Global Health and Tropical Medicine & World Health Organization Collaborating Center for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal.
School of Health Sciences, Oakland University, Rochester, MI.
Arch Phys Med Rehabil. 2018 Jun;99(6):1141-1148.e4. doi: 10.1016/j.apmr.2017.08.491. Epub 2017 Sep 28.
To characterize the peer-reviewed quality improvement (QI) literature in rehabilitation.
Five electronic databases were searched for English-language articles from 2010 to 2016. Keywords for QI and safety management were searched for in combination with keywords for rehabilitation content and journals. Secondary searches (eg, references-list scanning) were also performed.
Two reviewers independently selected articles using working definitions of rehabilitation and QI study types; of 1016 references, 112 full texts were assessed for eligibility.
Reported study characteristics including study focus, study setting, use of inferential statistics, stated limitations, and use of improvement cycles and theoretical models were extracted by 1 reviewer, with a second reviewer consulted whenever inferences or interpretation were involved.
Fifty-nine empirical rehabilitation QI studies were found: 43 reporting on local QI activities, 7 reporting on QI effectiveness research, 8 reporting on QI facilitators or barriers, and 1 systematic review of a specific topic. The number of publications had significant yearly growth between 2010 and 2016 (P=.03). Among the 43 reports on local QI activities, 23.3% did not explicitly report any study limitations; 39.5% did not used inferential statistics to measure the QI impact; 95.3% did not cite/mention the appropriate reporting guidelines; only 18.6% reported multiple QI cycles; just over 50% reported using a model to guide the QI activity; and only 7% reported the use of a particular theoretical model. Study sites and focuses were diverse; however, nearly a third (30.2%) examined early mobilization in intensive care units.
The number of empirical, peer-reviewed rehabilitation QI publications is growing but remains a tiny fraction of rehabilitation research publications. Rehabilitation QI studies could be strengthened by greater use of extant models and theory to guide the QI work, consistent reporting of study limitations, and use of inferential statistics.
描述康复领域同行评审的质量改进（QI）文献。
从 2010 年至 2016 年，五个电子数据库以 QI 和安全管理关键词，并结合康复内容和期刊关键词，对英文文献进行检索。还进行了二次检索（例如，参考文献扫描）。
两位审查员使用康复和 QI 研究类型的工作定义，独立选择文章；在 1016 篇参考文献中，有 112 篇全文符合入选标准。
由 1 位审查员提取报告的研究特征，包括研究重点、研究地点、使用推理统计、说明的局限性以及使用改进周期和理论模型，如有需要，将由第 2 位审查员进行推断或解释。
共发现 59 篇康复质量改进的实证研究：43 篇报告本地 QI 活动，7 篇报告 QI 效果研究，8 篇报告 QI 促进因素或障碍，1 篇特定主题的系统综述。2010 年至 2016 年，出版物数量呈显著逐年增长（P=.03）。在 43 篇关于本地 QI 活动的报告中，23.3%没有明确报告任何研究局限性；39.5%没有使用推理统计来衡量 QI 影响；95.3%没有引用/提及适当的报告指南；只有 18.6%报告了多个 QI 周期；刚刚超过 50%报告使用模型来指导 QI 活动；只有 7%报告使用了特定的理论模型。研究地点和重点多样；然而，近三分之一（30.2%）研究了重症监护病房的早期动员。
实证、同行评审的康复质量改进出版物数量正在增加，但仍只占康复研究出版物的一小部分。康复 QI 研究可以通过更广泛地使用现有模型和理论来指导 QI 工作、一致报告研究局限性以及使用推理统计来加强。
