Tariq Hina, Collins Kathryn, Tait Desiree, Dunn Joel, Altaf Shafaq, Porter Sam
Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK.
Dorset Healthcare University Foundation Trust, Poole, UK.
Disabil Rehabil. 2023 Jun;45(11):1755-1772. doi: 10.1080/09638288.2022.2071480. Epub 2022 May 11.
The primary objective of the review was to collate the available evidence on factors associated with joint contractures in adults.
A systematic literature search was conducted on MEDLINE, CINAHL, AMED, and EMBASE. Studies that involved participants aged ≥18 and assessed joint contracture as a primary or secondary outcome were included. Two independent reviewers screened studies against the eligibility criteria, performed data extraction, and assessed the quality of evidence. A narrative synthesis by domain and sub-domain was undertaken. The protocol was registered on PROSPERO: CRD42019145079.
Forty-seven studies were included in the review. Identified factors were broadly classified into three major domains: sociodemographic factors, physical factors, and proxies for bed confinement. Sociodemographic factors were not associated with joint contractures. Functional ability, pain, muscle weakness, physical mobility, and bed confinement provided the most consistent evidence of association with joint contractures. The evidence regarding the relationship between spasticity and joint contractures remains unclear. Other factors might be important, but there was insufficient evidence to make inferences.
The review identified and collated evidence on factors associated with joint contractures, which can be utilised to develop effective prevention and management strategies. Implications for rehabilitationClinical interventions based on the timely identification of risks related to joint contractures in vulnerable adults have the potential to prevent or ameliorate their development or progression.Quality and consistency of care for vulnerable adults would be enhanced by developing effective joint contracture prevention and rehabilitation strategies based on the evidence presented in this review.As many vulnerable adults are located in the community or non-acute care settings, strategies should target these loci of care.Structured risk assessments that can support non-physiotherapy staff working in these loci of care to identify risks related to joint contractures would provide an important resource for risk management.
本综述的主要目的是整理有关成人关节挛缩相关因素的现有证据。
在MEDLINE、CINAHL、AMED和EMBASE上进行了系统的文献检索。纳入了涉及年龄≥18岁参与者且将关节挛缩评估为主要或次要结局的研究。两名独立 reviewers 根据纳入标准筛选研究、进行数据提取并评估证据质量。按领域和子领域进行了叙述性综合分析。该方案已在PROSPERO上注册：CRD42019145079。
本综述纳入了47项研究。确定的因素大致分为三个主要领域：社会人口学因素、身体因素和卧床限制指标。社会人口学因素与关节挛缩无关。功能能力、疼痛、肌肉无力、身体活动能力和卧床限制提供了与关节挛缩相关的最一致证据。关于痉挛与关节挛缩之间关系的证据仍不明确。其他因素可能很重要，但证据不足无法进行推断。
本综述识别并整理了有关关节挛缩相关因素的证据，可用于制定有效的预防和管理策略。对康复的启示基于及时识别弱势成人关节挛缩相关风险的临床干预措施有可能预防或改善其发生或进展。基于本综述中提供的证据制定有效的关节挛缩预防和康复策略将提高对弱势成人护理的质量和一致性。由于许多弱势成人位于社区或非急性护理环境中，策略应针对这些护理场所。能够支持在这些护理场所工作的非物理治疗人员识别与关节挛缩相关风险的结构化风险评估将为风险管理提供重要资源。
