专家共识指导意见：肋骨骨折患者的呼吸物理治疗和康复——一项国际性、多学科的电子德尔菲研究。
Expert consensus guidance on respiratory physiotherapy and rehabilitation of patients with rib fractures: An international, multidisciplinary e-Delphi study.
出版信息
J Trauma Acute Care Surg. 2023 Apr 1;94(4):578-583. doi: 10.1097/TA.0000000000003875. Epub 2023 Jan 11.
BACKGROUND
There is limited research supporting optimal respiratory physiotherapy or physical rehabilitation strategies for patients with rib fractures. The aim of this study was to develop key recommendations for the physiotherapy management of patients with rib fractures.
METHODS
A three-round modified e-Delphi survey design, using an international Delphi panel including physiotherapy clinicians, researchers and lecturers, physician associates, trauma surgeons, and intensivists, was used in this study. The draft recommendations were developed by the Steering Group, based on available research. Over three rounds, panelists rated their agreement (using a Likert scale) with regard to recommendation for physiotherapists delivering respiratory physiotherapy and physical rehabilitation to patients following rib fractures. Recommendations were retained if they achieved consensus (defined as ≥70% of panelists ≥5/7) at the end of each round.
RESULTS
A total of 121 participants from 18 countries registered to participate in the study, with 87 (72%), 77 (64%), and 79 (65%) registrants completing the three rounds, respectively. The final guidance document included 18 respiratory physiotherapy and rehabilitation recommendations, mapped over seven clinical scenarios for patients (1) not requiring mechanical ventilation, (2) requiring mechanical ventilation, (3) with no concurrent fracture of the shoulder girdle complex, (4) with a concurrent fracture of the shoulder girdle complex, (5) with/without concurrent upper limb orthopedic injuries, (6) undergoing surgical stabilization of rib fractures, and (7) at hospital discharge.
CONCLUSION
This guidance provides key recommendations for respiratory physiotherapy and physical rehabilitation of patients with rib fractures. It could also be used to inform future research priorities in the field.
LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
背景
目前针对肋骨骨折患者，支持优化呼吸物理治疗或身体康复策略的研究有限。本研究旨在制定肋骨骨折患者物理治疗管理的关键建议。
方法
本研究采用三轮改良电子德尔菲调查设计，使用国际德尔菲小组，包括物理治疗临床医生、研究人员和讲师、医师助理、创伤外科医生和重症监护医生。草案建议由指导小组根据现有研究制定。在三轮中，小组成员根据推荐意见对为肋骨骨折患者提供呼吸物理治疗和身体康复的物理治疗师的推荐意见进行了评分（使用李克特量表）。如果每条建议在每轮结束时均获得共识（定义为≥70%的小组成员≥5/7），则保留该建议。
结果
共有来自 18 个国家的 121 名参与者注册参加了该研究，分别有 87（72%）、77（64%）和 79（65%）名参与者完成了三轮。最终的指导文件包括 18 条呼吸物理治疗和康复建议，针对患者的七种临床情况进行了映射（1）无需机械通气，（2）需要机械通气，（3）无肩部带骨骨折，（4）有肩部带骨骨折，（5）有/无上肢骨科损伤，（6）肋骨骨折手术固定，和（7）出院。
结论
本指南为肋骨骨折患者的呼吸物理治疗和身体康复提供了关键建议。它也可以用来为该领域的未来研究重点提供信息。
证据水平
治疗/护理管理；四级。
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