Regional Hyper-Acute Rehabilitation Unit, London North West University Healthcare NHS Trust and Department of Palliative Care, Policy and Rehabilitation, King's College, London, UK -
Centre for Nursing, Midwifery and Allied Health Research, University College London Hospitals, and Institute for Neurology, University College, London, UK -
Eur J Phys Rehabil Med. 2021 Oct;57(5):701-709. doi: 10.23736/S1973-9087.21.06624-7. Epub 2021 Feb 10.
Current practice for physical wellbeing of people in a Prolonged Disorder of Consciousness (PDOC) is variable. A scoping literature review identified no agreed standard of care for physical management of those in a PDOC. This study addressed this deficit using a consensus process applied using nominal group technique.
The aims of this project were to promote best practice for physical management in PDOC, by identifying consensus for: 1) a pathway of care; and 2) current best practice recommendations.
A consensus process using nominal group technique.
Representation from national, purposively selected, rehabilitation services assessing and managing people in a PDOC in the UK.
The population to whom the consensus process relates are people in a PDOC, requiring physical management.
An initial meeting with selected clinical experts from national centres was conducted to set terms of reference. A consensus meeting using nominal group technique (N.=33) then followed. Experts were initially asked to review systematic review findings reproduced as statements. Following systematic refinement, they were then asked to vote on the importance and relevance of statements.
Following the nominal group process, 25 initial recommendations were refined to 19, which expressed the principles of physical management for people with a Prolonged Disorder of Consciousness. Statements are grouped into "acute-care" (6-recommendations), "postacute care" (10-recommendations) and "long-term care" (3-recommendations). Across the participants, agreement with the final recommendation statements ranged from 100-61% (N.=33-20), 15 of the statements were supported by 85% or more experts (N.=29). In addition, a clinical pathway of care, incorporating the recommendation principles was produced (agreement from 28 experts, 83%).
The recommendations provide a basis for standardising current practice. They provide a standard against which care, and effectiveness can be evaluated. An accessible guideline document is planned for publication to enable implementation into practice, supported by online resources.
Recommendations have been produced under the headings of "acute care," "postacute care" and "long-term care." In addition, a pathway for provision of care interventions has been identified for the physical management of people in a prolonged disorder of consciousness.
目前，对于持续性意识障碍（PDOC）患者的身体健康管理方法各不相同，尚无针对此类患者身体管理的标准护理方法。本研究采用名义群体技术（Nominal Group Technique，NGT）这一共识方法，旨在解决这一空白问题。
本项目旨在通过确定 PDOC 患者身体管理的护理路径和当前最佳实践建议，促进最佳的身体管理实践。
采用名义群体技术（Nominal Group Technique，NGT）的共识过程。
英国，全国范围内有针对性地选择的康复服务机构，评估和管理 PDOC 患者。
本共识过程涉及的人群为需要身体管理的 PDOC 患者。
首先，与来自国家中心的选定临床专家举行了一次会议，以确定参考范围。然后，采用名义群体技术（Nominal Group Technique，NGT）进行了共识会议（N=33）。专家首先被要求审查作为陈述复制的系统评价结果。经过系统的改进后，他们被要求对陈述的重要性和相关性进行投票。
经过名义群体过程，最初的 25 项建议被细化为 19 项，表达了对持续性意识障碍患者的身体管理原则。陈述分为“急性护理”（6 项建议）、“亚急性护理”（10 项建议）和“长期护理”（3 项建议）。在所有参与者中，对最终建议陈述的一致性范围为 100-61%（N=33-20），15 项陈述得到 85%或更多专家的支持（N=29）。此外，还制定了包含建议原则的临床护理路径（28 名专家，83%表示同意）。
这些建议为标准化当前实践提供了依据。它们提供了一个标准，可以据此评估护理和效果。计划发布一份易于理解的指南文件，以支持在线资源的实施。
建议按“急性护理”、“亚急性护理”和“长期护理”的标题提出。此外，还确定了为持续性意识障碍患者提供身体管理干预措施的护理路径。
