短住型人工关节置换术项目实施和可持续性的障碍和促进因素：用于择期初次全髋关节和全膝关节置换的系统评价及定性证据综合

Barriers and enablers to the implementation and sustainability of short-stay arthroplasty programs for elective primary total hip and knee replacement: A systematic review with qualitative evidence synthesis.

机构信息

School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Service and Sport, La Trobe University, Melbourne, Victoria, Australia.

出版信息

Musculoskeletal Care. 2024 Jun;22(2):e1897. doi: 10.1002/msc.1897.

DOI:10.1002/msc.1897

PMID:38831253

Abstract

INTRODUCTION

We aimed to systematically review contemporary evidence on the barriers and enablers to implementing and sustaining short-stay arthroplasty programs for elective primary total hip and knee replacement from the perspectives of patients, health professionals, carers, healthcare administrators, funders and policymakers and to map the findings to the Theoretical Domains Framework (TDF).

METHODS

Medline, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and the Cochrane Central Register of Controlled Trials were searched (up to 19 August 2023). Primary qualitative or mixed-methods studies reporting on perspectives relating to the review aims that utilised a short-stay programme were eligible for inclusion. Study quality was assessed using the qualitative critical appraisal tool from the Joanna Briggs Institute. Data were analysed inductively. The final themes were mapped to the TDF. The confidence in the findings was assessed using GRADE CERQual.

RESULTS

Fifteen studies were included. Twelve barrier themes and twelve enabler themes were identified. Three themes were graded with high confidence, 10 were graded with moderate confidence, three were graded with low confidence, and eight were graded with very low confidence. The most pertinent domains that the themes were mapped to for patients were beliefs about capabilities, reinforcement, and the environmental context and resources. Health professionals identified knowledge, environmental context and resources as important domains. Two domains were identified for carers: (1) social/professional role and identity and (2) memory, attention, and decision processes.

CONCLUSION

We identified key barrier and enabler themes linked to the TDF that can be used to guide implementation initiatives and promote the sustainability of short-stay arthroplasty programs.

摘要

简介

我们旨在从患者、卫生专业人员、护理人员、医疗保健管理人员、资助者和政策制定者的角度，系统地回顾当代关于实施和维持择期初次全髋关节和全膝关节置换短住程序的障碍和促进因素的证据，并将研究结果映射到理论领域框架（TDF）。

方法

我们检索了 Medline、Cumulative Index to Nursing and Allied Health Literature、EMBASE 和 Cochrane 中央对照试验注册库（截至 2023 年 8 月 19 日）。符合纳入标准的是报告与审查目的相关观点的初级定性或混合方法研究，这些研究使用了短期住院计划。使用 Joanna Briggs 研究所的定性批判性评估工具评估研究质量。使用归纳法分析数据。最终主题被映射到 TDF。使用 GRADE CERQual 评估研究结果的可信度。

结果

纳入了 15 项研究。确定了 12 个障碍主题和 12 个促进因素主题。有三个主题被评为高度可信，10 个主题被评为中度可信，三个主题被评为低度可信，八个主题被评为非常低度可信。主题映射到患者最相关的领域是对能力的信念、强化以及环境背景和资源。卫生专业人员认为知识、环境背景和资源是重要的领域。护理人员确定了两个领域：（1）社会/专业角色和身份，以及（2）记忆、注意力和决策过程。