Wang Yuncui, Yang Fen, Shi Hao, Yang Chongming, Hu Hui
School of Nursing, Hubei University of Chinese Medicine, Hong Shan District, Wuhan 430065, China.
Department of Epidemiology and Biostatistics, and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Int J Environ Res Public Health. 2017 May 10;14(5):510. doi: 10.3390/ijerph14050510.
Stroke is a major cause of disability and mortality worldwide; yet; prior to this study; there had been no sufficient evidence to support the effectiveness of various transitional care interventions (TCI) on the disability and mortality of stroke survivors. This meta-analysis aimed to assess the effectiveness of TCI in reducing mortality and improving the activities of daily life (ADL) of stroke patients. PubMed; Web of Science; OVID; EMBASE; CINAHL; and Sino-Med were searched for articles published before November 2016. Thirty-one randomized controlled trials (RCTs) were identified in the study. This analysis showed that the total effect of TCI on reducing mortality was limited (Risk Ratio (RR) = 0.86; 95% Confidence Interval (CI): 0.75-0.98); that only home-visiting programs could reduce mortality rates (RR = 0.34; 95% CI: 0.17-0.67) compared with usual care; and that the best intervention was led by a multidisciplinary team (MT) ≤3 months (RR = 0.19; 95% CI: 0.05-0.71). In addition; home-visiting programs also produced ADL benefit (RR = 0.56; 95% CI: 0.31-0.81). Overall; there was a statistically significant difference in improving patients' independence between TCI and usual care (RR = 1.12; 95% CI: 1.02-1.23). However; none of the interventions was effective when they were differentiated in the analysis. It is the conclusion of this study that home-visiting programs; especially those led by MTs; should receive the greatest consideration by healthcare systems or providers for implementing TCI to stroke survivors.
中风是全球残疾和死亡的主要原因；然而，在本研究之前，尚无充分证据支持各种过渡性护理干预措施（TCI）对中风幸存者残疾和死亡率的有效性。这项荟萃分析旨在评估TCI在降低中风患者死亡率和改善日常生活活动（ADL）方面的有效性。检索了PubMed、科学网、OVID、EMBASE、CINAHL和中国生物医学文献数据库，查找2016年11月之前发表的文章。该研究共纳入31项随机对照试验（RCT）。分析表明，TCI降低死亡率的总体效果有限（风险比（RR）=0.86；95%置信区间（CI）：0.75 - 0.98）；与常规护理相比，只有家访项目可降低死亡率（RR = 0.34；95% CI：0.17 - 0.67），且最佳干预措施是由多学科团队（MT）在≤3个月内实施（RR = 0.19；95% CI：0.05 - 0.71）。此外，家访项目在ADL方面也有获益（RR = 0.56；95% CI：0.31 - 0.81）。总体而言，TCI与常规护理相比，在提高患者独立性方面存在统计学显著差异（RR = 1.12；95% CI：1.02 - 1.23）。然而，在分析中区分不同干预措施时，没有一种干预措施是有效的。本研究的结论是，家访项目，尤其是由MT主导的项目，医疗保健系统或提供者在对中风幸存者实施TCI时应给予最大考虑。
