Mapping of the evidence from systematic reviews of the Cochrane Collaboration for decision-making within physiotherapy

CONTEXT AND OBJECTIVEEvidence-based clinical practice emerged with the aim of guiding clinical issues in order to reduce the degree of uncertainty in decision-making. The Cochrane Collaboration has been developing systematic reviews on randomized controlled trials as high-quality intervention study subjects. Today, physiotherapy methods are widely required in treatments within many fields of healthcare. Therefore, it is extremely important to map out the situation regarding scientific evidence within physiotherapy. The aim of this study was to identify systematic reviews on physiotherapeutic interventions and investigate the scientific evidence and recommendations regarding whether further studies would be needed.TYPE OF STUDY AND SETTINGCross-sectional study conducted within the postgraduate program on Internal Medicine and Therapeutics and at the Brazilian Cochrane Center.METHODSSystematic reviews presenting physiotherapeutic interventions as the main investigation, in the Cochrane Reviews Group, edition 2/2009, were identified and classified.RESULTSOut of the 3,826 reviews, 207 (5.41%) that fulfilled the inclusion criteria were selected. Only 0.5% of the reviews concluded that the intervention presented a positive effect and that further studies were not recommended; 45.9% found that there seemed to be a positive effect but recommended further research; and 46.9% found that the evidence was insufficient for clinical practice and suggested that further research should be conducted.CONCLUSIONOnly one systematic review (“Pulmonary rehabilitation for chronic obstructive pulmonary disease”) indicated that the intervention tested could be used with certainty that it would be effective. Most of the systematic reviews recommended further studies with greater rigor of methodological quality.

【研究背景与目的】
循证临床实践旨在指导临床实践问题，以降低临床决策过程中的不确定性。科克伦协作网（Cochrane Collaboration）长期以来针对随机对照试验（Randomized Controlled Trial）——高质量干预性研究的核心类型——开展系统综述（Systematic Review）。当前，物理治疗（Physiotherapy）方法在诸多医疗领域的临床治疗中被广泛需求，因此梳理物理治疗领域内的科学证据现状极为重要。本研究旨在识别针对物理治疗干预措施的系统综述，并探究相关科学证据，以及针对是否需要开展后续研究的相关建议。

【研究类型与研究场景】
本研究为横断面研究，开展于巴西内科与治疗学研究生项目及巴西科克伦中心（Brazilian Cochrane Center）。

【研究方法】
本研究针对2009年第2版科克伦综述组（Cochrane Reviews Group）中以物理治疗干预措施为核心研究主题的系统综述，予以识别并分类。

【研究结果】
在3826篇综述中，共筛选出符合纳入标准的综述207篇，占比5.41%。其中仅0.5%的综述认为所评估的干预措施具有正向效果，且无需开展后续研究；45.9%的综述认为干预措施似乎具有正向效果，但建议开展后续研究；46.9%的综述认为现有证据不足以支撑临床实践，建议开展进一步研究。

【研究结论】
仅有1篇题为《慢性阻塞性肺疾病的肺康复干预》（Pulmonary rehabilitation for chronic obstructive pulmonary disease）的系统综述明确指出，所测试的干预措施可被确信为具有确切有效性。绝大多数系统综述建议开展方法学质量更严谨的后续研究。