Weinberg Beverley J, Roos Ronel, van Aswegen Heleen
Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
The Wits - JBI Centre for Evidenced-Based Practice: A Joanna Briggs Institute Affiliated Group, Johannesburg, South Africa.
S Afr J Physiother. 2022 Jun 28;78(1):1764. doi: 10.4102/sajp.v78i1.1764. eCollection 2022.
Rib fractures are a common thoracic injury and notable source of chest pain. Chest pain may lead to compromised respiratory and physical function.
Our study aimed to synthesise the evidence on the effectiveness of nonpharmacological therapeutic interventions on pain and physical function in adults admitted with rib fractures to acute care settings. Secondary outcomes included length of stay (LOS), respiratory complications, respiratory function and mortality rate.
A systematic literature search of English articles in nine databases was conducted. The Joanna Briggs Institute's System for the Unified Management, Assessment and Review of Information (SUMARI) was used to conduct our study. Articles written from January 2000 to December 2017 were considered and a search update was completed in 2021. Meta-analysis was conducted for pre- versus post-bundle of care implementation for LOS, pneumonia incidence and mortality rate. Certainty of evidence was appraised using the grading of recommendations, assessment, development and evaluation (GRADE) approach.
Sixteen studies were included ( = 2034). Certain interventions were shown to improve respiratory function and reduce pain, pulmonary complications, LOS and mortality rate. No interventions were identified which objectively improved physical function. Meta-analysis showed a statistically significant reduction in relative risk of developing pneumonia ( = 0.00) by 63% following bundled care implementation. Certainty of evidence for this outcome was rated as very low following GRADE appraisal.
Nonpharmacological therapeutic interventions used in combination with pharmacological management are viable treatment options to reduce pain, improve respiratory function and reduce the incidence of respiratory complications following acute rib fractures.
Acupuncture, transcutaneous electrical nerve stimulation (TENS), noninvasive ventilation (NIV) modalities, physiotherapy techniques and multidisciplinary pathways used alongside pharmacological interventions are effective modalities for use in the treatment of acute rib fractures. Multidisciplinary care pathways are important management strategies and reduce the risk of developing pneumonia.
肋骨骨折是常见的胸部损伤，也是胸痛的重要原因。胸痛可能导致呼吸和身体功能受损。
我们的研究旨在综合证据，探讨非药物治疗干预措施对入住急性护理机构的成年肋骨骨折患者疼痛和身体功能的有效性。次要结局包括住院时间（LOS）、呼吸并发症、呼吸功能和死亡率。
对九个数据库中的英文文章进行系统文献检索。使用乔安娜·布里格斯研究所的信息统一管理、评估和审查系统（SUMARI）进行我们的研究。纳入2000年1月至2017年12月撰写的文章，并于2021年完成检索更新。对护理实施前与实施护理束后在住院时间、肺炎发病率和死亡率方面进行荟萃分析。使用推荐分级、评估、制定和评价（GRADE）方法评估证据的确定性。
纳入16项研究（n = 2034）。某些干预措施显示可改善呼吸功能并减轻疼痛、肺部并发症、住院时间和死亡率。未发现能客观改善身体功能的干预措施。荟萃分析显示，实施护理束后，发生肺炎的相对风险在统计学上显著降低（RR = 0.00），降低了63%。根据GRADE评估，这一结局的证据确定性被评为极低。
非药物治疗干预措施与药物管理相结合是可行的治疗选择，可减轻急性肋骨骨折后的疼痛、改善呼吸功能并降低呼吸并发症的发生率。
针灸、经皮电刺激神经疗法（TENS）、无创通气（NIV）模式、物理治疗技术以及与药物干预同时使用的多学科路径是治疗急性肋骨骨折的有效模式。多学科护理路径是重要的管理策略，可降低发生肺炎的风险。
