脊髓狭窄患者的康复效果指标:文献综述

Gianluca Ciardi, G. Lamberti, Vittorio Casati, Elena Paris
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引用次数: 0

摘要

背景:腰椎管狭窄症在日常生活中引起相当大的残疾;由于世界人口老龄化,其发病率正在增加。一线治疗一般保守,但康复效果尚不明确;本系统综述的目的是确定腰椎管狭窄物理治疗方法需要评估哪些领域,进一步说明文献是否建议以患者为中心或客观测量。方法:根据PRISMA声明对相关文献进行系统综述;PICO模型用于绘制研究问题。近5年进行的腰椎管狭窄康复的随机对照试验被认为是可纳入的,在狭窄的位置方面没有差异。通过特定的搜索字符串筛选以下数据库:PubMed、EBSCO、PEDro、Cochrane Database、Scopus和谷歌Scholar;两名独立研究人员对结果进行评估,并请第三方意见来解决冲突。通过Pedro Jadad评分对纳入的研究进行批判性评估。提取以下数据:作者和年份、国家、样本、干预措施、结果域和工具。结果:10069例记录中,3例rct进入最终评审阶段;他们都表现出很高的方法论质量。对于处理腰椎管狭窄的物理治疗师,建议评估五个主要领域:残疾,疼痛,临床测试,心理健康和脊椎恐惧症,以及生活质量。领域主要通过自我报告的问卷/量表进行评估,而客观测试评估一般下肢运动,活动范围或肌肉的耐力。结论:该五域评价模型是可靠的,可在各个康复环境(家庭、门诊和医院)实施;自我报告工具的普遍使用保证了可持续性。未来的研究应该评估每个领域的最佳问卷/量表,特别是腰椎管狭窄患者疼痛评估的金标准的定义,因为这是未来的挑战。
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Rehabilitation Outcome Measures in Patients with Spinal Stenosis: A Literary Review
Background: Lumbar spinal stenosis causes considerable disability in everyday life; its incidence is increasing due to aging in the world population. First-line treatment is generally conservative, but rehabilitation outcome is still unclear; the aim of this systematic review was to define which domains need to be evaluated for the lumbar stenosis physiotherapy approach, further specifying if the literature suggests patient-centred or objective measures. Methods: A systematic review of the literature according to the PRISMA statement was carried out; the PICO model was used to draw research questions. RCTs about the rehabilitation of lumbar spinal stenosis conducted in the last five years were considered includible, with no difference in terms of stenosis location. The following databases were screened through specific search strings: PubMed, EBSCO, PEDro, Cochrane Database, Scopus, and Google Scholar; two independent researchers assessed results and a third opinion was requested to solve conflicts. Critical appraisal of the included studies was conducted through Pedro Jadad scores. The following data were extracted: author and year, country, sample, intervention, outcome domains, and tools. Results: From 10,069 records, three RCTs were included in the final review stage; they all showed high methodological quality. It is recommended for physiotherapists dealing with lumbar spinal stenosis to assess five main domains: disability, pain, clinical tests, mental wellbeing and kynesiophobia, and quality of life. Domains were mainly assessed through self-reported questionnaires/scales, while objective tests evaluate general lower limb movements, the active range of motion, or the muscles’ endurance. Conclusion: This five-domain evaluation model is reliable and can be practised in each rehabilitation setting (home, outpatient, and hospital); sustainability is guaranteed by the prevalent employment of self-reported tools. Future studies should evaluate the best questionnaire/scale for each domain, especially the definition of a gold standard for pain assessment in patients with lumbar stenosis as this is a challenge for the future.
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