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影响髋部骨折手术后早期活动的因素:范围综述。

What factors affect early mobilisation following hip fracture surgery: a scoping review.

机构信息

James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, Norfolk, UK

James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, Norfolk, UK.

出版信息

BMJ Open Qual. 2024 Jan 21;12(Suppl 2):e002281. doi: 10.1136/bmjoq-2023-002281.

Abstract

OBJECTIVES

Identify and evaluate factors affecting early mobilisation on the day following hip fracture surgery.

DESIGN

Mixed methods, scoping review.

DATA SOURCES

MEDLINE, AMED, CINAHL, APA PsycINFO, APA PsycArticles, ISRCTN, Clinical Trials registry and grey literature accessed in November 2022 with publication dates between 2001 and November 2022.

ELIGIBILITY CRITERIA

English language publications that:1. Include patient populations who sustain a fragility hip fracture managed surgically2. Include patient populations who are mobilised out of bed on the day following their hip fracture surgery3. Report factors which influence the ability to undergo early mobility postsurgery DATA EXTRACTION AND SYNTHESIS: One reviewer screened all titles and abstracts for inclusion. Two reviewers performed data extraction and quality assessments using the relevant Critical Appraisal Skills Programme tools and the Mixed Methods Appraisal Tool.

RESULTS

3337 papers were identified, of which 23 studies were eligible for review, representing 210 811 patients. The heterogeneity in the types of study included, the definition of early mobilisation and the outcome measures used precluded meta-analysis. 13 factors were identified as having an effect on whether people were mobilised on day 1 post-hip fracture surgery, grouped into 5 principal themes: (1) healthcare setting or worker-related factors, (2) patient psychological factors, (3) acute patient health factors, (4) non-acute patient health factors and (5) surgical factors.

CONCLUSIONS

There was a paucity of robust research investigating day 1 mobilisation post-hip fracture surgery.Each of the five factors identified is potentially modifiable through service improvement change and innovation strategies. There is an opportunity to explore how service provision change could be implemented to improve outcomes for all patients following hip fracture surgery demonstrating the clinical and cost benefits of these changes against the cost of delivering the change.

摘要

目的

确定并评估影响髋部骨折手术后当天早期活动的因素。

设计

混合方法,范围综述。

数据来源

2022 年 11 月,通过 MEDLINE、AMED、CINAHL、APA PsycINFO、APA PsycArticles、ISRCTN、临床试验注册处和灰色文献检索,检索日期为 2001 年至 2022 年 11 月期间发表的英文文献。

纳入标准

  1. 包括接受手术治疗的脆性髋部骨折患者人群;2. 包括术后当天离床活动的患者人群;3. 报告影响术后早期活动能力的因素。

数据提取和综合

一名审查员筛选所有标题和摘要以确定是否符合纳入标准。两名审查员使用相关的关键评估技能计划工具和混合方法评估工具进行数据提取和质量评估。

结果

共确定了 3337 篇论文,其中 23 项研究符合纳入标准,共涉及 210811 名患者。纳入的研究类型存在很大差异,包括早期活动的定义和使用的结局指标,这使得无法进行荟萃分析。确定了 13 个因素对髋部骨折手术后是否能在第 1 天活动有影响,分为 5 个主要主题:(1)医疗保健环境或工作人员相关因素;(2)患者心理因素;(3)急性患者健康因素;(4)非急性患者健康因素;(5)手术因素。

结论

髋部骨折手术后第 1 天活动的研究很少。确定的五个因素中的每一个都可以通过服务改进和创新策略来改变。有机会探讨如何实施服务提供的改变,以改善所有髋部骨折手术后患者的预后,并针对改变的成本来展示这些改变的临床和成本效益。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9e05/10806593/26b5a3d19022/bmjoq-2023-002281f01.jpg

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