disciplinary teams and one by dietitians. Variability in the types and intensity of interventions made comparison between each study difficult. Collectively, these studies provided some evidence to show that interventions by healthcare professionals improved the QOL medication compliance and calcium intake of patients but its effects on BMD, medication persistence, knowledge, and other lifestyle modifications were less conclusive.
From this review, it was found that some outcome measures of such non-drug interventions still required further studies. Future studies should use validated instruments to assess the outcomes, with focus on common definitions of interventions and outcome measures, more intensive one-to-one interventions, appropriate control groups, adequate randomization procedures, and also provide information on effect size.
进行了一项系统评价，以评估医疗保健专业人员的非药物干预措施对社区绝经后骨质疏松症妇女的影响的证据。现有证据表明，此类干预措施在改善生活质量、药物依从性和钙摄入量方面有效，但对其他结果的影响尚无定论。
本研究的目的是进行一项系统评价，以评估医疗保健专业人员的非药物干预措施对社区绝经后骨质疏松症妇女的影响的证据。
确定1990年至2009年间以英文发表的随机对照试验（RCT）。用作评估的患者结局类型包括生活质量（QOL）、骨密度（BMD）、药物依从性和持续性、知识水平以及生活方式改变。
24项RCT符合纳入标准。7项研究评估了物理治疗师的干预措施，6项由医生进行评估，7项由护士进行评估，3项由多学科团队进行评估，1项由营养师进行评估。干预措施的类型和强度存在差异，使得各研究之间难以进行比较。总体而言，这些研究提供了一些证据表明，医疗保健专业人员的干预措施改善了患者的生活质量、药物依从性和钙摄入量，但其对骨密度、药物持续性、知识和其他生活方式改变的影响尚无定论。
从本次评价中发现，此类非药物干预措施的一些结局指标仍需进一步研究。未来的研究应使用经过验证的工具来评估结局，重点关注干预措施和结局指标的通用定义、更密集的一对一干预、适当的对照组、充分的随机程序，并提供效应大小的信息。
