慢性阻塞性肺疾病患者短期康复疗效观察

３０例慢性阻塞性肺部疾病患者接受２～３周的综合康治疗后，咳嗽、咯痰、呼吸困难明显改善，最大运动负荷平均提高了６．４±３．６９Ｗ，与对照组相比有显著差异（Ｐ＜０．０１）。治疗组患者的ＶＴ、ＶＣ、ＦＶＣ、ＦＥＶ_（１．０）、ＴＬＣ较治疗前明显增加（Ｐ＜０．０１），其它肺功能指标的改变无统计学意义（Ｐ＞０．０５）。同时调查康复治疗前后１年的生活质量，治疗组有明显提高（Ｐ＜０．０１）。     

Filiform needle acupuncture for copd: A systematic review and meta-analysis

BackgroundThis is the first part of a larger spectrum systematic review which aims to identify and evaluates the effectiveness of all different non-pharmacological acupuncture techniques used for COPD. In this first publication, we describe the results of filiform needle acupunctureMethodsRandomised controlled trials up to May 2019 were searched in 11 databases. Data extraction and risk of bias assessment was conducted in pairs independently. RevMan 5.3 was used for the meta-analysis.Results28 trials using filiform needle alone or in combination of other techniques were included. Compared with no acupuncture, no difference was seen for dyspnoea, but statistical benefits were found on quality of life (Std. MD: -0.62, 95%CI: -0.90, -0.34), exercise capacity (stable subgroup) (6MWT MD: 33.05 m, 95%CI: 19.11, 46.99) and lung function (FEV₁% MD: 1.58, 95%CI: 0.51, 2.66). Compared with sham, statistical benefits were found on dyspnoea (Std. MD: -1.07, 95%CI: -1.58, -0.56), quality of life (Std. MD: -0.81, 95%CI: -1.12, -0.49), exercise capacity (6MWT MD: 76.68 m, 95% CI: 39.93, 113.43) and lung function (FEV₁% MD: 5.40, 95%CI: 2.90, 7.91; FEV1/FVC MD: 6.64, 95%CI: 3.44, 9.83).ConclusionsResults show that filiform needle acupuncture might be beneficial for COPD, but due to the low quality of the studies this should be confirmed by future well-designed trials.Protocol registrationPROSPERO (identifier: CRD42014015074).     

Effects of self-management support programmes on activities of daily living of older adults: A systematic review

BackgroundThe ability of older adults to carry out activities of daily living and to adapt and to manage their own life decreases due to deterioration of their physical and cognitive condition. Nurses and other health care professionals should support the self-management ability of older adults to prevent activities of daily living dependence and increase the ability to adapt and to self-manage the consequences of living with a chronic condition.ObjectiveTo gain insight into the evidence of the effects of self-management support programmes on the activities of daily living of older adults living at home.DesignA systematic literature review of original research publications.Data sourcesSearches were performed in PubMed, CINAHL, PsychInfo, EMBASE and the Cochrane Central Register of Controlled Trials (in February 2016). No limitations were applied regarding date of publication, language or country.Review methodsPublications were eligible for this review on condition that they described a self-management support programme directed at adults of on average 65 years or older, and living in the community; used a randomized control group design; and presented information about the effects on activities of daily living. The methodological quality of the included studies was independently assessed by the authors using the quality criteria for reviews of the Cochrane Effective Practice and Organisation of Care Review Group. A best evidence synthesis was performed using guidelines provided by the Cochrane Collaboration Back Review Group.ResultsA total of 6246 potentially relevant references were found. After screening the references, 12 studies with a randomized controlled trial design were included. The methodological assessment of the 12 studies indicated variations in the risk of bias from low (n = 1) to unclear (n = 3) and high (n = 8). Although there was considerable variation in study population, intervention characteristics and measurement instruments used, most studies (n = 11) showed effects of self-management support programmes on the activities of daily living of older adults.ConclusionsThere is a moderate level of evidence that self-management support programmes with a multi-component structure, containing disease-specific information, education of knowledge and skills and, in particular, individually tailored coaching, improve the activities of daily living of older adults.Further research is required to gain insight into the most appropriate context and approach of self-management support interventions targeting activities of daily living of older adults living in the community.     

Effect of life-space mobility on subjective well-being in aged home-based rehabilitation users with different levels of independence in activities of daily living

[Purpose] The relationship between quality of life and life-space mobility in community-dwelling older adults has recently been reported. The present study aimed to elucidate this relationship in home-based rehabilitation users with limited life-space mobility and loss of independence in activities of daily living. [Participants and Methods] The study population comprised 33 home-based rehabilitation users. The participants were expected to have a wide range of the level of independence in activities of daily living; therefore, they were categorized into three groups according to the Barthel Index score: independent (95–100 points), moderately disabled (90–65 points), and severely disabled (60–0 points) groups. We examined the relationships among the Philadelphia Geriatric Center Morale Scale, Life-Space Assessment, and Barthel Index scores and age. [Results] We detected a strong positive correlation between the Philadelphia Geriatric Center Morale Scale and Life-Space Assessment scores in the independent group; however, no significant correlations were observed in the moderately and severely disabled groups. [Conclusion] Our findings suggest a relationship between subjective well-being and life-space mobility in home-based rehabilitation users who are mostly independent in activities of daily living. However, owing to the small sample size and characteristics of the scales used in this study, further studies are warranted to verify these results.     

Weight stigmatisation in physiotherapy: a systematic review

Background: Physiotherapists play an integral role in the provision of health care to individuals who are overweight or obese. An understanding of weight stigma is therefore important in ensuring best practice. Despite these considerations, no previous systematic reviews have investigated weight stigma in physiotherapy.

Objectives: To determine if (i) physiotherapists demonstrate weight stigma through explicit or implicit means and (ii) how weight stigma is perceived by physiotherapy patients.

Methods: Database searches were conducted to identify quantitative and qualitative studies published between January 1960 and September 2015. Two reviewers independently performed data extraction and assessments of methodological quality. Outcome measures included explicit attitudes, implicit attitudes and beliefs about obesity held by physiotherapists, as well as patient perceptions of obesity management.

Results: Seven high-quality studies were included in the review. Six studies demonstrated the existence of explicit weight stigma, with a majority of physiotherapists describing people with increased weight as ‘noncompliant’ and ‘unmotivated’. One study demonstrated the existence of implicit weight stigma, but this did not appear to influence treatment approaches. Four studies found stigmatising beliefs about weight among physiotherapists, and one study found that physiotherapy patients believed both physical environments and paternalistic communication styles propagated weight stigmatisation.

Conclusions: Explicit weight stigmatisation is common in physiotherapy and is often perceived by patients, who may feel unmotivated or ignored as a result. While implicit stigmatisation also occurs, it is unclear if this influences physiotherapy management. Future research is required to assist in the development of appropriate preventative strategies.     

动态系统评价简介

系统评价作为循证医学中较高等级证据,其制作方法相对成熟,但更新机制尚不完善。动态系统评价通过周期性获取临床证据,及时更新系统评价结果,能有效提高系统评价的时效性。本文从动态系统评价的产生、特点、适用情况、实施过程、应用现状等几个方面对其进行简要介绍。     

社区阿尔茨海默病患者生活质量现状的系统评价

目的了解社区阿尔茨海默病(AD)患者生活质量现状及影响因素。方法参照Cochrane协作网工作手册检索PubMed、Scopus、EMbase、Web of Science、中国知网、万方、维普和中国生物医学文献数据库,纳入有关社区AD患者生活质量现状的横断面研究,由两名研究者独立进行文献筛选和质量评价,在提取资料后进行描述性分析。结果共纳入10篇文献,1721例患者。AD患者生活质量得分处于一般水平,AD生命质量量表测评结果显示,患者自评和照顾者代评总合并效应值分别为(35.27±4.08)分、(30.56±3.66)分,轻至中度患者合并效应值分别(35.47±6.03)分、(33.35±5.91)分,中至重度患者合并效应值分别(35.8±2.67)分、(30.33±2.26)分,患者自评得分明显高于照顾者代评得分。AD相关性生命质量量表测评结果显示,照顾者代评合并效应值为(66.95±13.03)分。影响AD患者生活质量的因素包括患者的年龄、性别、受教育程度、婚姻状况、居住方式、认知功能、精神行为症状、日常生活活动能力、疾病严重程度、药物的使用以及照顾者的年龄、性别、与患者的关系、身心健康状况、照顾负担等。结论社区AD患者的生活质量处于一般水平,影响其生活质量的因素较多,应针对可干预的影响因素进行有效干预。结论AD患者的生活质量处于一般水平,影响其生活质量的因素众多,我国AD患者生活质量现状及综合护理干预的研究有待加强。     

Optimizing patients' functional status during daily nursing care interventions: A systematic review

Patients often experience a functional decline due to physical inactivity during illness. Nurses can influence the physical activity of patients while assisting them with activities of daily living. The purpose of this study was to identify effective interventions that are embedded in daily nursing care (irrespective of care setting) that aim to optimize the functional status of patients by increasing their physical activity. A systematic review was performed and reported following the preferred reporting items for systematic reviews and meta-analyses. PubMed, CINAHL, and Cochrane were searched for studies from January 2002 to March 2019. The critical appraisal tools from the Joanna Briggs Institute were used to assess the risk of bias in individual studies. Study characteristics, intervention key components, and reported effects of included studies were extracted, summarized narratively, and compared. Twenty studies, evaluating nine different interventions were included. In these interventions, eight key components were identified. Four components were included in all six interventions with a positive effect on mobility, physical activity, or functional status. These components were: assessment of patient's functionality; goal setting with the patient; establishment of an individualized plan; and engagement of patients in physical and daily activity. The effects were limited due to the risk of bias in the studies, small sample sizes, limited clinical meaning of the effects, and variability of the adherence to the interventions. Multicomponent interventions were the most promising to enhance the functional status of patients. Future research should evaluate these interventions using research methods aiming at producing more rigorous evidence.     

The effect of functional-task training on activities of daily living for people with Parkinson`s disease,a systematic review with meta-analysis

ObjectiveTo evaluate the effect of functional-task training on activities of daily living (ADL) in people with Parkinson`s Disease.MethodsWe searched five databases (Cinahl, Embase, Medline, Pedro and CENTRAL). The included studies were assessed on therapeutic validity and risk of bias. We classified the quality of evidence according to the principles of the GRADE approach. All assessments were executed independently by two researchers. The results of included studies were pooled in a meta-analyses and heterogeneity was explored by meta-regression analysis.ResultsOut of 2546 identified studies, 69 full texts articles were checked for eligibility, of which ten were included in the systematic review. Moderate quality of evidence indicated that exercise interventions containing functional-task training had a positive effect on ADL performance scores on the Unified Parkinson's Disease Rating Scale (UPDRS) in people with Parkinson (pwp) directly after intervention (UPDRS=-2.62(-5.34;0.10)).This effect improved, in favor of functional-task interventions, at the first follow-up (UPDRS=-4.0(-7.56;-0.4)). A post-hoc meta-regression analysis yielded a significant relationship between intensity rate (minutes/week) and the size of the (average) effect on ADL score.ConclusionExercise interventions containing functional-task training have a clinically important positive effect on ADL performance in pwp directly after intervention and at first follow-up, compared to no intervention or placebo. The intensity rate of the functional-task training should be as intense as possible, within the capabilities of the person with PD. Future research is necessary to determine the exact amount of effect that can be contributed to functional-task training.     

Hydrotherapy in the management of chronic obstructive pulmonary disease: a qualitative systematic review

Abstract

Background: Many people worldwide suffer from chronic obstructive pulmonary disease (COPD). Diverse medical conditions have been treated using hydrotherapy for many years but its use in the treatment of COPD is a recent development. Its use in the COPD population may lead to improvements in cardiopulmonary outcomes and quality of life (QoL) and the mastery of activities of daily living (ADL) in people with this disease.

Objectives: To determine the effects of hydrotherapy on cardiopulmonary function, QoL, and ADL in people with COPD.

Method: Studies relating to adults with non-acute, non-terminal COPD were located by searching electronic databases. Included studies were critically appraised by two independent reviewers using the Lewis, Olds, and Williams tool.

Results: Nine studies met the inclusion criteria (n?=?207 subjects). Sample sizes of individual studies varied between 10 and 43 subjects. Three studies were of above average methodological quality, two were of average, and four were of a poor quality. Thirty-five outcome measures were identified. Cardiopulmonary parameters showed positive increases when the immersed COPD subjects exhaled into water. Aspects of QoL improved with physical training in water. Group hydrotherapy improved ADL performance.

Conclusions: The few included studies, which address the use of hydrotherapy in the management of COPD, had small sample sizes and were mainly of low to moderate methodological quality. Hydrotherapy may improve cardiopulmonary, QoL, and ADL outcomes in the COPD population. Investigation into the effects of combined breathing and physical exercise during hydrotherapy, in the COPD population, is needed.     

The effects of home-based pulmonary rehabilitation in patients with chronic lung disease

The purpose of this study was to examine the effects of a home-based pulmonary rehabilitation program on lung function, dyspnea, exercise tolerance, and quality of life in 23 Koreans with moderate to severe chronic lung disease. The outcome measures were forced expiratory volume in 1 s (FEV₁, % predicted), Borg score, 6 min walking distance (6 MWD), and chronic respiratory disease questionnaire (CRDQ). Experimental group (n=15) performed the 8-week home-based pulmonary rehabilitation program, composed of inspiratory muscle training, upper and lower extremity exercise, relaxation, and telephone visit. Patients in control group (n=8) were only given educational advice. The experimental group showed a lower level of exertional dyspnea, more exercise tolerance, and greater improvement in health-related quality of life than the control group (p<0.05). Lung function was not statistically different. This study yielded evidence for the beneficial effects of home-based pulmonary rehabilitation program.     

The efficacy of outpatient and community-based aphasia group interventions: A systematic review

Abstract

This paper examines the evidence for community and outpatient aphasia groups using the International Classification of Functioning, Disability and Health (ICF) framework. A systematic search of the literature using eight electronic databases was completed; 29 studies met inclusion and exclusion criteria. Level of evidence and methodological quality was assessed and effect sizes calculated where possible. Evidence favouring community and outpatient groups centred on four level ii and level iii-i studies that examined the efficacy of highly structured group activities for improving specific linguistic processes with five medium–large effect sizes calculated. Medium and large effect sizes were also calculated on a level iii-i study examining number of friendships and community access. No effect sizes were available for level ii or level iii studies examining communication activity and participation. Overall, the results indicate that community and outpatient group participation can improve specific linguistic processes. There is also some evidence that group participation can benefit social networks and community access. However, there is limited evidence demonstrating improvement in functional communication as a consequence of group participation. The current evidence is not comprehensive. Further well-designed studies, particularly examining activity and participation, and contextual factors are required to advance community and outpatient aphasia group practice and participation.     

数字化学习对护士在职培训效果的系统评价

目的系统评价数字化学习(Electronic Learning,E-learning)对护士在职培训的效果。方法计算机检索1990年1月1日-2015年5月31日Cochrane Library、Pub Med、MEDLINE、ERIC以及"中国期刊全文数据库"中关于E-learning对护士在职培训效果的随机对照实验(RCT),由双人进行文献筛选及质量评价,以Cochrane系统评价员手册5.1.0为文献质量评价准则。采用Rev Man 5.3对纳入研究的样本情况、干预方式、培训内容及展现形式、交流方式、对照组情况、效果及评价六方面进行数据录入和分析。结果 12篇关于E-learning运用于护士在职培训的RCT中,5篇文献质量等级为A,6篇文献质量等级为B,1篇文献质量等级为C(偏倚风险高,不纳入系统评价)。最终11篇RCT纳入了系统评价,样本总量为2 149人,干预方式涉及网络课程、CD-ROM和计算机辅助程序等Elearning手段。培训内容包括除颤、循证护理、个案管理等11个方面,其展现形式多为文档、图标、情景和教学视频。培训后考核、量表自评、工作表现以及参与者的课程完成度和满意度是评价E-learning效果的常用指标。结论 Elearning能够有效地提高护士的知识、技能水平,其灵活性得到护士的认可,而且不受地域限制,能够有效实现培训资源共享。但其培训效果受多方面因素影响。如何构建护士培训内容及展现形式,提高师生交流程度,是提高Elearning培训效果的关键,值得进一步研究。     

肺康复锻炼对稳定期COPD患者生活质量的影响

目的探讨肺功能康复锻炼对COPD患者的临床作用。方法26例中~重度COPD病人经过20周肺康复锻炼后,分别观察呼吸困难程度和6 min行走距离(6MWD),用圣乔治呼吸问卷(SGRQ)评定生活质量(总积分和分项积分)。结果10周及20周康复锻炼后,COPD患者6MWD及SGRQ积分(总积分及各项积分)均有改善,第20周呼吸困难指数有明显改善,且20周后6MWD、SGRQ总积分较第10周差异有显著意义。结论肺功能康复锻炼对COPD患者有积极作用,20周的康复锻炼比10周产生更好的临床疗效。     

社区综合性干预对慢性阻塞性肺疾病患者肺功能和生活质量的影响

目的　评价社区综合干预治疗慢性阻塞性肺疾病 (chronicobstructivepulmonarydisease,COPD)的效果。方法　选取华中科技大学 2 3名COPD患者为干预组 ,进行戒烟、COPD防治知识、康复治疗及氧疗等教育 ,并定期进行咨询和指导性治疗 ,包括雾化吸入支气管扩张剂 ,应用祛痰药和茶碱缓释片 ;2 2名未参与社区综合干预治疗的COPD患者作为对照组。 2组患者均具有较高学历。观察 2年后 ,分别采用肺功能和生活质量 (qualityoflife,QOL)评分进行评估。结果　 2年后 ,干预组与对照组比较 ,一秒用力呼气容积(FEV1 )与用力肺活量 (FVC)平均每年的下降速度差异有显著性 ,在COPDI、II级患者中尤为明显 ;干预组QOL评分低于对照组 ,2组比较 ,差异有显著性意义 (P <0 .0 5)。结论　社区综合性干预治疗COPD ,能有效改善患者肺功能及生活质量 ;患者的文化素质对病情无明显影响     

Interprofessional teamwork and team interventions in chronic care: A systematic review

To identify key features of teamwork and interventions for enhancing interprofessional teamwork (IPT) in chronic care and to develop a framework for further research, we conducted a systematic literature review of IPT in chronic care for the years 2002–2014. Database searches yielded 3217 abstracts, 21 of which fulfilled inclusion criteria. We identified two more studies on the topic by scanning the reference lists of included articles, which resulted in a final total of 23 included studies. The key features identified in the articles (e.g., team member characteristics, common task, communication, cooperation, coordination, responsibility, participation, staff satisfaction, patient satisfaction, and efficiency) were structured in line with the input–process–output model, and evaluated interventions, such as tools, workshops, and changes in team structure, were added to the model. The most frequently evaluated team interventions were complex intervention programs. All but one of the 14 evaluation studies resulted in enhancement of teamwork and/or staff-related, patient-related, and organization-related outcome criteria. To date, there is no consensus about the main features of IPT and the most effective team interventions in chronic care. However, the findings may be used to standardize the implementation and evaluation of IPT and team interventions in practice and for further research.