对肢体丧失和医疗保健运动患者功能分类的k级系统越来越不满,以循证实践为基础,这导致需要替代形式的功能分类和制定临床实践指南,以改善获得优质假体干预的机会。该项目的目的是根据系统文献综述的结果和综合,为假肢患者护理中的运动测试制定并提出临床实践建议。
PubMed的数据库搜索,谷歌学者,WebofScience,和Cochrane进行了研究,并对文章进行了综述。在潜在的1386个条款中,第10条符合列入标准。这些文章是使用英国国家服务长期条件框架的关键评估工具进行评估的。在纳入的10篇文章中,有8篇是高的,一种介质,和一个低,质量。这些文章的数据被合成为6个经验证据陈述,这些陈述被用于制定拟议的临床实践指南.
虽然本系统评价的结果不能支持心肺功能和钾水平之间的直接联系,文献确实支持在某些人口统计学中,运动测试结果预测假肢成功行走的能力。发现由健全的肢体推动的连续最大强度单下肢测力计和间歇性次最大上肢测力计方案都是目标人群心肺健康和功能的可行评估工具。
在单腿周期测功测试中,维持运动强度≥预测VO2max值的50%的能力以及在上肢测功测试中实现30W的持续工作量被发现与成功行走最相关用假肢。经过6周的锻炼计划,截肢者的VO2值增加。关于下肢丧失患者运动测试的系统文献综述的这些综合结果用于开发和提出临床治疗途径。
Growing discontent with the k-level system for functional classification of patients with limb loss and movement of healthcare toward evidence-based practice has resulted in the need for alternative forms of functional classification and development of clinical practice
guidelines to improve access to quality prosthetic interventions. The purpose of this project was to develop and present a clinical practice recommendation for exercise testing in prosthetic patient care based on the results and synthesis of a systematic literature review.
Database searches of PubMed, Google Scholar, Web of Science, and Cochrane were conducted and articles reviewed. Of the potential 1386 articles 10 met the criteria for inclusion. These articles were assessed using the critical appraisal tool of the United Kingdom National Service Framework for Long-Term Conditions. Of the 10 included articles eight were of high, one of medium, and one of low, quality. Data from these articles were synthesized into 6 empirical evidence statements, all qualifying for research grade A. These statements were used to develop the proposed clinical practice
guideline.
While the results of this systematic review were not able to support the direct connection between cardiorespiratory performance and K-levels, the literature did support the ability of exercise testing results to predict successful prosthetic ambulation in some demographics. Both continuous maximum-intensity single lower extremity ergometer propelled by a sound limb and intermittent submaximal upper extremity ergometer protocols were found to be viable evaluation tools of cardiorespiratory fitness and function in the target population.
The ability to sustain an exercise intensity of ≥50% of a predicted VO2max value in single leg cycle ergometry testing and achievement of a sustained workload of 30 W in upper extremity ergometry testing were found to be the strongest correlates to successful ambulation with a prosthesis. VO2 values were found to increase in amputee subjects following a 6-week exercise program. These synthesized results of the systematic literature review regarding exercise testing in patients with loss of a lower extremity were used to develop and a present a clinical treatment pathway.