School of Health Sciences, University of Southampton, Southampton, Hampshire, UK.
Department Social Affaire and Health, ECORYS Nederland BV, Rotterdam, Zuid-Holland, Netherlands.
RMD Open. 2020 Jan;6(1). doi: 10.1136/rmdopen-2019-001143.
To perform a systematic literature review (SLR) about the effect of non-pharmacological interventions delivered by non-physician health professionals to prevent and manage osteoporotic fractures.
Eight clinical questions based on two criteria guided the SLR: (1) adults≥50 years at high risk of osteoporotic fracture and (2) interventions delivered by non-physician health professionals to prevent and manage osteoporotic fractures. Interventions focused on diagnostic procedures to identify risk of falling, therapeutic approaches and implementation strategies. Outcomes included fractures, falls, risk of falling and change in bone mineral density. Systematic reviews and randomised controlled trials were preferentially selected. Data were synthesised using a qualitative descriptive approach.
Of 15 917 records, 43 articles were included. Studies were clinically and methodologically diverse. We identified sufficient evidence that structured exercise, incorporating progressive resistance training delivered to people who had undergone hip fracture surgery, and multicomponent exercise, delivered to people at risk of primary fracture, reduced risk of falling. The effectiveness of multidisciplinary fracture liaison services in reducing refracture rate was confirmed. There was insufficient evidence found to support the effectiveness of nutrients and falls prevention programmes in this patient population.
Despite study heterogeneity, our SLR showed beneficial effects of some interventions delivered by non-physician health professionals and the positive impact of multidisciplinary team working and patient educational approaches to prevent and manage osteoporotic fractures. These results informed a EULAR taskforce that developed points to consider for non-physician health professionals to prevent and manage osteoporotic fractures.
对非医师健康专业人员实施的非药物干预措施预防和管理骨质疏松性骨折的效果进行系统文献回顾（SLR）。
根据两个标准制定了 8 个临床问题来指导 SLR：（1）年龄≥50 岁且有骨质疏松性骨折高风险的成年人；（2）非医师健康专业人员实施的预防和管理骨质疏松性骨折的干预措施。干预措施侧重于识别跌倒风险的诊断程序、治疗方法和实施策略。结果包括骨折、跌倒、跌倒风险和骨密度变化。优先选择系统评价和随机对照试验。使用定性描述性方法对数据进行综合分析。
在 15917 条记录中，有 43 篇文章被纳入。研究在临床和方法学上存在多样性。我们有足够的证据表明，针对接受过髋部骨折手术的患者进行结构化锻炼，包括渐进式抗阻训练，以及针对有原发性骨折风险的患者进行多组分锻炼，可以降低跌倒风险。多学科骨折联络服务在降低再骨折率方面的有效性得到了证实。在该患者人群中，没有足够的证据支持营养素和防跌倒计划的有效性。
尽管研究存在异质性，但我们的 SLR 表明，非医师健康专业人员实施的某些干预措施具有有益效果，多学科团队合作和患者教育方法对预防和管理骨质疏松性骨折具有积极影响。这些结果为 EULAR 工作组提供了信息，工作组制定了非医师健康专业人员预防和管理骨质疏松性骨折的注意要点。
