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A systematic review of Clinical Practice Guidelines for persons with amputation. Identification of best evidence for rehabilitation to develop the WHO's Package of Interventions for Rehabilitation
Archives of Physical Medicine and Rehabilitation ( IF 3.6 ) Pub Date : 2021-01-01 , DOI: 10.1016/j.apmr.2020.11.019
Arne Heyns 1 , Sofie Jacobs 1 , Stefano Negrini 2 , Michele Patrini 3 , Alexandra Rauch 4 , Carlotte Kiekens 5
Affiliation  

OBJECTIVE To report the results of the systematic search performed to identify interventions and related evidence for rehabilitation of individuals with amputation based on the current evidence from Clinical Practice Guidelines (CPGs). DATA SOURCES Pubmed, Pedro, CINAHL, Embase, Google Scholar, and multiple guideline databases (date restriction 2008-2018). STUDY SELECTION Exclusion criteria were 'no CPG', 'not reporting on rehabilitation', 'published before 2008', 'developed for health conditions other than amputation', 'presence of conflict of interest (financial or non-financial)', 'lack of information on the strength of the recommendation' ,and 'lack of quality' assessed by the "Appraisal of Guidelines for Research and Evaluation". DATA EXTRACTION Data extraction using a standardized form, which comprised information on the recommendation, the strength of recommendation and the quality of the evidence used to inform the recommendation. DATA SYNTHESIS We included 4 guidelines, providing a total of 217 recommendations: 20 on assessments, 131 on interventions and 66 on service provision. Most recommendations concern pain management, education, pre- and postoperative management, and residual limb care. The strength of recommendation is generally weak to intermediate. The level of evidence mostly compromises expert opinions with only 6.9% (15/217) being provided by RCT's, systematic reviews or meta-analyses. CONCLUSIONS The field of amputation is well covered for recommended interventions, but the level of evidence is generally low and mostly based on expert opinion. Some important domains are not covered (e.g. vocation and education, sexual and/or intimate relationships, activities of daily living or leisure activities, education concerning socket/liner fitting, …). There is also a lack of description of training/rehabilitation programs contents. This should be taken into account for the development of future guidelines.

中文翻译:

截肢患者临床实践指南的系统评价。确定康复的最佳证据,以制定世卫组织的康复干预一揽子计划

目的 报告根据临床实践指南 (CPG) 的当前证据,为确定截肢患者康复干预措施和相关证据而进行的系统搜索的结果。数据来源 Pubmed、Pedro、CINAHL、Embase、Google Scholar 和多个指南数据库(日期限制 2008-2018)。研究选择 排除标准是“无 CPG”、“未报告康复”、“2008 年之前发表”、“针对截肢以外的健康状况开发”、“存在利益冲突(财务或非财务)”、“缺乏关于推荐强度的信息”,以及“研究和评估指南的评估”评估的“质量不足”。数据提取 使用标准化形式的数据提取,其中包括关于推荐、推荐强度和用于告知推荐的证据质量的信息。数据综合 我们纳入了 4 条指南,共提供 217 条建议:20 条关于评估,131 条关于干预,66 条关于服务提供。大多数建议涉及疼痛管理、教育、术前和术后管理以及残肢护理。推荐强度一般为弱到中等。证据水平大多与专家意见不符,只有 6.9% (15/217) 来自 RCT、系统评价或荟萃分析。结论 建议的干预措施很好地涵盖了截肢领域,但证据水平普遍较低,且主要基于专家意见。一些重要的领域没有包括在内(例如职业和教育、性和/或亲密关系、日常生活或休闲活动、有关插座/衬垫安装的教育,……)。也缺乏对培训/康复计划内容的描述。在制定未来指南时应考虑到这一点。
更新日期:2021-01-01
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