Academic and Clinical Unit for Musculoskeletal Nursing, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK.
Int J Nurs Stud. 2011 May;48(5):642-54. doi: 10.1016/j.ijnurstu.2011.02.007. Epub 2011 Mar 9.
The objective of this systematic review was to determine the effectiveness of nurse-led care in rheumatoid arthritis.
Systematic review of effectiveness.
Electronic databases (AMED, CENTRAL, CINAHL, EMBASE, HMIC, HTA, MEDLINE, NHEED, Ovid Nursing and PsycINFO) were searched from 1988 to January 2010 with no language restrictions. Inclusion criteria were: randomised controlled trials, nurse-led care being part of the intervention and including patients with RA.
Data were extracted by one reviewer and checked by a second reviewer. Quality assessment was conducted independently by two reviewers using the Cochrane Collaboration's Risk of Bias Tool. For each outcome measure, the effect size was assessed using risk ratio or ratio of means (RoM) with corresponding 95% confidence intervals (CI) as appropriate. Where possible, data from similar outcomes were pooled in a meta-analysis.
Seven records representing 4 RCTs with an overall low risk of bias (good quality) were included in the review. They included 431 patients and the interventions (nurse-led care vs usual care) lasted for 1-2years. Most effect sizes of disease activity measures were inconclusive (DAS28 RoM=0.96, 95%CI [0.90-1.02], P=0.16; plasma viscosity RoM=1 95%CI [0.8-1.26], p=0.99) except the Ritchie Articular Index (RoM=0.89, 95%CI [0.84-0.95], P<0.001) which favoured nurse-led care. Results from some secondary outcomes (functional status, stiffness and coping with arthritis) were also inconclusive. Other outcomes (satisfaction and pain) displayed mixed results when assessed using different tools making them also inconclusive. Significant effects of nurse-led care were seen in quality of life (RAQoL RoM=0.83, 95%CI [0.75-0.92], P<0.001), patient knowledge (PKQ RoM=4.39, 95%CI [3.35-5.72], P<0.001) and fatigue (median difference=-330, P=0.02).
The estimates of the primary outcome and most secondary outcomes showed no significant difference between nurse-led care and the usual care. While few outcomes favoured nurse-led care, there is insufficient evidence to conclude whether this is the case. More good quality RCTs of nurse-led care effectiveness in rheumatoid arthritis are required.
本系统评价旨在确定护士主导的护理在类风湿关节炎中的有效性。
有效性的系统评价。
从 1988 年至 2010 年 1 月，对电子数据库（AMED、CENTRAL、CINAHL、EMBASE、HMIC、HTA、MEDLINE、NHEED、Ovid Nursing 和 PsycINFO）进行了检索，无语言限制。纳入标准为：随机对照试验，护士主导的护理是干预的一部分，包括类风湿关节炎患者。
由一名评审员提取数据，另一名评审员进行核对。两名评审员使用 Cochrane 协作风险偏倚工具独立进行质量评估。对于每个结局指标，使用风险比或均值比（RoM）评估效应大小，并适当使用相应的 95%置信区间（CI）。在可能的情况下，将来自类似结局的资料合并进行荟萃分析。
综述纳入了 7 项研究，共涉及 4 项随机对照试验，整体偏倚风险较低（质量较高）（7 项记录代表 4 项 RCT，整体偏倚风险低（质量好）），共纳入 431 名患者，干预（护士主导的护理与常规护理）持续 1-2 年。大多数疾病活动度测量的效果大小不确定（DAS28 RoM=0.96，95%CI [0.90-1.02]，P=0.16；血浆粘度 RoM=1 95%CI [0.8-1.26]，p=0.99），除了 Ritchie 关节指数（RoM=0.89，95%CI [0.84-0.95]，P<0.001），该指数倾向于护士主导的护理。一些次要结局（功能状态、僵硬和关节炎应对）的结果也不确定。使用不同工具评估的其他结局（满意度和疼痛）显示出混合结果，因此也不确定。护士主导的护理在生活质量（RAQoL RoM=0.83，95%CI [0.75-0.92]，P<0.001）、患者知识（PKQ RoM=4.39，95%CI [3.35-5.72]，P<0.001）和疲劳（中位数差异=-330，P=0.02）方面具有显著效果。
主要结局和大多数次要结局的估计值表明，护士主导的护理与常规护理之间无显著差异。虽然有少数结局倾向于护士主导的护理，但没有足够的证据得出这一结论。需要更多高质量的类风湿关节炎护士主导护理有效性 RCT。
