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中国循证儿科杂志

中国循证儿科杂志 ›› 2025, Vol. 20 ›› Issue (1): 1-8.DOI: 10.3969/j.issn.1673-5501.2025.01.001

• 论著 •    下一篇

基于《儿童青少年脑性瘫痪临床实践指南》肌张力与其他健康相关信息交互性文献证据构建交互影响判断的方法学

谢旖婧1a,王翠2,李文竹2,王维3,黄真2,史惟1b,张崇凡1a   

  1. 1 复旦大学附属儿科医院上海，201102，a 临床指南制作和评价中心(复旦大学GRADE中心), b 康复科；2 北京大学第一医院北京，100034；3 香港复康会

  • 收稿日期:2025-02-25 修回日期:2025-02-25 出版日期:2025-02-25 发布日期:2025-02-25
  • 通讯作者: 史惟；张崇凡

Developing a methodological framework for associations and interactions: Integrating evidence on muscle tone and health-related information from the clinical practice guidelines for children and adolescents with cerebral palsy

XIE Yijing1a, WANG Cui2, LI Wenzhu2, WANG Wei3, HUANG Zhen2, SHI Wei1b, ZHANG Chongfan1a   

  1. (1 Children's Hospital of Fudan University, Shanghai 201102, China: a.Center for Clinical Practice Guideline Development and Evaluation (Fudan University GRADE Center), b. Department of Rehabilitation; 2 Peking University First Hospital, Beijing 100034, China; 3 Hongkong Society for Rehabilitation, Hongkong, China)
  • Received:2025-02-25 Revised:2025-02-25 Online:2025-02-25 Published:2025-02-25
  • Contact: HI Wei; ZHANG Chongfan

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摘要： 背景：针对脑性瘫痪（简称：脑瘫）健康相关信息间的交互性研究多为点对点研究，缺乏对多种交互关系的系统描述或构建复杂的交互网络。 目的：尝试创新性构建判断脑瘫肌张力与其他健康相关信息的交互作用的判断指标、阈值、判断逻辑和流程，为脑瘫健康信息交互影响判断提供参考。 设计：混合性研究。 方法：：①系统检索和筛选脑瘫肌张力交互性文献，②提取文献中可能反映肌张力交互结果：的特征性数据，③确定和汇总反映肌张力交互影响的统计学分析方法：：，④确定肌张力定义，并将与肌张力相关的其他健康信息分类至各指南维度，⑤尝试建立反映交互影响的判断指标及其阈值设置，⑥构建交互影响判断的逻辑框架，⑦行内部数据试验、调整和完善。 主要结局指标：脑瘫患儿肌张力与其他健康相关信息的交互关系判断的方法：：学。 结果：纳入分析的106篇提取到2 327条数据，其中相关分析78篇次共1 668条数据，回归分析44篇次共450条数据，其他方法：：13篇次共209条数据。基于设定的参数和逻辑框架，先行单篇文献分维度结果：判定再汇总文献判定分维度结果：。当同一维度多篇文献不确定篇数占比≥1/3时，直接判断维度间交互关系不确定，当同一维度多篇文献不确定篇数占比<1/3时，以篇数分布4种形式（n篇∶n篇，1篇∶n篇、n篇∶1篇和1篇∶1篇，0篇∶n篇和n篇∶0篇，0篇∶1篇和1篇∶0篇）进一步行相关篇数占比和篇均样本量比值的判断，必要时计算适宜样本量。并行肌张力维度与其他各个健康信息维度的内部数据实践。判断肌张力与粗大运动、肌力和肌耐力、继发性肌肉骨骼障碍和生活质量可能存在交互，与身体活动可能不存在交互，与步态、参与、日常生活活动能力和上肢功能不确定存在交互关系。 结论：原创性提出判断脑瘫肌张力与其他健康相关信息交互关系的判断指标及阈值并构建了反映交互影响判断的逻辑框架流程。

关键词: 脑瘫, 肌张力, 健康相关功能, 交互作用, 方法学构建

Abstract: Background：Previous Studies have focused on the associations between individual factors within the cerebral palsy (CP) population. However, there is limited research that systematically describes or constructs comprehensive networks for interaction analysis. Objective：To develop an innovative methodological framework with novel indicators, cut-off values, and decision pathways and to provide support for exploring the interactions between health-related factors in CP. Design：Mixed-Methods： study. Methods：A systematic literature search was conducted to identify relevant studies on associations or interactions between muscle tone and health-related factors in CP (Step 1). Characteristic data reflecting the effects or interactions of muscle tone were extracted from the selected studies (Step 2). Statistical analysis Methods： used to evaluate the relationships were identified and summarized (Step 3). A definition of muscle tone was established, and other health-related information associated with muscle tone was categorized according to various guideline dimensions (Step 4). Based on this information and multidisciplinary perspectives, indicators for evaluating relationships and their threshold values were proposed (Step 5). A logical framework for summarizing and identifying relationships was developed (Step 6), followed by internal data testing, adjustments, and refinements (Step 7). Main outcome measures：Methodology for identifying relationships between muscle tone and health-related factors in children and adolescents with CP. Results：The study extracted 2 327 rows of data from 106 articles. Of these, a total of 78 articles using correlations analysis included 1 668 data points, 44 using regression analysis included 450 data points, and 13 using other statistical Methods： included 209 data points. Following the established indicators and framework, we first selected data points within the same guideline dimensions. For each dimension, we classified each article into one of three outcomes (related, uncertain, or unrelated), and subsequently derived final judgments by summarizing the outcomes of each article. After summarizing, if the proportion of uncertain articles in a dimension is ≥1/3, the relationship between muscle tone and that guideline dimension is considered uncertain. Otherwise, we classified related and unrelated articles into four distributions (n∶n, 1∶n or n∶1 or 1∶1, 0∶n or n∶0, and 0∶1 or 1∶0) and derived judgments based on two additional indicators. The appropriate sample size is calculated if need. In practice, we applied the framework to the internal data and proposed that the muscle tone may interact with four dimensions (gross motor skills, muscle strength and endurance, secondary musculoskeletal disorder, and quality of life), but not with physical activity. The relationship between muscle tone and the dimensions of gait, participation, activities of daily living, and upper limb function remains unclear. Conclusion：This study introduced an original methodological approach for determining the relationships between muscle tone and other health-related factors in children with CP. A set of judgment indicators and threshold values were proposed, and a logical framework for identifying the relationships was developed.

Key words: Cerebral palsy, Muscle tone, Health-related function, Interaction effect, Methodology development