Chen Yiting, Li Zheng, Peng Jian, Shen Lanjun, Shi Juan
School of Nursing, Fudan University, No. 305 Fenglin Road, Shanghai 200032, China.
Shanghai Yangzhi Rehabilitation Hospital, No. 2209 Guangxing Road, Shanghai 201619, China.
Evid Based Complement Alternat Med. 2020 Jun 29;2020:7836024. doi: 10.1155/2020/7836024. eCollection 2020.
BACKGROUND: Psychological symptoms such as depression and anxiety are quite common among stroke survivors and have great negative impacts on patients. OBJECTIVE: To develop a care bundle through reviewing and integrating care strategies for psychological symptoms after stroke and then improve the bundle by Delphi study. METHODS: A structured search of the literature was performed to identify studies evaluating interventions for stroke patients with psychological symptoms such as depression and anxiety. Two trained researchers screened papers through the titles, abstracts, and full-texts independently. All studies complying with the eligibility criteria were appraised using quality assessment tools. Related interventions with evaluated evidence levels formed the preliminary bundle. Afterward, the Delphi study was carried out to improve the bundle, and the experts were contacted by e-mail. Ten clinical experts specialized in stroke and psychological rehabilitation were recruited. The reliability of experts was represented by the effective response rate and authority coefficient (Cr). The consensus was deemed to be reached when the mean score for item importance is all equal or above 3.50 and the coefficient of variation (CV) is all equal or below 0.20. The Kendall coefficient W test was adopted to evaluate the consensus on agreement among the experts as well. Data analysis was performed using SPSS V.22.0. RESULTS: Through a systematic evidence summary and two-round Delphi study, the items that were given high scores and got consensus by experts were chosen for the bundle. The iDAME bundle consisted of five interventions eventually: maintaining nteraction, tailored iet, cupressure, mindfulness editation, and physical xercise. CONCLUSION: The development of an evidence-based and consensus-based iDAME bundle which integrated western and traditional Chinese medicine intervention was described. Evidence summary made the bundle become scientific, while the Delphi study made it more maneuverable. Based on these results, the bundle would be potentially implemented in stroke patients for their psychological symptoms.
背景：抑郁和焦虑等心理症状在中风幸存者中相当常见，对患者有很大的负面影响。 目的：通过回顾和整合中风后心理症状的护理策略来制定一个护理包，然后通过德尔菲研究对该护理包进行完善。 方法：进行结构化文献检索，以确定评估针对有抑郁和焦虑等心理症状的中风患者干预措施的研究。两名经过培训的研究人员独立通过标题、摘要和全文筛选论文。所有符合纳入标准的研究均使用质量评估工具进行评价。具有评估证据水平的相关干预措施构成初步护理包。之后，开展德尔菲研究以完善护理包，并通过电子邮件联系专家。招募了10名专门从事中风和心理康复的临床专家。专家的可靠性以有效回复率和权威系数（Cr）表示。当项目重要性的平均得分均等于或高于3.50且变异系数（CV）均等于或低于0.20时，视为达成共识。还采用肯德尔系数W检验来评估专家之间的一致性共识。使用SPSS V.22.0进行数据分析。 结果：通过系统的证据总结和两轮德尔菲研究，选择了得分高且得到专家共识的项目纳入护理包。最终，iDAME护理包由五项干预措施组成：保持互动、个性化饮食、拔罐、正念冥想和体育锻炼。 结论：描述了基于证据和共识的iDAME护理包的开发，该护理包整合了中西医干预措施。证据总结使护理包更具科学性，而德尔菲研究使其更具可操作性。基于这些结果，该护理包可能会应用于中风患者的心理症状。
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