英文读书报告-腕管综合征护理PPT课件.pptx

腕管松解后的康复 Cochrane评价摘要 Rehabilitationfollowingcarpaltunnelrelease ACochranereviewsummary 2020 3 20 1 Content 01 CTS概念 WhatisCTS 02 Literatureinterpretation 文献解读 03 Personalexperience 个人体会 目录 2020 3 20 2 WhatisCTS CTS概念 CTS ItistheabbreviationofCarpalTunnelSyndrome CTSisaconditioninwhichanervethatrunsthroughabonyand broustunnelinthewristiscompressed Thisleadstopain numbnessandtinglinginthehand sometimesextendingintotheforearm CTS是CarpalTunnelSyndrome的缩写 腕管综合症 CTS 是一种通过手腕骨和纤维隧道的神经被压缩的病症 这会导致手部疼痛 麻木和刺痛 有时会延伸到前臂 2020 3 20 3 WhatisCTS CTS概念 Themediannerveofthehumanbody aswellasthebloodvesselsenteringthehand arecompressedatthecarpaltunnelduetoincorrecthandposture PainandnumbnessofnessNervousarea Mediannervecompression Carpalbone CTSPathogenesis Carpaltunnel Transversecarpalligament 2020 3 20 4 WhatisCTS CTS概念 Isyourwristposturecorrectwhenyouwork Rightposture Wrongposture 2020 3 20 5 WhatisCTS CTS概念 Rehabilitationtraining Wristmotionexercises Wristflexionexercises Wriststretchingexercises Flexortendonslidingpractice 2020 3 20 6 05 06 Conclusions结论 Implicationsforpractice练习的意义 01 02 03 Background背景 Objective目的 Methods方法 04 Results结果 Literatureinterpretation文献解读 2020 3 20 7 Background背景 Literatureinterpretation文献解读 CTSisthemostcommoncompressiveneuropathya ectingtheupperextremityandisanimportantcauseoflostworkplacepro ductivity IntheUnitedStatesofAmerica theprevalenceofCTSisestimatedtobe0 7 10 000workers CTS是最常见的压迫性神经病变 影响上肢 是导致工作场所生产力下降的重要原因 在美利坚合众国 CTS的患病率估计为0 7 10 000工人 Surgerymaybeindicatedforindividualswithpersistentsymptomsthathaveandthosepresentingwithmoreseveresymptoms IntheUnitedStatesofAmerica approximately40 ofpatientswithCTSaretreatedoperatively 对于具有持续症状且具有更严重症状的个体 可以进行手术 在美利坚合众国 大约40 的CTS患者接受手术治疗 2020 3 20 8 Objective目的 Literatureinterpretation文献解读 Toreviewthee ectivenessandsafetyofrehabilitationinterventionsfollowingCTSsurgerycomparedwithnotreatment placebo oranotherintervention 与无治疗 安慰剂或其他干预相比 检查CTS手术后康复干预的有效性和安全性 2020 3 20 9 Methods方法 Literatureinterpretation文献解读 Thisreviewwasanupdateofareview rstpublishedin2013 Petersetal 2013 TheauthorssearchedTheCochraneNeuromus cularSpecialisedRegister theCochraneRegisterofControlledTrials CENTRAL MEDLINE EMBASE CINAHLPlus AMED LILACS andPsycINFOthroughtoSeptember2015andPEDroandclinicaltrialsregistersthroughtoDecember2015 Selectioncriteriawererando misedorquasi randomisedclinicaltrialsthatcomparedanypost operativerehabilitationinterventionwitheithernointervention pla cebo oranotherpostoperativerehabilitationinterventioninindividualswhohadundergoneCTSsurgery Tworeviewauthorsin dependentlyselectedtrialsforinclusion extracteddata assessedriskofbias andassessedthequalityofthebodyofevidenceforprimaryoutcomesusingtheGRADE GradesofRecommendation Assessment DevelopmentandEvaluation approachaccordingtostandardCo chranemethodology 该评论是2013年首次发布的评论的更新 Peters等 2013 作者搜索了Cochrane神经肌肉专科登记册 Cochrane对照试验登记册 CENTRAL MEDLINE EMBASE CINAHLPlus AMED LILACS和PsycINFO至2015年9月 PEDro和临床试验注册至2015年12月 选择标准为临床或半随机临床试验 比较任何术后康复干预与无干预 安慰或其他术后康复干预接受过CTS手术的人 两位评价作者独立选择纳入试验 提取数据 评估偏倚风险 并根据标准Co使用GRADE 推荐 评估 开发和评估等级 方法评估主要结果的证据体质量 chrane方法 2020 3 20 10 Results结果 Literatureinterpretation文献解读 Thereviewincluded22trialswithatotalof1521participants Ofthese threetrialsprovidedsu cientoutcomedataforinclusioninthereview该评价包括22项试验 共有1521名参与者 其中 三项试验提供了足够的结果数据 以便纳入评价Onesmallhigh qualitytrial Powell 2003 studiedadesensitisationprogrammecomparedwithstandardtreatmentandrevealednostatisticallysigni cantfunctionalbene tbasedontheBostonCarpalTunnelQuestionnaire BCTQ meandi erence MD 0 03 95 con denceinterval CI 0 39to0 33 一项小型高质量试验 Powell 2003 研究了与标准治疗相比的脱敏计划 并且根据波士顿腕管隧道问卷 BCTQ 显示无统计学显著的功能性益处 平均差异 MD 0 03 95 置信区间 CI 0 39至0 33 Onelow qualitytrialparticipantssixmonthspost surgeryusingtheDisabilitiesoftheArm ShoulderandHand DASH questionnaireandfoundnosigni cantdi erencebetweenanoformaltherapygroupandagroupgivenatwo weekcourseofmulti modaltherapycommencedat vetosevendayspost surgery MD1 00 95 CI 4 44to6 44 一项低质量的试验 Pomerance和Fine 2007 使用手臂 肩膀和手的残疾 DASH 调查问卷评估了手术后6个月的参与者 发现没有正式治疗组和给予两个治疗组的组之间没有显着差异 2020 3 20 11 Conclusions结论 Literatureinterpretation文献解读 Thereviewfoundlimitedevidenceofbene tfromrehabilitationinthereviewedinterventions Thetrialsincludedinthisreviewwereheterogeneousintermsoftreatmentsprovided durationofinterventions thenatureandtimingofoutcomesmeasured andsettingandthereforetheauthorscouldnotpoolresultsacrosstrials Itisimportantforresearcherstoidentifypatientswhorespondtoaparticulartreat mentandthosewhodonot andtoundertakehigh qualitystudiesthatevaluatetheseverityofiatrogenicsymptomsfromsurgery measurefunctionandreturn to workrates andcontrolforconfoundingvariables 该审查发现 在审查的干预措施中 康复带来的好处有限 本评价纳入的试验在提供的治疗 干预持续时间 测量结果的性质和时间以及设置方面存在差异 因此作者无法在试验中汇总结果 对于研究人员来说 确定对特定治疗有反应的患者和那些不对其进行治疗的患者 并进行高质量的研究 从手术 测量功能和恢复工作率评估医源性症状的严重程度 以及控制混杂的变量 2020 3 20 12 Implicationsforpractice练习的意义 Literatureinterpretation文献解读 Nursescanplayanimportantroleininformingpeople preferablypre operatively ontheevidenceofe ectivenessofpostoperativere habilitationinterventions Untilresearchersgeneratehigherqualityresultsonthee ectivenessandsafetyofvariousrehabilitationtreat ments thedecisiontoproviderehabilitationfollowingCTSsurgeryneedstobebasedontheclinician sexpertise thepatient spreferencesandthecontextoftherehabilitationenvironment Thegoalofex peditingrecoverybyimprovingmobility strengtheningthehandandpromotingearlierreturntofunctionandworkisparamountforall 护士可以在告知人们 最好在手术前 对术后康复干预措施的有效性证据方面发挥重要作用 在研究人员对各种康复治疗的有效性和安全性产生更高质量的结果之前 在CTS手术后提供康复的决定需要基于临床医生的专业知识 患者的偏好和康复环境的背景 通过改善流动性 加强手部和促进早期恢复功能和工作来实现恢复的目标对所有人来说都是至关重要的 2020 3 20 13 Implicationsforpractice练习的意义 Literatureinterpretation文献解读 Nursescanplayanimportantroleininformingpeoplepost surgeryofthekeyissuestoassessfor suchaspostoperativeswelling scarde sensitisation pillarpainanddelayedwoundhealingandwhentoseekhelptohelpmanagethese Postoperativerehabilitationmightincludeinterventionssuchasmobilisationtechniques splintingofthewristwithanorthosis woundandscarmanagement oedemamanagement ergonomicmodi cation strengtheningandworkmodi cation Whilsttheevidenceofthee ectivenessofspeci crehabilitationapproachesisnotrobust thestrongestprognosticfactorforearlyreturntofunctionandworkiscompliancewithhandtherapy Nathanetal 1993