全膝关节置换术后出院后跌倒的风险因素：综合评价。
Risk factors of post discharge falls in patients undergoing total knee arthroplasty: An integrative review.
机构信息
Department of Physical Therapy, Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University, Lahore, Pakistan.
Orthopedic and Spine Department, Ghurki Trust Teaching Hospital, Lahore, Pakistan.
出版信息
J Back Musculoskelet Rehabil. 2024;37(6):1427-1439. doi: 10.3233/BMR-230165.
BACKGROUND
Total knee arthroplasty (TKA) is a widely performed surgical procedure aimed at alleviating pain and restoring functionality in individuals suffering from knee osteoarthritis. Despite substantial benefits of TKA, patients are exposed to potential risks, including the occurrence of falls during their recovery period following discharge from the hospital.
OBJECTIVE
This integrative review endeavors to comprehensively investigate the existing body of literature to identify and assess the diverse factors that contribute to occurrence of post-discharge falls among TKA patients. Through the synthesis of available research, this study seeks to offer valuable insights that can guide clinical practices and interventions designed to mitigate the incidence of post-TKA falls, ultimately enhancing patient outcomes and quality of healthcare.
METHODS
An integrative review was conducted and databases were searched including Pubmed, PEDro, Cochrane, and SPORTDiscus from 2000 to 2024. A thorough search was performed to retrieve articles missed through databases as well as unpublished grey literature. Methodological quality assessment was performed using Newcastle-Ottawa Scale for Case Control and Cohort studies and AXIS tool for cross-sectional study.
RESULTS
Eleven articles finally met the inclusion criteria and were included in the review based on eligibility. There were 8 cohort studies (7 prospective cohorts, 1 retrospective cohort), 2 case control studies, and 1 cross-sectional study. The prospective cohort studies included in the review collected data in real-time as events occurred, making them particularly relevant for studying post-TKA falls.
CONCLUSION
Patients who underwent TKA are at risk of post-discharge falls. Several key risk factors have been identified, including advancing age, female gender, reduced proprioception, psychiatric disorders, living alone, and knee pain in the operated knee. It is important to recognize that the significance of these risk factors can vary depending on individual circumstances and contexts.
背景
全膝关节置换术（TKA）是一种广泛实施的手术，旨在缓解膝关节骨关节炎患者的疼痛并恢复其功能。尽管 TKA 有很大的益处，但患者仍面临潜在风险，包括出院后恢复期间发生跌倒的风险。
目的
本次综合回顾旨在全面调查现有文献，以确定和评估导致 TKA 患者出院后跌倒的多种因素。通过对现有研究的综合分析，本研究旨在提供有价值的见解，以指导旨在降低 TKA 后跌倒发生率的临床实践和干预措施，从而最终改善患者的结局和医疗保健质量。
方法
进行了综合回顾，并检索了包括 Pubmed、PEDro、Cochrane 和 SPORTDiscus 在内的数据库，检索时间范围为 2000 年至 2024 年。还进行了全面搜索，以检索通过数据库错过的文章和未发表的灰色文献。使用纽卡斯尔-渥太华量表（针对病例对照和队列研究）和 AXIS 工具（针对横断面研究）对方法学质量进行评估。
结果
最终有 11 篇文章符合纳入标准，并根据资格纳入了综述。其中包括 8 项队列研究（7 项前瞻性队列研究，1 项回顾性队列研究）、2 项病例对照研究和 1 项横断面研究。纳入综述的前瞻性队列研究在事件发生时实时收集数据，因此特别适合研究 TKA 后跌倒的情况。
结论
接受 TKA 的患者有出院后跌倒的风险。已经确定了几个关键的风险因素，包括年龄增长、女性、本体感觉降低、精神障碍、独居和手术膝关节疼痛。重要的是要认识到这些风险因素的重要性可能因个体情况和背景而异。
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