目的:本综述的目的是评估身体康复和非康复比较对长期护理(LTC)痴呆症居民的身体功能和生活质量的有效性。
背景:患有痴呆症的LTC居民通常身体功能和生活质量受损。身体康复可以改善痴呆症患者的身体功能和生活质量;然而,许多患有痴呆症的LTC居民没有接受身体康复,提供者不确定采用什么干预措施。综合研究身体康复的研究将有助于指导大多数居民患有痴呆症的LTC部门的实践。以前的综合研究集中在LTC的所有居民,特定职业,干预措施,或者社区中的痴呆症患者。我们的审查重点是患有痴呆症的LTC居民和更广泛的身体康复定义。
方法:本综述包括评估患有任何严重痴呆症的LTC居民与非康复对照组相比的身体康复的研究。我们纳入了衡量对日常生活活动影响的研究,基于性能的物理功能,以及自我或代理人评估的生活质量。
方法:在APAPsycINFO(EBSCOhost)中进行了搜索,CINAHL(EBSCOhost),PubMed(国家医学图书馆),Embase,Scopus,和CochraneCENTRAL数据库,没有日期或语言限制。两个独立的评论根据纳入标准评估了研究。两名独立的审阅者提取了数据,并使用结构化的提取表进行了质量评估。使用建议分级来确定证据的确定性,评估,开发和评估(等级)方法。在可能的情况下,研究在荟萃分析中汇总;否则,进行了叙事合成。
结果:纳入了33项研究(n=3072名参与者);27项为随机对照试验,其余6项为非随机试验。纳入研究的总体偏倚风险低至不明确。许多纳入的研究集中在增加活动或步行,而很少有人单独定制或强度适合对身体功能产生治疗作用。身体功能也通过几种结果测量来测量,限制了我们汇集结果的能力。有低确定性证据表明,身体康复改善了日常生活活动(12项随机对照试验,1348名与会者,SMD0.78;95%CI0.27至1.30)和短物理性能电池评分(3项RCT,258名与会者,MD3.01分;95%CI1.37至4.66)与非康复干预相比。有低至中等的确定性证据表明,身体康复在30秒的坐下来测试中没有变化(2个随机对照试验,293名参与者,MD0.79重复;95%CI-0.45至2.03),6分钟步行测试(4个随机对照试验,363名与会者,MD17.32米;95%CI-29.41至64.05),步态速度(4个随机对照试验,400名参与者,MD0.10米/秒;95%CI-0.02至0.22),定时起床和去测试(3项研究,275名与会者MD-2.89秒;95%CI-6.62至0.84),或生活质量(4项随机对照试验,419名与会者,SMD0.20;95%CI-0.08至0.47)。
结论:这篇综述表明,身体康复可以改善患有痴呆症的LTC居民的日常生活活动,尽管证据的确定性很低.身体康复对特定功能任务的影响,比如步态速度和生活质量,不太清楚。未来的研究应该检查个性化的影响,对结局指标进行渐进式干预,以反映患有更晚期痴呆症的LTC居民的能力和偏好。
背景:PROSPEROCRD42022308444。
OBJECTIVE: The objective of this
review was to evaluate the effectiveness of physical rehabilitation vs non-rehabilitation comparators for physical functioning and quality of life in long-term care (LTC) residents with dementia.
BACKGROUND: LTC residents living with dementia often have impaired physical functioning and quality of life. Physical rehabilitation can improve physical functioning and quality of life for individuals living with dementia; however, many LTC residents with dementia do not receive physical rehabilitation and providers are unsure what interventions to employ. A synthesis of studies examining physical rehabilitation will help guide practice in the LTC sector where most residents live with dementia. Previous syntheses have focused on all residents in LTC, specific professions, interventions, or people with dementia in the community. Our
review focused on LTC residents with dementia and used a broader definition of physical rehabilitation.
METHODS: This
review included studies that evaluated physical rehabilitation in comparison with non-rehabilitation controls among LTC residents with any severity of dementia. We included experimental and quasi-experimental studies that measured the effect on activities of daily living, performance-based physical functioning, and self- or proxy-rated quality of life.
METHODS: Searches were conducted in APA PsycINFO (EBSCOhost), CINAHL (EBSCOhost), PubMed (National Library of Medicine), Embase, Scopus, and the Cochrane CENTRAL database with no date or language limitations. Two independent reviewers assessed the studies against the inclusion criteria. Two independent reviewers extracted data and conducted a methodological quality assessment using standardized checklists from JBI. Certainty of evidence was ascertained using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Where possible, studies were pooled in meta-analyses; otherwise, a narrative synthesis was presented.
RESULTS: Thirty-three studies were included (n=3072 participants); 27 were randomized controlled trials and (RCTs) the remaining 6 were non-randomized trials. The overall risk of bias of the included studies was low to unclear. Many of the included studies focused on increasing activity or walking, while few were individually tailored or at an intensity appropriate to induce therapeutic effects on physical function. Physical function was measured via several outcome measures, limiting our ability to pool results. There was low-certainty evidence that physical rehabilitation improved activities of daily living assessed with multiple instruments (12 RCTs, 1348 participants, standardized mean difference [SMD] 0.78; 95% CI 0.27 to 1.30) and lower extremity function assessed with the Short Physical Performance Battery Score (3 RCTs, 258 participants, mean difference [MD] 3.01 points; 95% CI 1.37 to 4.66), compared with non-rehabilitation interventions. There was very low- to moderate-certainty evidence that physical rehabilitation demonstrated no change in the 30-Second Sit to Stand Test (2 RCTs, 293 participants, MD 0.79 repetitions; 95% CI -0.45 to 2.03), 6-Minute Walk Test (4 RCTs, 363 participants, MD 17.32 meters; 95% CI -29.41 to 64.05), Timed Walk Test (4 RCTs, 400 participants, MD 0.10 meters/seconds; 95% CI -0.02 to 0.22), Timed Up and Go Test (3 RCTs, 275 participants, MD -2.89 seconds; 95% CI -6.62 to 0.84), or quality of life (4 RCTs, 419 participants, SMD 0.20; 95% CI -0.08 to 0.47).
CONCLUSIONS: This
review demonstrates that physical rehabilitation may improve activities of daily living for LTC residents living with dementia, although the evidence is of low certainty. The effect of physical rehabilitation on specific functional tasks, such as gait speed and quality of life, are less clear. Future research should examine the effects of individualized, progressive interventions on outcome measures that reflect the capacity and preferences of LTC residents with more advanced dementia.
BACKGROUND: PROSPERO CRD42022308444.