非药物护理干预对痴呆行为和心理症状的比较：系统回顾和网络荟萃分析

IF 7.1 1区医学 Q1 NURSING

International Journal of Nursing Studies Pub Date : 2025-07-02 DOI:10.1016/j.ijnurstu.2025.105153

Xiangfei Meng , Jiao Sun , Zhen Du , Wenxia Wang , Dan Sun , Yi Chen , Shengze Zhi , Sheng Wang

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引用次数: 0

摘要

非药物护理干预对于减少痴呆症的行为和心理症状是有价值的，但最有效的非药物干预类型尚不清楚。目的本研究旨在比较不同护理干预对痴呆行为和心理症状的影响以及护理者对这些症状的反应。方法系统检索PubMed、Embase、Cochrane图书馆、chinese Nursing and Allied Health Literature Cumulative Index （CINAHL）和PsycINFO数据库，检索时间为数据库建立至2023年10月18日。通过修订后的Cochrane随机试验偏倚风险评估工具（RoB 2）评估偏倚风险，通过网络meta分析的置信度评估证据的可信度。在频率学框架内进行随机效应网络元分析。主要结局是痴呆症的行为和心理症状，以及照顾者与痴呆症的行为和心理症状相关的反应。结果共纳入71项随机对照试验，共8336对，护理干预12项。对于痴呆症的行为和心理症状，多组分干预在干预后导致有效改善(SMD = - 0.30；95% CI,−0.47 ~−0.12；P = 0.001)和随访时(SMD = - 0.61；95% CI,−1.05 ~−0.18；p = 0.006)。对于与痴呆症行为和心理症状相关的照顾者反应，多组分干预(SMD = - 0.37；95% CI,−0.58 ~−0.16；P = 0.001)，技能培养(SMD = - 0.26；95% CI,−0.42 ~−0.10；P = 0.001)，认知行为疗法(SMD = - 0.22；95% CI,−0.41 ~−0.03；P = 0.023)，教育程度(SMD = - 0.20；95% CI,−0.35 ~−0.04；P = 0.017)导致干预后的有效改善。SUCRA分析显示，多组分干预措施在减少痴呆症的行为和心理症状（SUCRA, 83.4%）和改善护理者对这些症状的反应（SUCRA, 90.9%）方面排名最高。元回归和亚组分析显示，协变量“大陆”、“平均年龄”和“持续时间”影响多成分干预的效应量。结论多组分干预是减少痴呆行为和心理症状以及护理者对这些症状的反应的最佳干预措施，并产生持续的治疗效果。该系统评价和荟萃分析已在PROSPERO注册（CRD42024544701）。

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Comparisons of nonpharmacological caregiver interventions for behavioural and psychological symptoms of dementia: A systematic review and network meta-analysis

Background

Nonpharmacological caregiver interventions are valuable for reducing the behavioural and psychological symptoms of dementia, but the most effective type of nonpharmacological intervention remains unknown.

Objective

The present study aimed to compare different caregiver interventions for behavioural and psychological symptoms of dementia and caregiver reactions to these symptoms.

Methods

We systematically searched PubMed, Embase, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO from database inception to October 18, 2023. The risk of bias was assessed via the Revised Cochrane risk-of-bias assessment tool for randomised trials (RoB 2), and the credibility of evidence was assessed via Confidence in Network Meta-Analysis. Random-effects network meta-analysis within a frequentist framework was performed. The primary outcomes were behavioural and psychological symptoms of dementia, and caregiver reactions related to behavioural and psychological symptoms of dementia.

Results

Seventy-one randomised controlled trials involving 8336 dyads and 12 caregiver interventions were included. For behavioural and psychological symptoms of dementia, multicomponent interventions resulted in effective improvements at postintervention (SMD = − 0.30; 95 % CI, − 0.47 to − 0.12; P = 0.001) and on follow-up (SMD = − 0.61; 95 % CI, − 1.05 to − 0.18; P = 0.006). For caregiver reactions related to behavioural and psychological symptoms of dementia, multicomponent interventions (SMD = − 0.37; 95 % CI, − 0.58 to − 0.16; P = 0.001), skills building (SMD = − 0.26; 95 % CI, − 0.42 to − 0.10; P = 0.001), cognitive behavioural therapy (SMD = − 0.22; 95 % CI, − 0.41 to − 0.03; P = 0.023), and education (SMD = − 0.20; 95 % CI, − 0.35 to − 0.04; P = 0.017) resulted in effective improvements at postintervention. SUCRA analyses revealed that multicomponent interventions were the interventions with the highest ranking in reducing behavioural and psychological symptoms of dementia (SUCRA, 83.4 %) and improving caregiver reactions to these symptoms (SUCRA, 90.9 %). Meta-regression and subgroup analyses revealed that the covariables “continent”, “mean age” and “duration” affected the effect size of the multicomponent interventions.

Conclusions

Multicomponent interventions were the best interventions for reducing behavioural and psychological symptoms of dementia and caregiver reactions to these symptoms and produced sustainable treatment effects.

Registration

The systematic review and meta-analysis have been registered in PROSPERO (CRD42024544701).

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来源期刊

International Journal of Nursing Studies 医学-护理

CiteScore

15.00

自引率

2.50%

发文量

181

审稿时长

21 days

期刊介绍： The International Journal of Nursing Studies (IJNS) is a highly respected journal that has been publishing original peer-reviewed articles since 1963. It provides a forum for original research and scholarship about health care delivery, organisation, management, workforce, policy, and research methods relevant to nursing, midwifery, and other health related professions. The journal aims to support evidence informed policy and practice by publishing research, systematic and other scholarly reviews, critical discussion, and commentary of the highest standard. The IJNS is indexed in major databases including PubMed, Medline, Thomson Reuters - Science Citation Index, Scopus, Thomson Reuters - Social Science Citation Index, CINAHL, and the BNI (British Nursing Index).