基于循证理念的腰椎融合术后量化锻炼方案 的构建

Development of a Quantitative Exercise Protocol Based on Evidence-Based Concept after Lumbar Fusion Surgery

摘要: 目的：制定腰椎融合术后患者的量化锻炼方案，以便为患者术后早期开展功能锻炼给予理论参考。方法：根据PIPOST的原则确立循证问题，基于“6S”循证资源金字塔模型，自上而下检索有关腰椎融合术患者术后康复锻炼相关的中英文文献共2205篇，最终纳入15篇文献进行证据总结，形成腰椎融合术后量化锻炼的最佳证据总结，形成方案初稿，应用德尔菲专家函询法选取15位专家进行2轮函询，完善方案内容并形成终稿。结果：2轮问卷回收率分别为88%，100%。专家权威系数为0.95，两轮肯德尔和协系数分别为0.386和0.523，各项结果的统计学意义显著(P < 0.001)。构建的腰椎融合术后量化锻炼方案由3个一级条目、8个二级条目、24个三级条目组成。结论：所构建的腰椎融合术后量化锻炼方案具有科学性、必要性、实用性，能为腰椎融合术后患者的康复锻炼赋予参考意义。

Abstract: Objective: To formulate a quantitative exercise protocol for patients after lumbar fusion surgery, and provide theoretical references for early postoperative functional rehabilitation. Methods: Evidence-based questions were established following the PIPOST principle. Based on the 6S evidence resource pyramid model, a top-down retrieval was conducted, yielding 2205 Chinese and English literatures related to postoperative rehabilitation exercises for lumbar fusion patients. A total of 15 eligible studies were included for evidence synthesis to draft the initial quantitative exercise protocol. The Delphi expert consultation method was adopted, with 15 experts enrolled for two rounds of consultation to revise and finalize the protocol. Results: The questionnaire recovery rates of the two rounds were 88% and 100%, respectively. The expert authority coefficient was 0.95. The Kendall’s concordance coefficients of the two rounds were 0.386 and 0.523, showing statistically significant differences (P < 0.001). The finalized quantitative exercise protocol consisted of 3 primary indicators, 8 secondary indicators and 24 tertiary indicators. Conclusion: The established quantitative exercise protocol is scientific, necessary and practical, which can serve as a reliable reference for rehabilitation training of patients undergoing lumbar fusion surgery.