METHODS: A list of the most urgent key-questions was derived from a previous study. Literature was summarised using the grading of recommendations assessment, development, and evaluation (GRADE) evidence-to-decision framework. Recommendations were drafted based on four 90 min consensus meetings with expert physiotherapists. Recommendations were finalised after feedback and >80% consensus of all stakeholders (including PWH, physiotherapists, haematologists and the corresponding societies).
RESULTS: A list of 82 recommendations was formulated to support primary care physiotherapists when treating a person with a bleeding disorder. These recommendations could be divided into 13 categories: two including recommendations on organisation of care, six on therapy for adult patients with bleeding disorders and five on therapy adaptations for paediatric care. Therapy recommendations included treatment after a joint- or muscle bleed, haemophilic arthropathy, chronic synovitis, non-haemophilia related conditions and orthopaedic surgery.
CONCLUSIONS: An evidence-based practice guideline, based on current evidence from literature and clinical expertise, has been developed for primary care physiotherapists treating a person with haemophilia. To improve care, the recommendations should be implemented in daily practice.
方法:最紧迫的关键问题列表来自先前的研究。文献是使用推荐评估的分级进行总结的,发展,和评估(等级)证据到决策框架。建议是根据与物理治疗师专家进行的四次90分钟共识会议起草的。建议在反馈和>80%的所有利益相关者达成共识(包括PWH,物理治疗师,血液病学家和相应的社团)。
结果:制定了82项建议,以支持初级保健物理治疗师治疗出血性疾病患者。这些建议可分为13类:两类,包括关于护理组织的建议,六项关于成人出血性疾病患者的治疗,五项关于儿科护理的治疗适应。治疗建议包括关节或肌肉出血后的治疗,血友病性关节病,慢性滑膜炎,非血友病相关疾病和骨科手术。
结论:基于证据的实践指南,根据文献和临床专业知识的现有证据,已开发用于治疗血友病患者的初级保健物理治疗师。为了改善护理,建议应在日常实践中实施。