背景:测量治疗负担对于有效管理2型糖尿病(T2DM)护理很重要。本系统评价的目的是根据现有证据确定测量T2DM患者治疗负担的最可靠方法。
方法:检索了来自七个数据库的文章。定性,定量,纳入了研究2型糖尿病成人治疗负担和/或报告相关经验的混合方法研究。采用了融合的隔离方法,并采用了系统综述的混合方法设计,在叙述性审查中创建一个衡量框架,以实现一致的批判性评估。使用JoannaBriggs研究所工具评估纳入研究的质量。使用基于共识的健康测量仪器选择标准(COSMIN)清单评估仪器的测量特性。
结果:共筛选了21,584条记录,包括26篇文章,包括11个定量的,11定性,和4个混合方法研究。从所包含的文章中提取的定性数据的主题分析总结了一个包含七个核心和六个相关度量的度量框架。核心测量,包括金融,药物,行政,生活方式,healthcare,时间/旅行,和医疗信息负担,直接反映与T2DM治疗负担相关的结构。相比之下,相关的测量主题不能直接反映负担,也没有被当前的证据证实。COSMIN清单评估的结果表明,患者的治疗和自我管理体验(PETS),治疗负担问卷(TBQ),和多浊度治疗负担问卷(MTBQ)具有稳健的仪器开发过程。这三种乐器,在COSMIN评估中,涵盖的主题数量和“正面”评级相结合的总计数最高,处于最高的三元分层,证明了测量T2DM治疗负担的优越适用性。
结论:本系统评价为目前衡量T2DM患者治疗负担的较好选择提供了证据。报告还显示,目前大多数研究是在资源充足的机构中进行的,可能忽略资源不足设置中的可变性。
BACKGROUND: Measuring treatment burden is important for the effective management of Type 2 Diabetes Mellitus (T2DM) care. The purpose of this systematic
review was to identify the most robust approach for measuring treatment burden in people with T2DM based on existing evidence.
METHODS: Articles from seven databases were retrieved. Qualitative, quantitative, and mixed-methods studies examining treatment burden in adults with T2DM and/or reporting relevant experiences were included. A convergent segregated approach with a mixed-methods design of systematic
review was employed, creating a measurement framework in a narrative
review for consistent critical appraisal. The quality of included studies was assessed using the Joanna Briggs Institute tool. The measurement properties of the instruments were evaluated using the Consensus based Standards for selection of Health Measurement Instruments (COSMIN) checklist.
RESULTS: A total of 21,584 records were screened, and 26 articles were included, comprising 11 quantitative, 11 qualitative, and 4 mixed-methods studies. A thematic analysis of qualitative data extracted from the included articles summarised a measurement framework encompassing seven core and six associated measurements. The core measurements, including financial, medication, administrative, lifestyle, healthcare, time/travel, and medical information burdens, directly reflect the constructs pertinent to the treatment burden of T2DM. In contrast, the associated measurement themes do not directly reflect the burdens or are less substantiated by current evidence. The results of the COSMIN checklist evaluation demonstrated that the Patient Experience with Treatment and Self-management (PETS), Treatment Burden Questionnaire (TBQ), and Multimorbidity Treatment Burden Questionnaire (MTBQ) have robust instrument development processes. These three instruments, with the highest total counts combining the number of themes covered and \"positive\" ratings in COSMIN evaluation, were in the top tertile stratification, demonstrating superior applicability for measuring T2DM treatment burden.
CONCLUSIONS: This systematic
review provides evidence for the currently superior option of measuring treatment burden in people with T2DM. It also revealed that most current research was conducted in well-resourced institutions, potentially overlooking variability in under-resourced settings.