基于证据的急性踝关节损伤管理临床实践指南：根据 PRISMA 系统评价和 AGREE II 进行的质量评估。

Evidence-based clinical practice guidelines for the management of acute ankle injuries according to: a PRISMA systematic review and quality appraisal with AGREE II.

机构信息

Tsinghua University, Beijing, China.

First Affiliated Hospital of Tsinghua University, Beijing, China.

出版信息

BMC Musculoskelet Disord. 2024 Jul 8;25(1):523. doi: 10.1186/s12891-024-07655-z.

DOI:10.1186/s12891-024-07655-z

PMID:38978052

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11229291/

Abstract

BACKGROUND

Acute ankle injuries are commonly seen in emergency rooms, with significant social impact and potentially devastating consequences. While several clinical practice guidelines (CPGs) related to ankle injuries have been developed by various organizations, there is a lack of critical appraisal of them. The purpose of this systematic review is to identify and critically appraise evidence-based clinical practice guidelines (EB-CPGs) related to acute ankle injuries in adults.

METHOD

We conducted searches in the Cochrane Library, MEDLINE, EMBASE databases, WHO, and reviewed 98 worldwide orthopedic association websites up until early 2023. Two authors independently applied the inclusion and exclusion criteria, and each evidence-based clinical practice guideline (EB-CPG) underwent independent critical appraisal of its content by all four authors using the Appraisal of Guidelines for REsearch and Evaluation (AGREE II) instrument. AGREE II scores for each domain were then calculated.

RESULTS

This review included five evidence-based clinical practice guidelines. The mean scores for all six domains were as follows: Scope and Purpose (87.8%), Stakeholder Involvement (69.2%), Rigour of Development (72.5%), Clarity of Presentation (86.9%), Applicability (45.6%), and Editorial Independence (53.3%).

CONCLUSION

The number of EB-CPGs related to ankle injuries are limited and the overall quality of the existing evidence-based clinical practice guidelines (EB-CPGs) for ankle injuries is not strong, with three of them being outdated. However, valuable guidance related to Ottawa rules, manual therapy, cryotherapy, functional supports, early ambulation, and rehabilitation has been highlighted. Challenges remain in areas such as monitoring and/or auditing criteria, consideration of the target population's views and preferences, and ensuring editorial independence. Future guidelines should prioritize improvements in these domains to enhance the quality and relevance of ankle injury management.

SYSTEMATIC REVIEW

Systematic review.

摘要

背景

急性踝关节损伤在急诊室中较为常见，具有重大的社会影响，可能带来灾难性的后果。虽然多个组织已经制定了与踝关节损伤相关的若干临床实践指南（CPG），但对这些指南进行批判性评估的工作却相对缺乏。本系统评价的目的在于确定并批判性评估与成人急性踝关节损伤相关的循证临床实践指南（EB-CPG）。

方法

我们在 Cochrane 图书馆、MEDLINE、EMBASE 数据库、世界卫生组织（WHO）进行了检索，并对截至 2023 年初的 98 个全球骨科协会网站进行了综述。两位作者独立应用纳入和排除标准，每位作者独立使用 AGREE II 工具对每个证据基础临床实践指南（EB-CPG）的内容进行批判性评估，随后由四位作者对所有指南进行了独立评估。然后计算每个领域的 AGREE II 评分。

结果

本研究共纳入了 5 项循证临床实践指南。所有 6 个领域的平均评分如下：范围和目的（87.8%）、利益相关者参与（69.2%）、制定严谨性（72.5%）、表述清晰性（86.9%）、适用性（45.6%）和编辑独立性（53.3%）。

结论

目前与踝关节损伤相关的循证临床实践指南数量有限，现有的踝关节损伤循证临床实践指南（EB-CPG）整体质量不高，其中 3 项已经过时。然而，本研究突出了与 Ottawa 规则、手法治疗、冰敷、功能支撑、早期活动和康复相关的有价值的指导。在监测和/或审核标准、考虑目标人群的观点和偏好以及确保编辑独立性等方面仍然存在挑战。未来的指南应优先改进这些领域，以提高踝关节损伤管理的质量和相关性。