Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, University of Toronto, Toronto, Canada.
Gerstein Science Information Centre, University of Toronto, Toronto, Canada.
Disabil Rehabil. 2020 Apr;42(8):1055-1061. doi: 10.1080/09638288.2018.1512163. Epub 2018 Nov 25.
The purpose of this systematic review was to synthesize and appraise the evidence regarding the impact of quality improvement strategies on quality of life as well as physical and psychological well-being of individuals with stroke. Studies were identified by searching MEDLINE (OVID interface, 2000 onwards), CINAHL (EBSCO interface, 2000 onwards), EMBASE (OVID interface, 2000 to present), and PsycINFO (OVID interface, 2000 onwards). The Effective Practice and Organization of Care Risk of Bias Tool was applied. Extracted data from the publications included: study characteristics, participant characteristics, the strategy characteristics, the outcomes, and quality appraisal. Our review identified 12 trials that utilized only 4 of the 10 quality improvement strategies included in this review. The most common quality improvement strategy was self-management. Other studies included patient education, team changes, and case management. Only 5 of the 12 studies reported statistically significant improvements in some component of quality of life. There is a lack of evidence to demonstrate efficacy/effectiveness of patient education, self-management, team changes, and case management approaches on improving the quality of life of stroke survivors. Identifying the essential features of effective and ineffective strategies, especially in the area of self-management strategies would be beneficial.Implications for rehabilitationThere is a lack of evidence to demonstrate efficacy/effectiveness of patient education, self-management, team changes, and case management approaches on improving the quality of life of stroke survivors.To improve these outcomes, there may be a need to co-create/tailor quality improvement interventions with patients, their caregivers, and providers.The impact of a broader range of quality improvement interventions, including clinician education and patient reminder systems, on quality of life post-stroke should be considered.
本系统评价的目的是综合和评估关于质量改进策略对中风患者生活质量以及身心健康影响的证据。通过搜索 MEDLINE（OVID 界面，2000 年以后）、CINAHL（EBSCO 界面，2000 年以后）、EMBASE（OVID 界面，2000 年至今）和 PsycINFO（OVID 界面，2000 年以后）来确定研究。应用了有效实践和组织护理风险偏差工具。从出版物中提取的数据包括：研究特征、参与者特征、策略特征、结果和质量评估。我们的综述确定了 12 项试验，仅使用了本综述中包含的 10 项质量改进策略中的 4 项。最常见的质量改进策略是自我管理。其他研究包括患者教育、团队变更和病例管理。在 12 项研究中，只有 5 项报告了生活质量某些方面的统计显著改善。没有证据表明患者教育、自我管理、团队变更和病例管理方法在改善中风幸存者生活质量方面具有疗效/有效性。确定有效和无效策略的基本特征，特别是自我管理策略的基本特征，将是有益的。
康复的意义
没有证据表明患者教育、自我管理、团队变更和病例管理方法在改善中风幸存者生活质量方面具有疗效/有效性。
为了改善这些结果，可能需要与患者、他们的照顾者和提供者共同创造/定制质量改进干预措施。
应考虑更广泛的质量改进干预措施，包括临床医生教育和患者提醒系统，对中风后生活质量的影响。
