《中国康复理论与实践》

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (2): 156-160.doi: 10.3969/j.issn.1006-9771.2020.02.005

• 专题 康复指南研究:理论架构、方法体系、发展状况与质量评价 • 上一篇    下一篇

基于GRADE康复临床实践指南证据质量与推荐强度研究

周奇1,2,3,4,5,王玲2,3,4,5,6,杨楠2,3,4,5,玉炫3,4,张静怡2,3,4,5,6,马艳芳2,3,4,5,王健健2,3,4,5,6,张先卓1,石秀娥7,8,陈耀龙2,3,4,5(),杨克虎1,2,3,4,5()   

  1. 1.兰州大学第一临床医学院,甘肃兰州市 730000
    2.兰州大学基础医学院循证医学中心,甘肃兰州市 730000
    3.世界卫生组织指南实施与知识转化合作中心,甘肃兰州市 730000
    4.GRADE中国中心,甘肃兰州市 730000
    5.甘肃省循证医学与临床转化重点实验室,甘肃兰州市 730000
    6.兰州大学公共卫生学院,甘肃兰州市 730000
    7.甘肃省康复中心医院,甘肃兰州市 730000
    8.甘肃省循证康复医学研究中心,甘肃兰州市 730000
  • 收稿日期:2020-02-10 修回日期:2020-02-13 出版日期:2020-02-25 发布日期:2020-03-19
  • 通讯作者: 陈耀龙,杨克虎 E-mail:chenyaolong@vip.163.com;kehuyangebm2006@126.com
  • 作者简介:周奇(1995-),男,汉族,江西南昌县人,硕士研究生,主要研究方向:临床实践指南方法学和循证外科学。|王玲(1998-),女,汉族,甘肃陇西县人,主要研究方向:公共卫生、循证医学。
  • 基金资助:
    1.国家社科基金重大项目(19ZDA142);2.甘肃省循证医学与临床转化重点实验室创新基金项目(CXJJ2019002)

Quality of Evidence and Strength of Recommendations of Clinical Practice Guidelines of Rehabilitation Based on GRADE

ZHOU Qi1,2,3,4,5,WANG Ling2,3,4,5,6,YANG Nan2,3,4,5,YU Xuan3,4,ZHANG Jing-yi2,3,4,5,6,MA Yan-fang2,3,4,5,WANG Jian-jian2,3,4,5,6,ZHANG Xian-zhuo1,SHI Xiu-e7,8,CHEN Yao-long2,3,4,5(),YANG Ke-hu1,2,3,4,5()   

  1. 1. the First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu 730000, China
    2. Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu 730000, China
    3. WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, Gansu 730000, China
    4. Chinese GRADE Center, Lanzhou University, Lanzhou, Gansu 730000, China
    5. Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, Gansu 730000, China
    6. School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China
    7. Rehabilitation Center Hospital of Gansu, Lanzhou, Gansu 730000, China
    8. Gansu Evidence-based Rehabilitation Medical Research Center, Lanzhou, Gansu 730000, China
  • Received:2020-02-10 Revised:2020-02-13 Published:2020-02-25 Online:2020-03-19
  • Contact: CHEN Yao-long,YANG Ke-hu E-mail:chenyaolong@vip.163.com;kehuyangebm2006@126.com
  • Supported by:
    Gansu Major Project of the National Social Science Fund(19ZDA142);Key Laboratory of Evidence-based Medicine and Clinical Translation Innovation Fund(CXJJ2019002)

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摘要：

目的 分析康复临床实践指南的GRADE结果。方法 在PubMed、EMBASE、中国知网(CNKI)、中国生物医学文献数据库(CBM)和万方等数据库以及指南相关网站检索康复医学临床指南,检索时限均为建库至2020年1月11日。由2名研究员独立筛选采用GRADE系统的指南,并对GRADE分级结果进行提取分析。结果 共纳入康复临床实践指南83篇,其中46篇(55.4%)应用分级系统,采用GRADE分级系统的指南仅4篇(4.8%),包含44条推荐意见,其中39条(88.6%)具有明确的证据质量。在推荐意见所引用证据中,低质量证据最多(34.1%);在推荐意见中,弱推荐较多(56.8%)。强推荐支持证据的质量高于弱推荐(χ2 = 8.218, P < 0.05)。 结论 康复临床实践指南对GRADE分级系统的应用仍待提高。建议指南制订者进一步掌握指南和GRADE方法学,更有效地改善康复临床实践指南的可靠性和应用性。

关键词: 康复医学, 临床实践指南, GRADE, 证据质量, 推荐强度

Abstract:

Objective To analyze the results of Grading of Recommendations Assessment, Development and Evaluation (GRADE) for clinical practice guidelines of rehabilitation.Methods Clinical practice guidelines of rehabilitation were systematically retrieved from PubMed, EMBASE, CNKI, China Biology Medicine disc, Wanfang database and the guideline-related websites until January 11, 2020. Two researchers independently screened guidelines using Grading of Recommendations Assessment, Development and Evaluation (GRADE), and extracted and analyzed the results.Results A total of 83 clinical practice guidelines of rehabilitation were included, in which 46 (55.4%) applied grading systems. Only four (4.8%) guidelines applied GRADE, including 44 recommendations, in which 39 guidelines (88.6%) had quality of evidence. Among the evidences citied in the recommendations, low quality evidences were the most (34.1%); among the recommendations, weak recommendations were more (56.8%). The quality of strong recommendation supporting evidence was higher than that of weak recommendation (χ2 = 8.218, P < 0.05). Conclusion The application of the GRADE grading system in clinical practice guidelines of rehabilitation remains to be improved. It is proposed for guideline makers to further implement the methodology of guidelines and GRADE to improve the reliability and applicability of the clinical practice guidelines of rehabilitation more effectively.

Key words: rehabilitation medicine, clinical guidelines, Grading of Recommendations Assessment,Development and Evaluation, quality of evidence, strength of recommendation

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