康复临床实践指南:发展现状研究

目的 分析康复临床实践指南的发展现状和存在的问题,为制订康复临床实践指南提供参考和借鉴。方法 检索PubMed、EMBASE、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据库、医脉通、英国国家卫生与临床优化研究所(NICE)、美国国立指南文库(NGC)、苏格兰校际指南协作网(SIGN)、世界卫生组织(WHO)、国际指南协作网(GIN)等数据库和指南相关网站,搜索国内外已发布的康复临床实践指南,检索时限均从建库至2020年1月11日。根据纳入和排除标准筛选文献,提取纳入指南的发表年代、国家、期刊、发布机构、涉及的健康问题和制订方法等数据,并做描述性统计分析。结果 共纳入康复临床实践指南84篇,其中中文17篇,英文67篇。康复临床实践指南发表量位于前4位的国家是美国(19篇)、中国(17篇)、英国(12篇)和加拿大(11篇),制订指南的机构主要是各医学专业学会和协会(49篇)。康复临床实践指南发表量位于前5位的疾病为脑卒中(12篇)、心血管疾病(9篇)、肩关节损伤(5篇)、肺部疾病(5篇)和脊髓损伤(5篇)。35篇(42%)指南的推荐意见有证据分级和推荐强度;22篇(26%)指南指出会定期更新推荐意见。结论 康复临床实践指南数量较少,纳入指南聚焦的健康问题主要为神经、肌肉骨骼系统疾病,以及心肺功能障碍康复。多数指南的推荐意见以文献综述或专家意见为主,少数指南基于循证方法系统制订,康复指南的制订需要进一步规范化。

Clinical Practice Guidelines of Rehabilitation: Development Status

Objective To analyze the development trends and issues of clinical practice guidelines of rehabilitation.Methods Clinical practice guidelines of rehabilitation were retrieved from PubMed,EMBASE,China Biology Medicine disc,CNKI,Wangfang database,Medlive,National Institute for Health and Care Excellence,National Guideline Clearinghouse,Scottish Intercollegiate Guidelines Network,World Health Organization and Guidelines International Network from establishiment to January 11,2020.The number,publication date,distribution of countries,journals,institutions,subject areas and methods for developing guidelines of included literatures were analyzed.Results A total of 84 clinical practice guidelines of rehabilitation were included,in which there were 17 published in Chinese and 67 in English.The top four countries that published rehabilitation guidelines were the United States(19 articles),China(17 articles),the United Kingdom(12 articles)and Canada(11 articles).The guidelines were developed mainly by the health professional societies and associations(49 articles).The main health conditions involved stroke(12 articles),cardiovascular disease(9 articles),shoulder joint injury(5 articles),pulmonary disease(5 articles)and spinal cord injury(5 articles).There were 35 guidelines expressiong evidence classification and recommendation intensity(42%),and 22 guidelines(26%)would update regularly.Conclusion Clinical practice guidelines of rehabilitation focuse on neurological and musculoskeletal system diseases and cardiopulmonary dysfunction.There are relatively few published clinical practice guidelines for rehabilitation.Most guidelines are based on literature review or expert opinions,while a few are evidence-based.It is proposed to implement standardized approaches to develop clinical practice guidelines of rehabilitation.