{"title":"早期活动对创伤性脑损伤患者临床预后的影响。","authors":"Fei Xia, Caiyun Li, Yiwen Liu","doi":"10.1111/nicc.70166","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Early mobilisation (EM) is a rehabilitative approach hypothesised to improve functional and clinical outcomes in patients with traumatic brain injury (TBI). However, its benefits remain controversial.</p><p><strong>Aim: </strong>The aim of this study was to evaluate the influence of EM on neurological recovery, motor function, quality of life (QoL) and clinical outcomes in patients with TBI.</p><p><strong>Study design: </strong>A systematic review and meta-analysis was performed. We systematically searched PubMed, Embase, Cochrane Library, Wanfang and CNKI databases for relevant randomised controlled trials (RCTs). Outcomes included changes in National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment (FMA), Functional Independence Measure (FIM), QoL, mortality and adverse events. A random-effects model was used to pool the results by incorporating heterogeneity.</p><p><strong>Results: </strong>Eleven RCTs with 898 patients with TBI were included. EM significantly reduced NIHSS scores (MD: -4.51, 95% CI: -5.60 to -3.43, p < 0.001; I<sup>2</sup> = 0%) and improved FMA scores (MD: 5.39, 95% CI: 3.81-6.97, p < 0.001; I<sup>2</sup> = 31%), indicating enhanced neurological recovery and motor function. QoL scores also improved with EM (SMD: 0.80, 95% CI: 0.48-2.12, p < 0.001; I<sup>2</sup> = 42%). However, EM did not significantly influence FIM (p = 0.15) or mortality (p = 1.00). Trends towards lower adverse event rates were observed but did not reach statistical significance.</p><p><strong>Conclusions: </strong>EM is associated with improved neurological and motor recovery and enhanced QoL in patients with TBI. While its impact on mortality and adverse events requires further validation, this evidence supports incorporating EM into standard TBI rehabilitation protocols.</p><p><strong>Relevance to clinical practice: </strong>The findings of this meta-analysis highlight the importance of early mobilisation (EM) as a key component of rehabilitation for patients with traumatic brain injury. EM significantly improves neurological recovery, motor function and quality of life, supporting its integration into standard clinical practice. Given the potential for improved patient outcomes, healthcare providers, particularly nurses and rehabilitation specialists, should prioritise safe and individualised EM protocols to enhance functional recovery while minimising risks.</p><p><strong>Trial registration: </strong>The protocol of the meta-analysis has been registered at PROSPERO with the identifier CRD42025640625.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 5","pages":"e70166"},"PeriodicalIF":2.6000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Early Mobilisation on the Clinical Outcomes of Patients With Traumatic Brain Injury.\",\"authors\":\"Fei Xia, Caiyun Li, Yiwen Liu\",\"doi\":\"10.1111/nicc.70166\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Early mobilisation (EM) is a rehabilitative approach hypothesised to improve functional and clinical outcomes in patients with traumatic brain injury (TBI). However, its benefits remain controversial.</p><p><strong>Aim: </strong>The aim of this study was to evaluate the influence of EM on neurological recovery, motor function, quality of life (QoL) and clinical outcomes in patients with TBI.</p><p><strong>Study design: </strong>A systematic review and meta-analysis was performed. We systematically searched PubMed, Embase, Cochrane Library, Wanfang and CNKI databases for relevant randomised controlled trials (RCTs). Outcomes included changes in National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment (FMA), Functional Independence Measure (FIM), QoL, mortality and adverse events. A random-effects model was used to pool the results by incorporating heterogeneity.</p><p><strong>Results: </strong>Eleven RCTs with 898 patients with TBI were included. EM significantly reduced NIHSS scores (MD: -4.51, 95% CI: -5.60 to -3.43, p < 0.001; I<sup>2</sup> = 0%) and improved FMA scores (MD: 5.39, 95% CI: 3.81-6.97, p < 0.001; I<sup>2</sup> = 31%), indicating enhanced neurological recovery and motor function. QoL scores also improved with EM (SMD: 0.80, 95% CI: 0.48-2.12, p < 0.001; I<sup>2</sup> = 42%). However, EM did not significantly influence FIM (p = 0.15) or mortality (p = 1.00). Trends towards lower adverse event rates were observed but did not reach statistical significance.</p><p><strong>Conclusions: </strong>EM is associated with improved neurological and motor recovery and enhanced QoL in patients with TBI. While its impact on mortality and adverse events requires further validation, this evidence supports incorporating EM into standard TBI rehabilitation protocols.</p><p><strong>Relevance to clinical practice: </strong>The findings of this meta-analysis highlight the importance of early mobilisation (EM) as a key component of rehabilitation for patients with traumatic brain injury. EM significantly improves neurological recovery, motor function and quality of life, supporting its integration into standard clinical practice. Given the potential for improved patient outcomes, healthcare providers, particularly nurses and rehabilitation specialists, should prioritise safe and individualised EM protocols to enhance functional recovery while minimising risks.</p><p><strong>Trial registration: </strong>The protocol of the meta-analysis has been registered at PROSPERO with the identifier CRD42025640625.</p>\",\"PeriodicalId\":51264,\"journal\":{\"name\":\"Nursing in Critical Care\",\"volume\":\"30 5\",\"pages\":\"e70166\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Nursing in Critical Care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/nicc.70166\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"NURSING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Nursing in Critical Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/nicc.70166","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}
Impact of Early Mobilisation on the Clinical Outcomes of Patients With Traumatic Brain Injury.
Background: Early mobilisation (EM) is a rehabilitative approach hypothesised to improve functional and clinical outcomes in patients with traumatic brain injury (TBI). However, its benefits remain controversial.
Aim: The aim of this study was to evaluate the influence of EM on neurological recovery, motor function, quality of life (QoL) and clinical outcomes in patients with TBI.
Study design: A systematic review and meta-analysis was performed. We systematically searched PubMed, Embase, Cochrane Library, Wanfang and CNKI databases for relevant randomised controlled trials (RCTs). Outcomes included changes in National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment (FMA), Functional Independence Measure (FIM), QoL, mortality and adverse events. A random-effects model was used to pool the results by incorporating heterogeneity.
Results: Eleven RCTs with 898 patients with TBI were included. EM significantly reduced NIHSS scores (MD: -4.51, 95% CI: -5.60 to -3.43, p < 0.001; I2 = 0%) and improved FMA scores (MD: 5.39, 95% CI: 3.81-6.97, p < 0.001; I2 = 31%), indicating enhanced neurological recovery and motor function. QoL scores also improved with EM (SMD: 0.80, 95% CI: 0.48-2.12, p < 0.001; I2 = 42%). However, EM did not significantly influence FIM (p = 0.15) or mortality (p = 1.00). Trends towards lower adverse event rates were observed but did not reach statistical significance.
Conclusions: EM is associated with improved neurological and motor recovery and enhanced QoL in patients with TBI. While its impact on mortality and adverse events requires further validation, this evidence supports incorporating EM into standard TBI rehabilitation protocols.
Relevance to clinical practice: The findings of this meta-analysis highlight the importance of early mobilisation (EM) as a key component of rehabilitation for patients with traumatic brain injury. EM significantly improves neurological recovery, motor function and quality of life, supporting its integration into standard clinical practice. Given the potential for improved patient outcomes, healthcare providers, particularly nurses and rehabilitation specialists, should prioritise safe and individualised EM protocols to enhance functional recovery while minimising risks.
Trial registration: The protocol of the meta-analysis has been registered at PROSPERO with the identifier CRD42025640625.
期刊介绍：
Nursing in Critical Care is an international peer-reviewed journal covering any aspect of critical care nursing practice, research, education or management. Critical care nursing is defined as the whole spectrum of skills, knowledge and attitudes utilised by practitioners in any setting where adults or children, and their families, are experiencing acute and critical illness. Such settings encompass general and specialist hospitals, and the community. Nursing in Critical Care covers the diverse specialities of critical care nursing including surgery, medicine, cardiac, renal, neurosciences, haematology, obstetrics, accident and emergency, neonatal nursing and paediatrics.
Papers published in the journal normally fall into one of the following categories:
-research reports
-literature reviews
-developments in practice, education or management
-reflections on practice
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