远程康复和基于家庭的社区老年人跌倒预防计划的有效性：系统评价和荟萃分析方案。

Effectiveness of telerehabilitation and home-based falls prevention programs for community-dwelling older adults: a systematic review and meta-analysis protocol.

机构信息

Department of Family Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada

Department of Internal Medicine (Geriatrics), University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada.

出版信息

BMJ Open. 2023 Apr 21;13(4):e069543. doi: 10.1136/bmjopen-2022-069543.

DOI:10.1136/bmjopen-2022-069543

PMID:37085313

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10124284/

Abstract

INTRODUCTION

Falls among older adults are associated with adverse sequelae including fractures, chronic pain and disability, which can lead to loss of independence and increased risks of nursing home admissions. The COVID-19 pandemic has significantly increased the uptake of telehealth, but the effectiveness of virtual, home-based fall prevention programmes is not clearly known. We aim to synthesise the trials on telerehabilitation and home-based falls prevention programmes to determine their effectiveness in reducing falls and adverse outcomes, as well as to describe the safety risks associated with telerehabilitation.

METHODS AND ANALYSIS

This protocol was developed using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Database searches from inception to August 2022 will be conducted without language restrictions of MEDLINE, EMBASE, Ovid HealthSTAR, CINAHL, SPORTDiscus, Physiotherapy EvidenceDatabase (PEDro) and the Cochrane Library. Grey literature including major geriatrics conference proceedings will be reviewed. Using Covidence software, two independent reviewers will in duplicate determine the eligibility of randomised controlled trials (RCTs). Eligible RCTs will compare telerehabilitation and home-based fall prevention programmes to usual care among community-dwelling older adults and will report at least one efficacy outcome: falls, fractures, hospitalisations, mortality or quality of life; or at least one safety outcome: pain, myalgias, dyspnoea, syncope or fatigue. Secondary outcomes include functional performance in activities of daily living, balance and endurance. Risk of bias will be assessed using the Cochrane Collaboration tool. DerSimonian-Laird random effects models will be used for the meta-analysis. Heterogeneity will be assessed using the I statistic and Cochran's Q statistic. We will assess publication bias using the Egger's test. Prespecified subgroup analyses and univariate meta-regression will be used.

ETHICS AND DISSEMINATION

Ethics approval is not required. The results will be disseminated through peer-reviewed publications and conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42022356759.

摘要

简介

老年人跌倒与不良后果相关，包括骨折、慢性疼痛和残疾，这可能导致丧失独立性和增加入住养老院的风险。COVID-19 大流行显著增加了远程医疗的应用，但虚拟的、基于家庭的跌倒预防计划的有效性尚不清楚。我们旨在综合关于远程康复和基于家庭的跌倒预防计划的试验，以确定它们在减少跌倒和不良后果方面的有效性，并描述与远程康复相关的安全风险。

方法和分析

本方案使用系统评价和荟萃分析报告的首选条目（PRISMA-P）制定。从成立到 2022 年 8 月，将对数据库进行无语言限制的检索，包括 MEDLINE、EMBASE、Ovid HealthSTAR、CINAHL、SPORTDiscus、物理治疗证据数据库（PEDro）和 Cochrane 图书馆。还将审查主要老年医学会议论文集等灰色文献。使用 Covidence 软件，两名独立评审员将对随机对照试验（RCT）进行重复性评估。合格的 RCT 将比较远程康复和基于家庭的跌倒预防计划与社区居住的老年人的常规护理，并报告至少一项疗效结果：跌倒、骨折、住院、死亡或生活质量；或至少一项安全结果：疼痛、肌痛、呼吸困难、晕厥或疲劳。次要结果包括日常生活活动中的功能表现、平衡和耐力。使用 Cochrane 协作工具评估偏倚风险。将使用 DerSimonian-Laird 随机效应模型进行荟萃分析。使用 I 统计量和 Cochran's Q 统计量评估异质性。我们将使用 Egger 检验评估发表偏倚。将进行预设的亚组分析和单变量荟萃回归。