Zusammenfassung, Replizierbarkeit und methodologische Qualität von Frühmobilisation im Akutkrankenhaus bei Patienten mit Schädel-Hirn-Trauma – Systematische Literaturübersicht

Zusammenfassung

Hintergrund Die Implementierung von Frühmobilisation in der Akutversorgung bei Patienten mit Schädel-Hirn-Trauma (SHT) könnte sowohl in Bezug auf die funktionelle Erholung als auch auf die Hospitalisationsdauer von großer Bedeutung sein. Derzeit fehlen hierzu jedoch detaillierte, replizierbare Interventionsbeschreibungen.

Ziel Der Beitrag bietet eine Zusammenfassung der aktuellen Literatur zu Therapieinterventionen der Frühmobilisation einschließlich detaillierter Interventionsbeschreibung mit einer Bewertung der berichteten Interventionsparameter und der methodologischen Qualität der randomisierten klinischen Studien (RCT).

Methode In 5 Datenbanken (Medline-Ovid, Embase, CINAHL, PsychINFO, Cochrane Library) erfolgte eine systematische Literatursuche. Unabhängig voneinander bewerteten 2 Autoren die berichteten Interventionsparameter mittels Template for Intervention Description and Replication (TIDieR) Checkliste und überprüften die methodologische Qualität der RCT anhand der Downs-and-Black-Checkliste [1].

Ergebnisse In den Review wurden 2 RCT eingeschlossen [2] [3]. Die Überprüfung anhand der TIDieR-Checkliste zeigte, dass diese jeweils 6 bzw. 8 von 12 TIDieR-Items beschrieben. Die Informationssammlung bezog sich auf die verwendeten Materialien (Item 3), die Fachexpertise der Behandler (Item 5), den Zeitpunkt und die Häufigkeit der Frühmobilisation (Item 8), den Zeitpunkt einer eventuellen Anpassung (Item 9), die mögliche Modifikation der Intervention (Item 10), die Art der Überprüfung der Adhärenz (Item 11) und die Adhärenz (Item 12). Beide RCT erhielten 20 bzw. 22 von 28 möglichen Punkten der Down-and-Black-Checkliste [1]. Die Items 8 (Beschreibung von Nebenwirkungen), 12 (Repräsentativität der eingeschlossenen Patienten), 14 (Verblindung der eingeschlossenen Patienten) und 25 (statistische Korrektur einer Verzerrung) waren in beiden Studien nicht erwähnt.

Schlussfolgerungen Die Replizierbarkeit der Frühmobilisation bei Patienten mit SHT im Akutkrankenhaus ist derzeit nicht gegeben. Um die Qualität der Interventionsbeschreibungen zu verbessern und somit die Replizierbarkeit der Interventionen für Folgestudien und den Transfer in den klinischen Alltag zu gewährleisten, wird eine konsequente Verwendung der TIDieR-Checkliste in klinischen Studien empfohlen.

Abstract

Background The implementation of early mobilization in acute care in patients with traumatic brain injury (TBI) could have great significance regarding both functional recovery as well as hospitalization periods. Concordant detailed replicable descriptions of interventions are lacking to date.

Objective This article provides a summary of the current literature related to early mobilization interventions, including detailed description of the intervention with evaluation of the reported intervention parameters and the methodological quality of the included randomised clinical trials (RCT).

Method A systematic literature search was conducted in 5 databases (Medline-Ovid, Embase, CINAHL, PsychINFO, Cochrane Library). Two independent reviewers assessed the reported intervention parameters using the Template for Intervention Description and Replication (TIDieR) and investigated the RTC’s methodological quality using the Downs and Black Checklist [1].

Results Two RCT were included in this review [2] [3]. The investigation using the TIDieR checklist showed that both described 6 and 8 out of 12 TIDieR items. Data collection referred to the used study materials (item 3), therapists’ expertise (item 5), point of time and frequency of the applied mobilization (item 8), adaptation point of time (item 9), possible intervention modification (item 10), assessment type of the adherence (item 11) and adherence (item 12). Both RCT attained 20 and 22 of possible 28 points on the Downs and Black Checklist. Neither of the RCT mentioned the items 8 (reported adverse events), 12 (representativeness of included patients, 14 (blinding of included patients and 25 (statistical bias correction).

Conclusions The replicability of early mobilization in acute care patients with SHT is currently not granted. In order to improve the quality of the intervention descriptions and as such to guarantee the replicability of the interventions in follow-up studies as well as the transfer into daily practice the consistent use of the TIDieR checklist in clinical trials is recommended

Schlüsselwörter

Akutkrankenhaus - Frühmobilisation - methodologische Qualität - Replizierbarkeit - Schädel-Hirn-Trauma - TIDieR-Checkliste

Key words

acute care - early mobilization - methodological quality - replicability - traumatic brain injury - TIDieR checklist

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