目的:本系统综述总结了实践指南中治疗和管理膝关节骨性关节炎(OA)的康复建议,并使用研究和评估指南(AGREE)II工具评估其适用性和质量。
方法:PubMed,Cochrane图书馆,EMBASE,CINAHL,PEDro,指南中心,指南国际网络和医疗保健研究与质量机构(AHRQ)用于搜索2008年1月1日至2022年5月31日发表的相关研究。
方法:AGREEII用于评估纳入的指南质量,采用SPSS25.0统计软件进行数据分析,并计算组内相关系数值,以验证评估者之间的一致性。使用双向随机效应模型计算一致性得分,并计算每个域名的总分。此外,计算领域和总分的中位数和四分位数范围.
结果:包括24个推荐膝关节OA康复的指南。评估者之间的一致性评估范围为0.62至0.90。指南的总体和康复部分得分最高和最低的领域是范围和目的(领域1)和适用性(领域5),分别。强烈推荐的康复意见包括有氧运动计划(21/24),体重控制(16/24),自我教育和管理(16/24),步态/助行器(7/24),太极拳(6/24)。然而,骨科鞋垫和冷热治疗的作用仍然存在争议。
结论:膝关节OA康复的临床实践指南总体质量良好;然而,适用性稍差。因此,我们应该改善促进因素和阻碍因素,指南应用建议,工具,和资源时制定相关准则。
OBJECTIVE: This systematic review summarized the rehabilitation recommendations for treating and managing knee osteoarthritis (OA) in practice guidelines and evaluated their applicability and quality using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument.
METHODS: PubMed, the Cochrane Library, EMBASE, CINAHL, PEDro,
Guideline central,
Guideline International Network and Agency for Healthcare Research and Quality (AHRQ) were used to search for relevant studies published between 1 January 2008 and 31 May 2022.
METHODS: AGREE II was used to evaluate the included guidelines quality, SPSS 25.0 statistical software was used for data analysis, and the intra-group correlation coefficient value was calculated to verify the consistency between the raters. The two-way random effects model was used to calculate concordance scores, and each domain\'s total scores were calculated. Additionally, the median and interquartile range for domain and total scores were calculated.
RESULTS: Twenty-four
guidelines recommending knee OA rehabilitation were included. Inter-rater consistency evaluation ranged from 0.62 to 0.90. The domains where the
guideline\'s overall and rehabilitation parts scored highest and lowest were scope and purpose (domain 1) and applicability (domain 5), respectively. The highly recommended rehabilitation opinions included aerobic exercise programs (21/24), weight control (16/24), self-education and management (16/24), gait/walking aids (7/24), and tai chi (6/24). However, the orthopedic insole and hot/cold therapy roles remain controversial.
CONCLUSIONS: The clinical practice guidelines\' overall quality for knee OA rehabilitation is good; however, the applicability is slightly poor. Therefore, we should improve the promoting factors and hindering factors,
guideline application recommendations, tools, and resources when developing relevant
guidelines.