儿童肥胖预防及管理的最佳证据总结

目的:查找、筛选并汇总儿童肥胖预防及管理有关文献,总结最佳证据。方法:对儿童肥胖预防及管理提出问题,根据“6S”模型进行计算机文献检索,检索Up To Date、BMJ Best Practice、JBI循证卫生保健中心数据库、英国国家临床医学研究所指南库、加拿大安大略护理协会网、中国指南网、美国指南网、PubMed、ScienceDirect、国际指南网、the Cochrane Library、梅斯医学网、中国生物医学文献数据库、万方数据库、中国知网等数据库中关于儿童肥胖预防及管理的相关文献,文献类型包括临床决策、指南、专家共识、专家意见、证据总结、系统评价、原始研究。检索时限为建库至2020年12月30日。由2名研究员对文献质量评价合格的文献进行证据提取、总结。结果:纳入11篇文献,包括4篇指南、2篇专家意见、2篇专家共识、1篇证据总结、2篇系统评价,从儿童肥胖的评估与筛查、饮食方案、身体活动、生活方式、家庭社会支持系统5个方面总结最佳证据14条。结论:总结儿童肥胖预防及管理最佳证据,建议临床应用证据时,结合医疗条件、患儿意愿等情况,进行针对性调整。此外,证据应用人员应关注证据更...     

脑卒中患者远程康复运动管理有效性及安全性的系统评价再评价

目的 检索、再评价脑卒中患者远程康复运动管理的系统评价,为临床医护人员临床决策及康复运动干预策略的持续改进提供借鉴。 方法 计算机检索Cochrane Library、Embase、PubMed、Web of Science、CINAHL、澳大利亚乔安娜布里格斯研究所（Joanna Briggs Institute,JBI）循证卫生保健中心数据库以及万方数据库、中国知网、维普数据库和中国生物医学文献数据库,查找关于脑卒中患者运动功能远程康复管理相关的系统评价/Meta分析/荟萃分析,检索时限为建库至2021年9月19日。2名经过循证知识系统培训的研究人员应用系统评价方法学质量评价工具（Assessment of Mutiple Systematic Reviews,AMSTAR）对文献进行方法学质量评价后,采用推荐分级的评估、制订与评价（Grades of Recommendations Assessment,Development and Evaluation,GRADE）系统进行证据汇总与分级。 结果 初检文献124篇,纳入文献14篇,AMSTAR质量评价结果显示,中等质量文献有5篇,其余9篇为高等质量,纳入文献的整体方法学质量较高。采用GRADE系统对14篇系统评价的67条主要结局指标的证据质量评价结果显示,22条证据为中等质量,29条证据为低等质量,16条证据为极低质量。 结论 该研究纳入的系统评价方法学质量较高,但其结局指标证据质量较低。远程康复运动管理有利于改善患者的运动功能、生活自理能力及生活质量,可提高患者的满意度与参与度,但远程运动管理干预方式的研究设计及结局指标的客观性仍需改进。     

穴位按摩治疗失眠效果的系统评价再评价

目的 对穴位按摩治疗失眠的系统评价或Meta分析进行再评价,为穴位按摩治疗失眠的临床应用提供参考。方法 系统检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Web of Science、The Cochrane Library、Embase、MEDLINE数据库,检索穴位按摩治疗失眠的系统评价或Meta 分析,检索时限为建库至2023年1月19日。采用AMSTAR 2和GRADE Ⅱ评价纳入文献的方法学质量和证据质量等级。结果 纳入8 篇系统评价/Meta分析。AMSTAR 2评分结果显示,1篇文献为中等质量,5篇为低质量,2篇为极低质量。结果显示,穴位按摩可提高失眠患者的睡眠质量,效果指标以主观评估为主;选穴遵循一定的规律,但缺乏统一。结论 穴位按摩可提高不同疾病类型失眠患者的睡眠质量,穴位按摩常用穴位、按摩时间、频率、时长、周期等大同小异。由于纳入文献的方法学质量及证据等级偏低,其疗效尚需开展高质量、大样本的随机对照研究进一步验证。     

八段锦对脑卒中患者肢体功能康复影响的Meta分析

目的系统评价八段锦对脑卒中患者肢体功能康复的影响。方法计算机检索Pubmed、Cochrane图书馆、中国生物医学数据库、万方数据库等,纳入符合标准的随机对照试验,检索时间为建库至2016年11月。纳入文献的方法学质量采用Cochrane偏倚风险评估工具进行评价。应用RevMan 5.3统计软件进行Meta分析。结果最终纳入6篇文献,共涉及443名研究对象。Meta分析结果显示,八段锦组与对照组相比能改善脑卒中患者的平衡功能;八段锦联合平衡功能训练可改善下肢运动功能;八段锦联合常规健康指导或康复治疗,可改善脑卒中患者的日常生活活动能力和神经功能缺损状况。结论八段锦在一定程度上能够促进脑卒中患者肢体功能的康复,但需进一步在大样本中验证其有效性。     

基于内容分析法的国内虚拟仿真技术在护理教学领域的文献研究

目的:运用内容分析法对国内护理教学领域虚拟仿真技术的相关文献进行分析,为以后的教学改革提供借鉴和依据。方法:检索中国知网、万方数据库、SinoMed和维普数据库,提取出文献题名、作者及单位、文献来源、研究类型等信息,并依据乔安娜布里格斯研究中心(JBI)循证卫生保健中心(2016)关于不同研究类型的质量评价工具,对实验性研究、类实验性研究、系统评价、质性研究进行真实性评价。结果:纳入的90篇文献包括26篇实验性研究、35篇类实验性研究、2篇系统评价、2篇质性研究和25篇其他类型的文献,并对教学领域、教学对象、教学内容及研究类型进行基本信息提取,根据质量评价结果显示纳入文献的整体质量不高。结论:我国虚拟仿真在护理教学领域的研究尚不成熟,且文献质量不高,未来应完善研究设计,开发更具深度和广度的虚拟仿真系统。     

痉挛型脑性瘫痪儿童轮椅适配情况的调查

目的:调查研究痉挛型脑瘫儿童轮椅适配情况。方法:参照世界卫生组织发布的轮椅服务教程,编制脑瘫儿童轮椅适配情况评价表,由专业人员逐一对来自陕西、湖南、深圳、北京的四个地区的康复机构收治的正在使用轮椅的89例痉挛型脑瘫患儿轮椅适合性进行了评估。结果:本研究从轮椅的基本结构和姿势支撑装置两方面进行评估,结果显示,在所有调查的痉挛型脑瘫儿童中,43.8%患儿的轮椅经过了专业人员评估适配,大约有9%的患儿获得了较为适合的轮椅;专业人员评估适配的轮椅较自己挑选的更为适合患儿(P0.05),重度运动功能障碍的患儿的轮椅不适合现象明显多于轻中度的患儿(P0.05)。结论:专业化的轮椅适配服务在康复机构中有了一定程度的认识,但适配正确率仍然较低,辅助器具适配服务专业化程度和专业能力需要进一步提升。     

肠内营养患者机械性并发症预防及管理的最佳证据总结

目的检索肠内营养患者机械性并发症预防及管理的相关证据, 并对证据进行总结。方法系统检索Cochrane Library、PubMed、美国临床指南网、英国国家卫生与临床优化研究所、美国肠外肠内营养学会、中国知网、万方数据库、中国生物医学文献数据库等, 检索时限为建库至2022年3月20日。采用澳大利亚乔安娜布里格斯研究所(JBI)循证卫生保健中心的文献评价标准和证据分级系统进行文献的质量评级和证据的评估与汇总。结果共纳入13篇文献, 包括指南4篇、专家共识4篇、证据总结4篇、病例对照研究1篇, 最终从发生原因、预防管理、妥善固定、定时冲洗、合理输注营养液/用药、并发症处理—堵管、并发症处理—黏膜受损、并发症处理—非计划性拔管8个方面形成31条最佳证据。结论医护人员可应用最佳证据构建并开展肠内营养患者机械性并发症预防及管理方案, 提高肠内营养患者机械性并发症管理的科学性, 改善患者的生存质量和疾病预后。     

计算机化认知训练对轻度认知障碍患者干预效果的系统评价再评价

目的 对计算机化认知训练对轻度认知障碍患者干预效果的系统评价再评价,为开展计算机化认知训练提供证据支持。方法 计算机检索PubMed、Cochrane Library、Embase、澳大利亚乔安娜布里格斯研究所（Joanna Briggs Institute,JBI）循证卫生保健中心数据库、万方数据库、中国知网、中国生物医学文献数据库、维普数据库,检索内容涉及计算机化认知训练对轻度认知障碍患者干预效果的系统评价/Meta分析,检索时限为建库至2021年12月。由2名研究者独立进行文献筛选、分别对纳入的系统评价和结局指标进行质量评价。排除重复的随机对照试验（randomized controlled trials,RCT）,并对主要RCT重新进行Meta分析。结果 最终纳入10篇系统评价/Meta分析,系统评价方法学质量评价结果显示,1篇为中等质量,其余均为低或较低质量。结果显示,计算机化认知训练有助于改善轻度认知障碍患者的整体认知功能,但对执行功能、记忆功能、注意功能等的干预效果仍需进一步证实。结论 计算机化认知训练有助于改善轻度认知障碍患者的认知功能,受纳入研究的数量及质量限制,尚需...     

身体活动干预儿童青少年执行功能效果的系统综述

目的 系统分析身体活动对儿童青少年执行功能的干预效果，并对影响干预效果的因素进行梳理。方法 检索2010年1月1日至2021年6月30日中国知网、万方数据库、Google Scholar、Wiley Online Library、PubMed中对儿童青少年执行功能进行身体活动干预的文献，经筛选、质量评定后，进行系统综述。结果 最终纳入21篇文献，来自11个国家，包含13项随机对照试验，涉及2 496例研究对象，年龄5～18岁，文献发表日期主要集中在2010年至2019年，物理治疗证据数据库量表平均分5.57分。身体活动类型主要包括体能、技能和运动项目三类，活动强度为低至高强度，每次8～120 min，每周1～5次，时间最长10个月。身体活动可以有效改善执行功能，主要改善抑制控制、工作记忆和认知可塑性，体现在完成认知任务的准确率提高、反应时缩短，双侧前额叶皮质活动增加等。影响干预效果的因素包括身体活动类型、活动组织形式、活动强度、单次活动持续时间、活动频率和周期、干预对象的选取、执行功能指标的选取等。结论 身体活动可以改善儿童青少年的抑制控制、工作记忆和认知可塑性。影响干预效果的因素主要...     

乳腺癌生存者运动康复的范围综述

目的：对运动康复在乳腺癌生存者中应用的研究进行范围综述,为未来开展运动康复提供依据。方法：以乔安娜布里格斯研究所范围综述指南为方法学框架,检索8个中英文数据库,检索时限为建库至2022年2月1日。结果：纳入20篇文献,全面总结运动康复的类型、时间、频率、干预周期、强度及监测方式、干预者及依从性支持措施等。结局指标主要涉及生理学指标、负性情绪和生活质量等。结论：运动康复可改善乳腺癌生存者的生理学指标,改善身体功能,缓解负性情绪,提升生活质量。未来研究需要基于生存者的身体状况、运动偏好等,探究个性化的运动康复策略,采用支持措施提高运动的依从性,运用全面科学的指标体系对运动效果进行评价。     

48例肾移植患儿围手术期的液体管理

目的探讨肾移植患儿围手术期液体管理的方法和效果。方法对48例行肾移植术的患儿,术前做好心功能和治疗依从性评估,根据儿童的循环特点,制订围手术期的输液方案,保持电解质平衡,减少因输液导致的各种并发症。结果本组48例患儿中有29例术后第1 d发生不同程度的电解质紊乱,经处理后在术后第2 d得到改善。出现少尿5例,移植肾功能延迟恢复3例,贫血9例,经控制输液量,改善肾脏微循环后,患儿移植肾功能恢复正常。结论制订合理的输液计划,保持电解质平衡,做好多尿、少尿和无尿期及移植肾功能延迟恢复患儿的液体管理对降低围手术期并发症发生,保证患儿顺利渡过围手术期具有重要的意义。     

The Relationship Between Fatigue and Quality of Life in Children With Chronic Health Problems: A Systematic Review

PURPOSE: This systematic review synthesized the literature regarding fatigue in children with chronic health problems and examined the relationship to quality of life. CONCLUSIONS: Most studies that have examined fatigue and its relationship to quality of life in children with chronic health problems have focused on children with cancer. Studies found that children often reported fatigue and that it decreased quality of life. PRACTICE IMPLICATIONS: Quantifying fatigue in children with chronic illnesses and disabilities is critical for pediatric nursing assessment. Understanding the impact of fatigue on children with chronic health problems is a first step in improving their quality of life.     

Technical devices in children with motor disabilities: a review

Abstract

Purpose: To assess the effectiveness of technical devices used in children with motor disabilities. Method: A systematic search of CINAHL Plus, EMBASE, PEDro, Cochrane Library, Isi Web of Knowledge and Scifinder Web was carried out, covering the period between January 2000 and January 2012. The inclusion criteria were: (1) Studies involving a minimum of five children (randomized-clinical trials with control group and experimental group, clinical trials without control group and prospective cohort studies; (2) age range, 0 to 18 years. The methodological quality of the included studies was assessed by the two authors through the application of the PEDro scale. Results: Of the 59 articles identified by the search strategy, 27 articles were considered eligible. The most frequently evaluated devices were ankle and foot orthoses and the most studied pathology was cerebral palsy. The mean score on the PEDro scale was 6.8. Conclusions: The methodological quality of studies needs to be improved and more rigorous research designs should be followed that will allow the effectiveness and quality of movement to be assessed. The satisfaction of the patient and family with the devices should be analyzed in future studies.

• Implications for Rehabiliation

• The study adds an analysis of studies to determine the effectiveness of technical devices in children with motor disabilities and proposals for future studies to assess the long-term outcomes and improve the quality of interventions.

• Therefore, this review proposes to identify:

• The main technical device used in children with motor disability.

• Which types of pathology or motor disorders require technical devices to be used and what devices are available.

• The effects on the child of wearing technical devices.

• The measurements used to determine the effectiveness of technical aids.

     

Efficacy of Community‐Based Rehabilitation for Children with or at Significant Risk of Intellectual Disabilities in Low‐ and Middle‐Income Countries: A Review

Background Community‐based rehabilitation (CBR) is being implemented in more than 90 countries. Concerns have been voiced about the adequacy of the evidence base regarding the efficacy, effectiveness and efficiency of CBR. This review summarizes evidence on the efficacy of CBR for children with intellectual disabilities. Materials and method Electronic literature database searches were conducted to identify articles in the English language published since 1980 relating to the efficacy of CBR for children with intellectual disabilities. Requests for information were also sent to membership of International Association for the Scientific Study of Intellectual Disabilities and relevant organizations in selected low‐ and middle‐income countries. Results Thirteen studies were identified for inclusion in the review. The quality of evidence for the efficacy of CBR for children with intellectual disabilities was ‘very low’. Conclusion Improving the evidence base will require greater investment in evaluation and addressing the marginalization of people with intellectual disabilities in CBR.     

The Effectiveness of Ischemic Compression Technique on Pain and Function in Individuals With Shoulder Pain: A Systematic Review

ObjectiveTo systematically review current literature to determine the effectiveness of the ischemic compression (IC) technique on pain and function in individuals with shoulder pain.MethodsThis review was conducted according to recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Collaboration for Systematic Reviews; a search was performed in the electronic databases PubMed, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Physiotherapy Evidence Database, and Web of Science. Randomized clinical trials and quasi-randomized clinical trials were included, and the methodological quality was evaluated through the Physiotherapy Evidence Database scale.ResultsThe search found 572 studies; of these, 71 were selected by title and, subsequently, 29 were selected through abstract analyses. After critical analyses, 5 studies were included. The methodological quality ranged from 4 (reasonable) to 9 (excellent) points. Pain was assessed by all studies using the visual analog scale, Global Perceived Effect scale, Numerical Rating Scale, pressure pain threshold, or Perceived Amelioration Numerical Scale. Function was evaluated by 3 studies through the Shoulder Pain and Disability Index; Neck Disability Index; American Shoulder and Elbow Surgeons Standardized Shoulder Assessment; and Disabilities of the Arm, Shoulder, and Hand questionnaires. The studies showed that the IC technique produces immediate and short-term positive effects for pain, and positive short-term effects for shoulder function in individuals with shoulder pain.ConclusionThe IC technique seems to be beneficial for pain and shoulder function. However, caution is needed when considering this evidence owing to the limited quality of some studies, the few articles found, and the lack of standardization of the application parameters of the technique to facilitate its reproducibility.     

Smart wheelchairs: A literature review

Several studies have shown that both children and adults benefit substantially from access to a means of independent mobility. While the needs of many individuals with disabilities can be satisfied with traditional manual or powered wheelchairs, a segment of the disabled community finds it difficult or impossible to use wheelchairs independently. To accommodate this population, researchers have used technologies originally developed for mobile robots to create "smart wheelchairs." Smart wheelchairs have been the subject of research since the early 1980s and have been developed on four continents. This article presents a summary of the current state of the art and directions for future research.     

Is goal planning in rehabilitation effective? A systematic review

OBJECTIVE: To determine the evidence regarding the effectiveness of goal planning in clinical rehabilitation. DESIGN: Systematic review. METHOD: MEDLINE, EMBASE, PsycINFO, CINAHL, AMED, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, American College of Physicians (ACP) Journal Club, and the Database of Abstracts of Reviews of Effects (DARE) were searched for randomized controlled trials on the therapeutic effectiveness of goal planning in the rehabilitation of adults with acquired disability. Studies were categorized by patient population and the clinical context of the study. Data were analysed using best-research synthesis, based on methodological quality determined by Physiotherapy Evidence Database (PEDro) scale scores. RESULTS: Nineteen studies were included in this review. Study populations in these papers included patients with neurological disorders, psychiatric disorders, musculoskeletal disorders, cardiovascular disorders, respiratory disorders and dietary/endocrine disorders. Six studies investigated the immediate effects of goal planning on patient behaviour. Thirteen studies investigated the effects of goal planning in the context of a rehabilitation programme lasting more than one week. Some limited evidence was identified that goal planning can influence patient adherence to treatment regimes and strong evidence that prescribed, specific, challenging goals can improve immediate patient performance in some specific clinical contexts. However, evidence regarding how these effects translated to improved outcomes following rehabilitation programmes was inconsistent. CONCLUSIONS: This review identified that while some studies demonstrated positive effects associated with goal planning in local contexts, the best available empirical evidence regarding the generalizable effectiveness of goal planning was inconsistent and compromised by methodological limitations.     

1996 RESNA/Whitaker Student Scientific Paper Competition

A national survey of providers of pediatric powered wheelchairs was conducted to collect background data on these professionals and to develop a “model” of their current assessment and recommendation practices. Data collected in the survey included provider demographics, frequency of powered wheelchair provision to young children, common reasons for not recommending a powered wheelchair, reasons why a child who is recommended a powered wheelchair does not receive one, current pediatric powered wheelchair assessment and recommendation practices, and subjective data regarding the efficacy of these practices and the impact of powered wheelchairs on children. Respondents rated the frequency with which they performed various wheelchair assessment and recommendation practices, and these ratings were analyzed to determine activities that were performed frequently. These activities were then combined into common “factors” using factor analysis, and the results of the factor analysis were used to create a model of current pediatric powered wheelchair assessment and recommendation practices. A total of 140 surveys were received from providers in 46 states. Of these providers, 54% were clinicians (e.g., physical therapists, occupational therapists), and 46% were suppliers (e.g., Rehabilitation Technology Specialists), representing a variety of geographic locations and facility types. The 3 major reasons for not recommending a powered wheelchair included cognitive, physical, and behavioral factors. The 3 major reasons why a child who is recommended a powered wheelchair does not receive one included funding issues, lack of family support, and transportation issues. The model of current pediatric powered wheelchair provision includes 4 assessment factors: Preliminary Clinical Assessment, Intake, Advanced Clinical Assessment, and Consideration of Other Factors. Typical recommendations include both therapeutic and nonclinical interventions. A modified version of this model, which addresses some issues identified in the survey that limit wheelchair recommendations, is currently being tested at 4 clinical sites.     

Comparison between performances of three types of manual wheelchairs often distributed in low-resource settings

Purpose: This study was conducted to compare the performance of three types of chairs in a low-resource setting. The larger goal was to provide information which will enable more effective use of limited funds by wheelchair manufacturers and suppliers in low-resource settings. Methods: The Motivation Rough Terrain and Whirlwind Rough Rider were compared in six skills tests which participants completed in one wheelchair type and then a day later in the other. A hospital-style folding transport wheelchair was also included in one test. For all skills, participants rated the ease or difficulty on a visual analogue scale. For all tracks, distance traveled and the physiological cost index were recorded. Data were analyzed using repeated measures analysis of variance. Results: The Motivation wheelchair outperformed Whirlwind wheelchair on rough and smooth tracks, and in some metrics on the tight spaces track. Motivation and Whirlwind wheelchairs significantly outperformed the hospital transport wheelchair in all metrics on the rough track skills test. Conclusion: This comparative study provides data that are valuable for manufacturers and for those who provide wheelchairs to users. The comparison with the hospital-style transport chair confirms the cost to users of inappropriate wheelchair provision.

• Implications for Rehabilitation

• For those with compromised lower limb function, wheelchairs are essential to enable full participation and improved quality of life. Therefore, provision of wheelchairs which effectively enable mobility in the cultures and environments in which people with disabilities live is crucial. This includes low-resource settings where the need for appropriate seating is especially urgent.

• A repeated measures study to measure wheelchair performances in everyday skills in the setting where wheelchairs are used gives information on the quality of mobility provided by those wheelchairs.

• This study highlights differences in the performance of three types of wheelchairs often distributed in low-resource settings. This information can improve mobility for wheelchair users in those settings by enabling wheelchair manufacturers to optimize wheelchair design and providers to optimize the use of limited funds