Almoajil Hajar, Theologis Tim, Dawes Helen, Parsonage Jackie, Pierce Jo, Hopewell Sally, Toye Francine
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
Department of Physical Therapy, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Saudi Arabia.
J Child Orthop. 2020 Dec 1;14(6):562-573. doi: 10.1302/1863-2548.14.200139.
The article identifies the aspects of health and outcomes that are considered important from the perspective of ambulatory children with cerebral palsy (CP) and their parents regarding lower limb orthopaedic surgery and explores how they experience surgical interventions.
Four databases (Embase, MEDLINE (Ovid), CINAHL and PsycINFO) were searched from inception to 11 April 2020. Studies were included if they: 1) they involved children or young adults diagnosed with ambulant CP or their family, 2) participants had experience with lower limb orthopaedic surgery and 3) studies employed qualitative research methods. The Critical Appraisal Skills Programme was used to appraise identified studies. The 'Best-fit framework' synthesis approach was used by applying the International Classification of Functioning-Children and Youth (ICF-CY) linking rules and thematic synthesis. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Six studies were included. Four themes were generated which were linked to the ICF-CY framework: Body function and structure, Activity and participation, Environmental factors, Personal factors, as well as non-ICF-CY themes including Emotional well-being and Goal setting. Important surgical outcomes identified were pain, fatigue, movement-related function, mobility, walking ability, community life, emotional well-being, and adequate provision of public and health services.
These findings are important for understanding patient-centred outcomes in lower limb ortho-paedics surgery and providing focus for future interventional studies aimed at improving outcomes of importance to children with CP. These findings highlight the importance of long-term support to help people negotiate the challenge of surgical regimes and to achieve good outcomes after orthopaedic surgery. The outcomes identified will contribute to the development of a core outcome set in this field.
III.
本文从患有脑瘫（CP）的门诊儿童及其父母的角度，确定了与下肢矫形外科手术相关的健康和结果方面，并探讨了他们对手术干预的体验。
检索了四个数据库（Embase、MEDLINE（Ovid）、CINAHL和PsycINFO），检索时间从建库至2020年4月11日。纳入的研究需满足以下条件：1）涉及被诊断为可独立行走的CP儿童或年轻人及其家庭；2）参与者有下肢矫形外科手术经历；3）研究采用定性研究方法。使用批判性评估技能计划对纳入的研究进行评估。采用“最佳拟合框架”综合方法，应用国际功能、残疾和健康分类-儿童和青年版（ICF-CY）的关联规则和主题综合法。根据系统评价和Meta分析的首选报告项目（PRISMA）指南进行综述过程。
纳入六项研究。生成了四个与ICF-CY框架相关的主题：身体功能和结构、活动与参与、环境因素、个人因素，以及包括情绪健康和目标设定在内的非ICF-CY主题。确定的重要手术结果包括疼痛、疲劳、与运动相关的功能、活动能力、行走能力、社区生活、情绪健康，以及公共和卫生服务的充分提供。
这些发现对于理解下肢矫形外科手术中以患者为中心的结果以及为未来旨在改善对CP儿童重要的结果的干预性研究提供重点具有重要意义。这些发现突出了长期支持的重要性，以帮助人们应对手术方案的挑战并在矫形外科手术后取得良好结果。确定的结果将有助于该领域核心结局集的发展。
III级。
