神经系统疾病患者康复国际临床指南的系统评价:上肢评估有哪些建议?

A Systematic Review of International Clinical Guidelines for Rehabilitation of People With Neurological Conditions: What Recommendations Are Made for Upper Limb Assessment?

作者信息

Burridge Jane, Alt Murphy Margit, Buurke Jaap, Feys Peter, Keller Thierry, Klamroth-Marganska Verena, Lamers Ilse, McNicholas Lauren, Prange Gerdienke, Tarkka Ina, Timmermans Annick, Hughes Ann-Marie

机构信息

Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom.

Institute of Neuroscience and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

出版信息

Front Neurol. 2019 Jun 25;10:567. doi: 10.3389/fneur.2019.00567. eCollection 2019.

Abstract

Upper limb impairment is a common problem for people with neurological disabilities, affecting activity, performance, quality of life, and independence. Accurate, timely assessments are required for effective rehabilitation, and development of novel interventions. International consensus on upper limb assessment is needed to make research findings more meaningful, provide a benchmark for quality in clinical practice, more cost-effective neurorehabilitation and improved outcomes for neurological patients undergoing rehabilitation. To conduct a systematic review, as part of the output of a European COST Action, to identify what recommendations are made for upper limb assessment. We systematically reviewed published guidance on measures and protocols for assessment of upper limb function in neurological rehabilitation via electronic databases from January 2007-December 2017. Additional records were then identified through other sources. Records were selected for inclusion based on scanning of titles, abstracts and full text by two authors working independently, and a third author if there was disagreement. Records were included if they referred to "rehabilitation" and "assessment" or "measurement". Reasons for exclusion were documented. From the initial 552 records identified (after duplicates were removed), 34 satisfied our criteria for inclusion, and only six recommended specific outcome measures and /or protocols. Records were divided into National Guidelines and other practice guidelines published in peer reviewed Journals. There was agreement that assessment is critical, should be conducted early and at regular intervals and that there is a need for standardized measures. Assessments should be conducted by a healthcare professional trained in using the measure and should encompass body function and structure, activity and participation. We present a comprehensive, critical, and original summary of current recommendations. Defining a core set of measures and agreed protocols requires international consensus between experts representing the diverse and multi-disciplinary field of neurorehabilitation including clinical researchers and practitioners, rehabilitation technology researchers, and commercial developers. Current lack of guidance may hold-back progress in understanding function and recovery. Together with a Delphi consensus study and an overview of systematic reviews of outcome measures it will contribute to the development of international guidelines for upper limb assessment in neurological conditions.

摘要

上肢功能障碍是神经功能残疾患者的常见问题,会影响其活动、表现、生活质量和独立性。有效的康复治疗以及新干预措施的研发需要准确、及时的评估。需要就上肢评估达成国际共识,以使研究结果更具意义,为临床实践质量提供基准,实现更具成本效益的神经康复,并改善接受康复治疗的神经疾病患者的治疗效果。作为欧洲一项成本行动的产出的一部分,进行一项系统综述,以确定针对上肢评估提出了哪些建议。我们通过电子数据库,对2007年1月至2017年12月期间发表的有关神经康复中上肢功能评估的措施和方案的指南进行了系统综述。然后通过其他来源识别出更多记录。两名独立工作的作者根据标题、摘要和全文扫描来选择纳入记录,如果存在分歧则由第三名作者参与。如果记录涉及“康复”和“评估”或“测量”,则将其纳入。记录排除原因。从最初识别出的552条记录(去除重复项后)中,34条符合我们的纳入标准,只有6条推荐了特定的结局指标和/或方案。记录分为国家指南和发表在同行评审期刊上的其他实践指南。大家一致认为评估至关重要,应尽早且定期进行,并且需要标准化措施。评估应由经过使用该测量方法培训的医疗专业人员进行,应涵盖身体功能和结构、活动及参与情况。我们提供了当前建议的全面、批判性和原创性总结。定义一组核心指标和商定的方案需要神经康复多学科领域的专家(包括临床研究人员和从业者、康复技术研究人员以及商业开发者)达成国际共识。当前缺乏指导可能会阻碍在理解功能和恢复方面的进展。它将与德尔菲共识研究以及结局指标系统综述概述一起,为制定神经疾病上肢评估的国际指南做出贡献。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/526c/6603199/dc2b7ca7f3e3/fneur-10-00567-g0001.jpg

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