膝關節置換術後病人接受連續被動運動對膝關節的活動功能效益The effectiveness of continuous passive motion after total knee replacement

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2019-05-02 已刊登
新刊登 綜 整 預防/治療/介入類型

作  者

李美滿 高淑華* 黃慈心 謝素英 陳淑賢

實證知識類別

A 類:實證健康照護綜整

PICO

治療/預防性問題

治療/介入措施

一般外科醫學 General Surgery

科別

  • 進階實務 Advanced Practice
  • 老化 Ageing
  • 整形/重建外科護理 Plastic / Reconstructive Surgery Nursing

中文關鍵詞

膝關節置換術、連續被動性運動、膝屈曲

英文關鍵詞

Total Knee Replacement Arthroplasty Continuous Passive Motion Range of Motion knee flexion

機構名稱

長庚醫療財團法人桃園長庚紀念醫院

申請單位

護理部教研組

中文摘要

形成臨床提問:
身體的老化過程,無法生產足夠的蛋白多糖和成膠質來維持健康的軟骨結構,老化的關節愈來愈沒有彈性,關節軟骨的磨損便不能避免,退化性關節炎症狀嚴重,影響日常生活,醫師會建議病人接受膝關節置換術以改善、緩解疼痛與僵硬情形。膝關節置換術術後會讓病人接受連續被動性運動(Continuous Passive Motion, CPM),主要是為促進膝關節置換術術後膝屈曲(Range of Motion, ROM)功能,對於行走 ,轉位等行動任務非常重要,以進行日常生活活動;但是沒有足夠的資訊或證據可以衛教病人或作為照顧常規依據。
文獻搜尋的方法與分析:
本文確立臨床問題,根據PICO的關鍵字、同義字,以布林邏輯「OR」、「AND」串聯關鍵字及同義字搜尋,包括The Cochrane Library、PubMed、Embase資料庫,不設限年份與語言,得到英文文獻共89篇(如圖一),以人工方式進行閱讀主題和摘要,將涉及全膝關節置換術、連續被動運動、活動範圍的文章納入,最後以證據等級較高的1篇Systematic Reviews(2014)與2篇RCT(2014, 2015)文獻進行評讀。
文獻的品質評讀:
列入評讀的3篇文獻中,Systematic Reviews(2014)依據CASP與英國Oxford研究證據應用等級分類來評價證據等級為Level 1(治療型);以及2篇RCT採用Cochrane (2016) RoB 2.0評讀文獻品質為some concerns。研究對象皆為接受膝關節置換術且大於18歲,介入措施是膝關節術後病人每天接受連續被動運動2~6小時與物理治療2 小時;控制組接受常規物理治療2~3小時。測量膝曲範圍,採實驗前、後測方法評估膝曲範圍之改善成效;3篇文獻分別在統計學上無統計意義,沒有臨床效果。
結論與建議:
經本篇實證報告的高品質證據,實驗組與控制組間,CPM對於ROM與 Hospital Length of Stay並無臨床效果。第二篇研究發現無臨床效果後,該機構即中止常規使用CPM。未來有待更多嚴謹的隨機試驗,控制隨機分配與隱匿偏差,提供臨床參考。

英文摘要

Ask an answerable question (PICO):
The symptoms of degenerative arthritis are serious, affecting daily life. Patients are advised to undergo knee replacement to improve and relieve pain and stiffness. After knee arthroplasty, patients will receive Continuous Passive Motion (CPM), but there is not enough information or evidence to teach the patient or to take care of the routine.
The Method and Analysis of Literature Review:
Databases included The Cochrane Library, PubMed, and Embase and are not limited to year and language. A total of 89 articles in English were obtained. Finally, a systematic review with a higher level of evidence was included and RCT literatures were reviewed.
Critical Appraisal:
Systematic reviews evaluated the evidence level as level 1 based on the CASP and RCTs using Cochrane RoB 2.0. The quality of the document has some concerns. All subjects underwent knee arthroplasty and were older than 18 years old. The patients received continuous passive exercise for 2 to 6 hours and physical therapy (PT) for 2 hours per day after surgery; the control group received routine PT for 2 to 3 hours.
Conclusions and Recommendations:
CPM has no clinical effect on range of motion and hospital length of stay between the experimental group and the control group. In the future, more rigorous randomized trials are needed to control random assignment and concealment bias for providing clinical reference.