As evidence-based practice (EBP) continues to be valued, the guideline implementation has become an important field for research and practice in health care. In order to better guide the guideline implementation in the field of health care, this paper combines the EBP experience gained from several EBP programs carried out in our hospital those years, in aim of exploring and sharing the methodology of guideline implementation in domestic clinical settings.
ObjectivesTo systematically review the efficacy of home-based telerehabilitation (HTR) for stroke survivors.MethodsPubMed, EMbase, Web of Science, Joanna Briggs Institute Library, The Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on HTR for stroke survivors from inception to January 1st, 2019. Two reviewers independently screened literature, extracted data, and assessed risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 11 RCTs involving 793 patients were included. The results of meta-analysis showed that: after 1 to 2 years of treatment, BI scores (MD=20.22, 95%CI 17.10 to 23.35, P<0.000 01) in HTR group were higher than those in the traditional rehabilitation group. However, there were no statistical differences between two groups in ARAT scores (SMD=0.16, 95%CI −0.14 to 0.45, P=0.30) after 1 to 2 months of treatment, as well as MBI scores (SMD=0.98, 95%CI −0.33 to 2.29, P=0.14) and FMA scores (SMD=0.57, 95%CI −0.08 to 1.23, P=0.09) after 3 months of treatment, and CSI scores (MD=−1.48, 95%CI −3.90 to 0.94, P=0.23) and BBS scores (MD=1.33, 95%CI −1.15 to 3.81, P=0.29) after 6 months of treatment. The results of descriptive analysis indicated that there was no statistically significant difference in quality of life between the two groups at 6 months after intervention. However, the HTR group was superior to the traditional rehabilitation group after 2 years of treatment.ConclusionsCurrent evidence shows that, compared with traditional rehabilitation, long-term intervention (1-2 years) with HTR can improve the ability to perform activities of daily living and quality of life of stroke survivors. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.
ObjectivesTo evaluate the quality of evidence-based guidelines for the treatment of female stress urinary incontinence, so as to provide evidence for clinical stress urinary incontinence management research.MethodsWebsite of the professional society, clinical practice guide website, Yimaitong website, PubMed, CNKI, WanFang Data and VIP databases were electronically searched to collect stress urinary incontinence management related guidelines from January 1st, 2014 to January 1st, 2019. Two reviewers independently screened literature, extracted data and evaluated the quality of included guidelines using Appraisal of Guidelines for Research and Evaluation (AGREE Ⅱ) and the characteristics of each guidelines were analyzed.ResultsWe identified totally 8 relevant evidence-based guidelines in this field. The average standardized scores in the 6 domains of AGREE II were 90.74% (scope and purpose), 78.71% (stakeholder involvement), 74.60% (rigor of development), 93.52% (clarity of presentations), 61.81% (applicability), and 91.67% (independence). The overall standardized scores of 8 guidelines were 77.70%, and the total scores were 5.31 (out of 7). For overall quality, 4 of them were grade A and 4 of them were grade B.ConclusionsThe overall quality of evidence-based guidelines for stress urinary incontinence is high, and scores in different fields are vary large. Fields of " stakeholder involvement”, " rigor of development” and " applicability” with lower scores still requires strengthening. The current guidelines for female stress urinary incontinence in China still fails to meet the standards of evidence-based guidelines, so the quality of the guidelines should be improved to improve guide clinical practice.