Sun Jing, Xu Yirong, Zhu Juan, Zhu Bei, Gao Wei
School of Nursing, Jiangsu Vocational College of Medicine, Yancheng, China.
Department of Nursing, Faculty of Nursing, Lincoln University College, Kuala Lumpur, Malaysia.
Int J Nurs Sci. 2024 Mar 11;11(2):286-294. doi: 10.1016/j.ijnss.2024.03.013. eCollection 2024 Apr.
This systematic review was conducted to evaluate the efficacy and safety of continuous nursing care for the recovery of joint function in older adults with total hip or knee arthroplasty.
Randomized controlled trials and cohort studies of continuous nursing in older patients after joint replacement were searched from the database of Cochrane Library, Web of Science, PubMed, and Embase from their establishment to October 25, 2023. After literature screening, two researchers completed data extraction, and the risk of bias was assessed using the Cochrane risk-of-bias tool. The risk analysis included in cohort studies was based on the Newcastle-Ottawa Scale (NOS).
The study included a total of 15 articles, comprising 34,186 knee and hip replacement patients. In this review, the effects of continuous nursing on the recovery of joint function of knee replacement and hip replacement in older adults were classified and discussed. Continuous nursing interventions targeted for total hip replacement could greatly increase the range of joint mobility, enhance muscle strength during hip movements like flexion, extension, and abduction, maintain joint stability, relieve pain, improve daily activities, and lower the risk of complications. For older patients with knee arthroplasty, continuous nursing programs could markedly improve knee motion range, joint flexion, joint stability, daily activities, and pain management. Despite the implementation of interventions, the incidence of complications caused by total knee replacement did not decrease. Out of all the studies reviewed, only one used a theoretical framework for interventions provided to patients during the postoperative period of hip arthroplasty. The overall quality of the included studies was very high.
Continuous nursing can effectively improve the joint function of older patients after joint replacement. However, its effectiveness in terms of clinical outcomes, patient satisfaction, and medical cost of associated continuous nursing needs to be further clarified. In addition, continuous nursing has no significant advantage in the safety of postoperative complications and readmission rates in older adults after knee joint replacement. To enhance the efficacy and safety of continuous nursing effectively, it is crucial to refine the continuous nursing program in the future, thereby elevating the quality of nursing services.
本系统评价旨在评估持续护理对全髋关节或膝关节置换术后老年人关节功能恢复的有效性和安全性。
从Cochrane图书馆、Web of Science、PubMed和Embase数据库自建库至2023年10月25日，检索关节置换术后老年患者持续护理的随机对照试验和队列研究。经过文献筛选，两名研究人员完成数据提取，并使用Cochrane偏倚风险工具评估偏倚风险。队列研究中的风险分析基于纽卡斯尔-渥太华量表（NOS）。
该研究共纳入15篇文章，包括34186例膝关节和髋关节置换患者。在本综述中，对持续护理对老年人膝关节置换和髋关节置换关节功能恢复的影响进行了分类和讨论。针对全髋关节置换的持续护理干预可大幅增加关节活动范围，增强髋关节屈伸、外展等运动时的肌肉力量，维持关节稳定性，缓解疼痛，改善日常活动，并降低并发症风险。对于膝关节置换的老年患者，持续护理方案可显著改善膝关节活动范围、关节屈伸、关节稳定性、日常活动和疼痛管理。尽管实施了干预措施，但全膝关节置换引起的并发症发生率并未降低。在所有纳入的研究中，只有一项在髋关节置换术后为患者提供干预措施时使用了理论框架。纳入研究的总体质量非常高。
持续护理可有效改善关节置换术后老年患者的关节功能。然而，其在临床结局、患者满意度和相关持续护理医疗成本方面的有效性有待进一步明确。此外，持续护理在膝关节置换术后老年人的术后并发症安全性和再入院率方面没有显著优势。为有效提高持续护理的有效性和安全性，未来完善持续护理方案至关重要，从而提升护理服务质量。
