对中风后感知障碍患者的干预:PIONEER 范围综述、Cochrane 系统综述和优先事项设定项目。

IF 3.5 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Christine Hazelton, Alex Todhunter-Brown, Pauline Campbell, Katie Thomson, Donald J Nicolson, Kris McGill, Charlie Sy Chung, Liam Dorris, David C Gillespie, Susan M Hunter, Linda J Williams, Marian C Brady
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引用次数: 0

摘要

背景:中风通常会影响我们对感官信息的识别和解读,从而导致知觉障碍。为治疗提供依据的证据尚不明确:确定中风相关知觉障碍干预措施的广度和有效性,并确定优先研究的问题:方法:我们进行了范围综述,然后进行了 Cochrane 系统综述。我们与中风后感知障碍患者和医护人员共同制定了定义、结果优先级、数据解释和研究优先级。我们系统地检索了电子数据库(包括 MEDLINE、EMBASE,从开始到 2021 年 8 月)和灰色文献。我们纳入了针对中风后听觉、嗅觉、躯体感觉、味觉、触觉或视觉感知障碍患者的干预研究(任何设计)。摘要和全文均经过独立的双重审阅。对数据进行制表、综合叙述,并按可用性、感官和干预措施进行映射。未对研究质量进行评估。我们的 Cochrane 综述综合了随机对照试验数据,评估了偏倚风险(包括随机化、盲法、报告),并使用 RevMan 5.4 对干预比较(与对照组或无治疗)进行了元分析。我们使用建议、评估、发展和评价分级来判断证据的确定性。治疗后的日常生活活动是我们的主要结果。我们还提取了扩展的日常生活活动、生活质量、精神健康和心理健康、感知功能和不良事件数据:我们纳入了 80 项研究(n = 893):病例研究(36/80)和随机对照试验(22/80)。没有中风幸存者或家庭利益相关者参与的报告。研究涉及视觉(42.5%,34/80)、躯体感觉(35%,28/80)、听觉(8.7%,7/80)和触觉(7.5%,6/80)知觉障碍;一些研究侧重于 "混合知觉障碍"(6.2%,5/80,如味觉-嗅觉障碍)。我们确定了 93 项药物、非侵入性脑部刺激或康复(恢复、替代、补偿或混合)干预措施。详细内容有限。研究通常测量知觉(75%,60/80)、运动-感觉运动(40%,32/80)、日常生活活动(22.5%,18/80)或感觉功能(15%,12/80)的结果:我们纳入了 18 项随机对照试验(n = 541),涉及触觉(3 项随机对照试验;n = 70)、体感(7 项随机对照试验;n = 196)、视觉(7 项随机对照试验;n = 225)和触觉-体感混合(1 项随机对照试验;n = 50)障碍。没有一项试验涉及听觉、味觉或嗅觉障碍。有一项非侵入性脑部刺激、一项补偿、25 项恢复和 4 项混合干预进行了介绍。随机序列生成(13/18)、自然减员(14/18)和结果报告(16/18)的偏倚风险较低。感知是最常测量的结果(11 项随机对照试验);只有 7 项随机对照试验测量了日常生活活动。有限的数据提供的证据不足以确定任何干预措施的有效性。证据的可信度很低。我们的临床(4 人)和生活经验(5 人)专家在整个项目中做出了贡献,共同制定了一份临床影响和研究重点清单。研究重点包括探索中风后知觉障碍的影响、评估和干预措施:局限性:由于确定的研究数量少,样本量小,单人参与的研究比例高,因此研究结果受到限制。对所评估的知觉障碍和干预措施的描述有限。很少有研究测量了与功能影响有关的结果。对听觉、嗅觉、味觉和触觉障碍的调查有限:今后的工作:研究注册:研究注册:本研究注册为 PROSPERO CRD42019160270:该奖项由美国国家健康与护理研究所(NIHR)健康技术评估项目资助(NIHR奖项编号:NIHR128829),全文发表于《健康技术评估》第28卷第69期。如需了解更多奖项信息,请参阅英国国家健康与护理研究所资助与奖项网站。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Interventions for people with perceptual disorders after stroke: the PIONEER scoping review, Cochrane systematic review and priority setting project.

Background: Stroke often affects recognition and interpretation of information from our senses, resulting in perceptual disorders. Evidence to inform treatment is unclear.

Objective: To determine the breadth and effectiveness of interventions for stroke-related perceptual disorders and identify priority research questions.

Methods: We undertook a scoping review and then Cochrane systematic review. Definitions, outcome prioritisation, data interpretation and research prioritisation were coproduced with people who had perceptual disorders post stroke and healthcare professionals. We systematically searched electronic databases (including MEDLINE, EMBASE, inception to August 2021) and grey literature. We included studies (any design) of interventions for people with hearing, smell, somatosensation, taste, touch or visual perception disorders following stroke. Abstracts and full texts were independently dual reviewed. Data were tabulated, synthesised narratively and mapped by availability, sense and interventions. Research quality was not evaluated. Our Cochrane review synthesised the randomised controlled trial data, evaluated risk of bias (including randomisation, blinding, reporting) and meta-analysed intervention comparisons (vs. controls or no treatment) using RevMan 5.4. We judged certainty of evidence using grading of recommendations, assessment, development and evaluation. Activities of daily living after treatment was our primary outcome. Extended activities of daily living, quality of life, mental health and psychological well-being perceptual functional and adverse event data were also extracted.

Results: We included 80 studies (n = 893): case studies (36/80) and randomised controlled trials (22/80). No stroke survivor or family stakeholder involvement was reported. Studies addressed visual (42.5%, 34/80), somatosensation (35%, 28/80), auditory (8.7%, 7/80) and tactile (7.5%, 6/80) perceptual disorders; some studies focused on 'mixed perceptual disorders' (6.2%, 5/80 such as taste-smell disorders). We identified 93 pharmacological, non-invasive brain stimulation or rehabilitation (restitution, substitution, compensation or mixed) interventions. Details were limited. Studies commonly measured perceptual (75%, 60/80), motor-sensorimotor (40%, 32/80) activities of daily living (22.5%, 18/80) or sensory function (15%, 12/80) outcomes.

Cochrane systematic review: We included 18 randomised controlled trials (n = 541) addressing tactile (3 randomised controlled trials; n = 70), somatosensory (7 randomised controlled trials; n = 196), visual (7 randomised controlled trials; n = 225) and mixed tactile-somatosensory (1 randomised controlled trial; n = 50) disorders. None addressed hearing, taste or smell disorders. One non-invasive brain stimulation, one compensation, 25 restitution and 4 mixed interventions were described. Risk of bias was low for random sequence generation (13/18), attrition (14/18) and outcome reporting (16/18). Perception was the most commonly measured outcome (11 randomised controlled trials); only 7 randomised controlled trials measured activities of daily living. Limited data provided insufficient evidence to determine the effectiveness of any intervention. Confidence in the evidence was low-very low. Our clinical (n = 4) and lived experience (n = 5) experts contributed throughout the project, coproducing a list of clinical implications and research priorities. Top research priorities included exploring the impact of, assessment of, and interventions for post-stroke perceptual disorders.

Limitations: Results are limited by the small number of studies identified and the small sample sizes, with a high proportion of single-participant studies. There was limited description of the perceptual disorders and intervention(s) evaluated. Few studies measured outcomes relating to functional impacts. There was limited investigation of hearing, smell, taste and touch perception disorders.

Conclusion: Evidence informing interventions for perceptual disorders after stroke is limited for all senses.

Future work: Further research, including high-quality randomised controlled trials, to inform clinical practice are required.

Study registration: This study is registered as PROSPERO CRD42019160270.

Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128829) and is published in full in Health Technology Assessment; Vol. 28, No. 69. See the NIHR Funding and Awards Website for further award information.

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来源期刊
Health technology assessment
Health technology assessment 医学-卫生保健
CiteScore
6.90
自引率
0.00%
发文量
94
审稿时长
>12 weeks
期刊介绍: Health Technology Assessment (HTA) publishes research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS.
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